Generic Application

Request for Approval under the
“Generic Clearance for FEMA’s Collection of Qualitative Feedback on Agency
Service Delivery”
(OMB Control Number: 1660-0130)
(Please refer to the instructions starting on page 4.)
TITLE OF SUB-COLLECTION: Hermits Peak/Calf Canyon Claims Office Customer
Satisfaction Surveys
Form Number(s):
1) FEMA Form FF-104-FY-24-118, Proof of Loss Survey -Phone
2) FEMA Form FF-104-FY-24-119, Assessment Survey - Phone
3) FEMA Form FF-104-FY24-120, Acknowledgement Survey – Phone
PURPOSE:
In 2022 the U.S. Forest Service lost control of a prescribed burn in New Mexico, resulting in a
record-breaking wildfire that burned thousands of acres of lands and damaged/destroyed thousands
of structures. The Hermits Peak Fire Assistance Act required FEMA to design and administer a
program for fully compensating those who suffered personal injury, property losses, business and
financial losses resulting from the Hermit's Peak Fire, through a new Office of Hermits Peak Fire
Claims.
The purpose of the Claims Office Surveys is to gather customer service feedback on the claims
process and service delivery for individuals, businesses, or local government entities who have
interacted with a Hermit’s Peak/Calf Canyon Claim’s Office.
Because of the nature of the respondents (many are reluctant to interact with government officials)
coupled with the small number of claimants, the entire population will receive each of the three
surveys.
The survey results provide FEMA an overall gauge of performance at different points in the claims
process. Surveys will be conducted via phone.
Survey titles follow:
1. Acknowledgement Survey – gauges satisfaction with the claims process and clarity of
information/understanding of next steps
2. Proof of Loss (POL) Survey – gauges ease of engagement with the Claims Office and
interaction with documentation requirements
3. Assessment Survey – gather information about overall claims experience and if the
compensation provided has aided in resuming lives of claimants
Surveys will be conducted via phone. This collection will yield new information about the Claims
Office and their customer service. Survey titles follow:
1. Acknowledgment Survey - Phone
2. Proof of Loss Survey - Phone
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3. Assessment Survey – Phone
Results will be used internally to provide insights into the claims process in to improve
operations. Surveying has been ongoing since 2024. Estimated sample is lower for
beginning surveys (Acknowledgment and Proof of Loss) because the majority of those
surveys are complete.
TYPE OF RESPONDENTS: (Check one)
[X] Individuals and Households
[X] State, Local, or Tribal Governments

[X] Private Sector
[ ] Federal Government

TYPE OF COLLECTION INSTRUMENT: (Check one)
[ ] Quantitative Customer Satisfaction Surveys
[ ] Focus Groups
[ ] Discussion Groups

[X] Qualitative Customer Satisfaction Surveys
[ ] Interviews
[ ] Other:

PRIVACY INFORMATION:
1. Is personally identifiable information (PII) collected? [ ] Yes [X] No
2. Is there a Privacy Threshold Analysis (PTA) approved by DHS? [X] Yes [ ] No
a. Date of Approval: March 11, 2024
3. Is Privacy Impact Assessment (PIA) coverage required? [X] Yes [ ] No
a. Applicable PIA(s): DHS/FEMA/PIA-035(a) Enterprise Customer Survey System
(ECSS)
4. Is System of Records Notice (SORN) coverage required? [ ] Yes [X] No
a. Applicable SORN(s): N/A
ELECTRONIC COLLECTION
1. What percentage of responses are collected by electronic means? n/a
2. What is the website URL or email address that collects the responses?
GIFTS OR PAYMENTS:
Is an incentive (e.g., money or reimbursement of expenses, token of appreciation) provided to
participants? [ ] Yes [X] No
USABILITY TESTING:
1. Has useability testing been conducted on this instrument? [X] Yes [ ] No
2. Please provide a short narrative answering the following questions about your usability
testing.


What was the purpose of the usability testing?
Testing was originally done for the survey questionnaires in the previous filing to
determine ease of use, ensuring surveys were understandable, time trials for burden hour
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






determination, and question acceptance by stakeholders. All changes were done to the
original filing – not to this filing.
How was the useability testing conducted? Usability was done in two ways: in-house by
staff for use of the survey system and technical aspects (time trials, readability, etc.) and
by stakeholders for question content.
How many participants and what was their familiarity with the collection? In-house
participants – five analysts tested usability. Stakeholders – 9 stakeholders.
What were the results of the useability testing? After the stakeholder usability testing,
there were some question changes to the original questionnaires and moved some
questions in a different order.
What did you find (burden, ease of use, etc.)? The 9 stakeholders had some issues come
up in the original usability testing for ease of use for question readability.
What did the participants recommend? Changes to some of the questions to make things
clearer for respondents and some question order.
What changes, if any, will be made to the collection? No changes were made to this
collection, all changes were made to the original collection during the original usability
testing.

BURDEN: The estimated annual respondent burden is 1,335 hours with an annual
respondent cost of $64,674.
Estimated Annualized Burden Hours and Costs
Total No.
of
Responses

Avg.
Burden
per
Response
(in
hours)

Total
Annual
Burden
(in
Hours)

Avg.
Hourly
Wage
Rate

Total
Annual
Respondent
Cost

Type of
Respondent

Form Name /
Form No.

No. of
Respondents

No. of
Responses
per
Respondent

Individual or
Household

Acknowledgement
Survey

200

1

200

5
Minutes
(0.0833)

17

$47.40

$806

State, Local,
and Tribal
Government

Acknowledgement
Survey

50

1

50

5
Minutes
(0.0833)

4

$56.45

$226

Private Sector

Acknowledgement
Survey

50

1

50

5
Minutes
(0.0833)

4

$47.40

$190

Individual or
Household

POL Survey

500

1

500

6
Minutes
(0.1000)

50

$47.40

$2,370

State, Local,
and Tribal
Government

POL Survey

500

1

500

6
Minutes
(0.1000)

50

$56.45

$2,823

Private Sector

POL Survey

100

1

100

6
Minutes
(0.1000)

10

$47.40

$474

Individual or
Household

Assessment
Survey

5,000

1

5,000

12
Minutes
(0.2000)

1000

$47.40

$47,400

3

State, Local,
and Tribal
Government

Assessment
Survey

500

1

500

12
Minutes
(0.2000)

100

$56.45

$5,645

Private Sector

Assessment
Survey

500

1

500

12
Minutes
(0.2000)

100

$47.40

$4,740

Totals





7,400

7,400

1,335

$64,674

Bureau of Labor Statistics, Employer Costs for Employee Compensation, Table
1. Available at https://www.bls.gov/news.release/archives/ecec_03142025.pdf. Accessed
August 4, 2025. The national wage multiplier is calculated by dividing total compensation
for all workers of $47.20 by wages and salaries for all workers of $32.52 per hour yielding a
benefits multiplier of approximately 1.45. For State and local government workers the wage
multiplier is calculated by dividing total compensation for State and local government
workers of $63.46 by wages and salaries for State and local government workers of $39.22
per hour yielding a benefits multiplier of approximately 1.62.
Information on the May 2024 National mean wage rate from the U.S. Department of Labor,
Bureau of Labor Statistics is available online at: https://www.bls.gov/oes/tables.htm.

FEDERAL COST: The estimated annual cost to the Federal Government is $285,922.
Annualized Cost to the Federal Government
Performance of Surveys, Analysis and Reporting, Recommendations for Improvement, Desktop Application of Survey Tools
and Maintenance of Tools.
Fully
Cost (for
Salary at 2025
Survey
Number
Loaded
Salaries
Title and GS
with Locality
Percent of
Administration
of Staff at
Wage Rate
includes the
Total Cost
Level
Pay Dallas - Ft
Time
or Functions
GS Level
at 1.45
Wage Rate
Worth
Multiplier
Multiplier)
Management,
survey
administration

Section Manager

$153,432

1

1.45

$222,476

5%

$11,124

$109,192

1

1.45

$158,328

40%

$63,331

$129,842

1

1.45

$188,271

5%

$9,414

(GS 14 Step 5)
Program Analyst

Program Analyst
(GS 12 step 5)

Supervisory,
survey
administration

Supervisory
Customer
Service
Specialist
(GS 13 Step 5)

4

Project
management,
administer survey
program,
recommend
improvements,
oversee reports
and software
application
implementation,
testing and
maintenance of
survey tools
Statistician:
OMB
compliance, data
analysis and
reporting.
Survey
Management:
Administer
surveys, prepare
sample, track
data, analyze
survey data, write
reports and
recommend
improvements,
software
application
implementation,
testing and
maintenance of
survey tools and
survey

QC, Training

Customer
Satisfaction
Analyst

$109,192

1

1.45

$158,328

5%

$7,916

$129,842

1

1.45

$188,271

10%

$18,827

$91,097

1

1.45

$132,091

40%

$52,836

$91,097

1

1.45

$132,091

10%

$13,209

$109,192

1

1.45

$158,328

5%

$7,916

$72,293

1

1.45

$104,825

10%

$10,482

$72,293

5

1.45

$524,124

10%

$52,412

(GS 12 Step 5)
Customer
Satisfaction
Analyst
(GS 13 Step 5)

Customer
Service
Specialist

(GS 11 Step 5)
Customer
Service
Specialist
(GS 11 Step 5)

Supervisory,
Survey
Administration

Supervisory
Customer
Service
Specialist
(GS 12 Step 5)

Survey Scheduler

Customer
Service
Specialists
(GS 9 Step 5)

Interviewer

Customer
Service
Specialists
(GS 9 Step 5)

Subtotal

$247,469

5

Other Costs
Facilities [cost for renting, overhead, etc. for data collection activity]
Computer Hardware, Software, Support [cost of equipment annual lifecycle]
Other: C3MP Usage / Licenses

$59,019

10%

$5,902

$297,212

10%

$29,721

$28,296

10%

$2,830

Subtotal

$38,453

Total

$285,922

CERTIFICATION:
I certify the following to be true:
1. The collection is voluntary.
2. The collection information is low-burden for respondents and are low-cost for both the
respondents and the Federal Government.
3. The collection of information is non-controversial and does not raise issues of concern to other
Federal Agencies.
4. The results are not intended to be disseminated to the public.
5. Information gathered will not be used for the purpose of substantially informing influential
policy decisions.
6. The collection is targeted to the solicitation of opinions from respondents who have experience
with the program or may have experience with the program in the future.
7. All instruments have undergone usability testing to improve the customer experience for
respondents.
Digital Signature:

CHAD E FABER

Digitally signed by CHAD E
FABER
Date: 2025.08.04 12:25:17 -05'00'

Please make sure that all instruments, privacy documents (PTA, PIA, and/or SORN),
instructions, and scripts are submitted with the request.

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Instructions for Completing Request for Approval under the “Generic
Clearance for FEMA’s Collection of Qualitative Feedback on Agency Service
Delivery”
(OMB Control Number: 1660-0130)
TITLE OF INFORMATION COLLECTION: Provide the name of the instrument being
submitted as a sub-collection and the FEMA Form Number.
(Format: “FEMA Form FF-xxx-FY-xx-xxx (formerly xxx-x-xx), Name of Instrument”)
PURPOSE: Provide a brief description of the purpose of this collection and how it will be used. If
this is part of a larger study or effort, please include this in your explanation.
LEGISLATIVE AUTHORITY: Please list any Public Laws, statutes, Executive Orders,
regulations, Department policies, and/or Agency policies that authorize FEMA to collect and use
this information. Please use correct legal citation in a simple list.
TYPE OF RESPONDENTS: Identify who you expect the respondents to be in terms of the
following categories: (1) Individuals or Households;(2) Private Sector; (3) State, Local, or Tribal
Governments; or (4) Federal Government. Only one type of respondent can be selected.
TYPE OF COLLECTION INSTRUMENT: Select one of the provided options. If you are
requesting approval of other instruments under the generic, you must complete an application for
each instrument.
PRIVACY INFORMATION: Please select a provided option for each of the numbered questions.
For any questions that you select “Yes”, please provide the requested information in the second line.
Please contact FEMA’s Privacy Division at FEMA-Privacy@fema.dhs.gov for any questions
regarding your PTA, PIA, SORN or other privacy documents.
ELECTRONIC COLLECTION: Please provide answers to the questions.
GIFTS OR PAYMENTS: If you answer yes to the question, please describe the incentive and
provide a justification for the amount.
SUPPORTING STATEMENT B: If you answer yes to the first question, please respond to the
second. If you answer no to the first question, please skip the second question.
USABILITY TESTING: Please provide answers to the questions. Testing should be completed
prior to submitting this application to FEMA’s PRA Office.
BURDEN HOURS: If you have questions about how to calculate these numbers, please reach out
to the economists in the Office of Chief Counsel's Regulatory Affairs Division (Point of Contact:
Michael Conforti, Jr at michael.confortijr@fema.dhs.gov).
Type of Respondent: Identify who you expect the respondents to be in terms of the following
categories: (1) Individuals or Households;(2) Private Sector; (3) State, Local, or Tribal
Governments; or (4) Federal Government. Only one type of respondent can be selected.
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Form Name / Form No.: Provide the name of the instrument and the FEMA Form Number.
No. of Respondents: Provide an estimate of the number of Respondents.
No. of Responses per Respondent: Provide an estimate of how many times a year that each
Respondent is expected to provide a response.
Total No. of Responses: Multiply the number of Respondents from the third column and the
number of responses per Respondent in the fourth column to determine the total number of
responses.
Avg. Burden per Response (in hours): Provide an estimate of the amount of time required for a
respondent to complete the instrument in hours (See DHS’s Burden Conversion Table for
conversion of minutes to decimal units of an hour).
Total Annual Burden (in hours): Multiply the total number of responses in the fifth column and
the average burden per response from the sixth column to determine the total annual burden for the
instrument.
Avg. Hourly Wage Rate: Enter the fully-loaded wage rate in this column. Determine the fullyloaded wage rate by multiplying the non-loaded “Avg. Hourly Wage Rate” from the Bureau of
Labor Statistics (BLS) Employer Costs for Employee Compensation, Table 1 by either a wage rate
multiplier of 1.61 for State, Local, or Tribal Government or a wage rate multiplier of 1.45 for
Federal Government.
Total Annual Respondent Cost: Multiply the total annual burden (in hours) in the seventh column
and the average hourly wage rate from the eighth column to determine the total annual respondent
cost for the instrument.
Totals: Add up the totals for number of Respondents for all instruments in this submission in the
third column, the total number of responses for all instruments in this submission in the fifth
column, the total annual burden hours in the seventh column, and the total annual respondent cost in
the ninth column in the bottom row.
FEDERAL COST: Provide an estimate of the annual cost to the Federal Government. This is the
total amount of contract costs, staff salaries, special facilities, computer equipment and other
associated costs that you would list in Question 14 of the Supporting Statement A. We just need the
total.
CERTIFICATION: Please read the certification carefully. If you incorrectly certify, the
collection will be returned as improperly submitted or it will be disapproved.
DIGITAL SIGNATURE: Apply the digital signature of the appropriate official within the
Program Office; Branch Chief or higher.
Please make sure that all instruments, privacy documents (PTA, PIA, and/or SORN),
instructions, and scripts are submitted with the request.

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