Signed 83-C Form

PAPERWORK REDUCTION ACT

CHANGE WORKSHEET

Agency/subagency

OMB Control Number

Department of Homeland Security/FEMA

0061
1660
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Enter only items that change
Current record

Agency form number (s)

New record

FF-104-FY-21-118-B (Yup'ik)
FF-104-FY-21-118-C (Haitian Creole)
FF-104-FY-21-118 -D (Vietnamese)

FF-104-FY-21-118-B (Yup'ik)
FF-104-FY-21-118-C (Haitian Creole)
FF-104-FY-21-118-D (Vietnamese)
Annual reporting and recordkeeping hour
burden
Number of respondents

3

Total annual responses

3

Percent of these responses
collected electronically

%

%

Total annual hours

3

Difference

+3

Explanation of difference

New translations of existing form.

Program change
Adjustment
Annual reporting and recordkeeping cost
burden (in thousands of dollars)

Adjustment

Total annualized Capital/Startup costs

$0

Total annual costs (O&M)

$0

Total annualized cost requested

$0

Difference

$0

Explanation of difference

None

Program change
Adjustment

Adjustment

Other changes**

FEMA is moving one previously approved translation (FF-104-FY-21-118-B) to its own line item and adding two new
translations of the same form (FF-104-FY-21-118-C and FF-104-FY-21-118-D) on their own line items. Each will have the
minimum one burden hour that ROCIS will accept. A more accurate estimate may be available in the future.
Signature of Senior Official or designee:
signed by BRIAN G THOMPSON
BRIAN G THOMPSON Digitally
Date: 2025.03.17 11:21:26 -04'00'

** This form cannot be used to extend an expiration date.

OMB 83-C

Date:

3/17/25

For OIRA Use
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10/95