OMB No. 1660-0079, Expiration Date: 07/31/2006
Public reporting burden for this collection of information is estimated to be 10 minutes per response. The burden estimate includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and submitting the response. You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this data collection instrument. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing the burden to: Information Collections Management, Department of Homeland Security, Emergency Preparedness and Response Directorate, Federal Emergency Management Agency, 500 C Street, SW, Washington, DC 20472, Paperwork Reduction Project (1660-0079) NOTE: Do not send your completed form to this address.