INSPECTION AND ESTIMATE/ADJUSTER'S SHORT FORM REPORT/WORK SHEET CONTENTS/PERSONAL PROPERTY/STATEMENT REPLACEMENT COST COVERAGE/PROOF OF LOSS/NOTICE OF LOSS
ICR 198107-3067-016
OMB: 3067-0021
Federal Form Document
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 3067-0021 can be found here:
INSPECTION AND
ESTIMATE/ADJUSTER'S SHORT FORM REPORT/WORK SHEET CONTENTS/PERSONAL
PROPERTY/STATEMENT REPLACEMENT COST COVERAGE/PROOF OF LOSS/NOTICE
OF LOSS
Extension without change of a currently approved collection
These forms are
approved for use through the end of the current year. Prior to that
time, FEMA will submit an evaluation of the information needs the
forms support and a proposal to combine/delete/or otherwise reduce
the total burden these forms impose.
Inventory as of this Action
Requested
Previously Approved
12/31/1981
12/31/1981
07/31/1981
200,000
0
30,000
50,000
0
15,000
0
0
0
FORMS NEEDED FOR THE CONTINUED
PROCESSING OF CLAIMS FOR FLOOD DAMAGES UNDER THE NATIONAL FLOOD
INSURANCE PROGRAM.
On behalf of this Federal agency, I certify that
the collection of information encompassed by this request complies
with 5 CFR 1320.9 and the related provisions of 5 CFR
1320.8(b)(3).
The following is a summary of the topics, regarding
the proposed collection of information, that the certification
covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a
benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control
number;
If you are unable to certify compliance with any of
these provisions, identify the item by leaving the box unchecked
and explain the reason in the Supporting Statement.