Form 086-0-18 Manufactured (Mobile) Home/Travel Trailer Worksheet (Con

DEPARTMENT OF HOMELAND SECURITY
FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM

O.M.B. No. 1660-0005
Expires September 30, 2010

MANUFACTURED (MOBILE) HOME/TRAVEL TRAILER WORKSHEET
(Continued)

(See Privacy Act Statement and
Paperwork Burden Disclosure Notice
on reverse side)

DATE OF THE BOOK USED

MANUFACTURER

MODEL

REGION

GRAY PAGE NUMBER LISTED

TO REFERENCE IN THE YELLOW PAGES

WHITE PAGE NUMBER LISTED FOR NEWEST YEAR BUILT

TO REFERENCE IN THE YELLOW PAGES, OR PAGE NUMBER

FOR THE OLDEST YEAR ON THAT PAGE

TO REFERENCE IN THE GREEN PAGES ( for use in the older home conversion), FOR

THE CORRECT YELLOW PAGE NUMBER

.

NEW VALUE

USED VALUE

( X ) LOCATION ADJ.

( X ) CONDITION ADJ.

( X ) COMMUNITY ADJ.

= TOTAL VALUE

ADDITIONS/OPTIONS @ SQUARE FOOT or GREEN SECTION IN WHICH, location, condition and community adjustments apply.
DESCRIPTION

=$
=$
=$
=$
=$
=$
=$
=$
=$

FEMA Form 086-0-18, JAN 08

REPLACEMENT COST VALUE

=$

DEPRECIATION

=$

ACTUAL CASH VALUE

=$

Privacy Act Statement
The information requested is necessary to process the subject loss. The authority to collect the information is Title 42, U.S. Code, Section 4001 to 4028. It
is voluntary on your part to furnish the information. However, omission of an item may preclude processing of the form. The information will not be
disclosed outside of the Federal Emergency Management Agency, except to the servicing agent, acting as the government's fiscal agent; to claims
adjusters to enable them to confirm coverage and the location of insured property; to certain Federal, State, and Local Government agencies for
determining eligibility for benefits and for verification of agencies for acquisition and relocation-related projects, consistent with the National Flood
Insurance Program and consistent with the routine uses described in the program's system of record. Failure by you to provide some or all of the
information may result in delay in processing or denial of this claim and/or application.
PAPERWORK BURDEN DISCLOSURE NOTICE
Public reporting burden for the collection of information titled Claims for National Flood Insurance Program (NFIP) is estimated to average 6 hours 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 these forms. You are not required to respond to this collection of information unless a currently valid OMB control
number and expiration date is displayed in the upper right corner of the these forms. Send comments regarding the accuracy of the burden estimate and
suggestions for reducing the burden to: Information Collections Management, Department of Homeland Security, Federal Emergency Management
Agency, 500 C Street, S.W., Washington, DC 20472, Paperwork Reduction Project (1660-0005). NOTE: Do not send your completed form to this
address.
FEMA Form No.
086-0-6
086-0-7
086-0-8
086-0-9
086-0-10
086-0-11
086-0-12
086-0-13
086-0-14
086-0-15
086-0-16
086-0-17
086-0-18
086-0-19
086-0-20
086-0-21

Title
Worksheet-Contents-Personal Property
Worksheet-Building
Worksheet-Building (Cont'd)
Proof of Loss
Increased Cost of Compliance
Notice of Loss
Statement as to Full Cost to Repair or Replacement
Cost Coverage, Subject to the Terms and Conditions
of this Policy
National Flood Insurance Program Preliminary Report
National Flood Insurance Program Final Report
National Flood Insurance Program Narrative Report
Cause of Loss and Subrogation Report
Manufactured (Mobile) Home/Travel Trailer Worksheet
Mobile Home/Travel Trailer Worksheet (Continued)
Increased Cost of Compliance (ICC) Adjuster Report
Adjuster Preliminary Damage Assessment
Adjuster Certification Application

Burden Hours
2.5 Hours
2.5 Hours
1.0 Hours
.08 Hours
2.0 Hours
.07 Hours
.10 Hours
.07 Hours
.07 Hours
.08 Hours
1 Hour
.50 Hours
.25 Hours
.42 Hours
.25 Hours
.25 Hours