Notice of Loss

National Flood Insurance Program Claims Forms

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1660-0005 can be found here:

Documents and Forms

Document Name Document Type
Form 086-0-11 Notice of Loss Form
086-0-11 Notice of Loss 086-0-11.pdf Form

Information Collection (IC) Details

IC Title:	Notice of Loss	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	086-0-11	Notice of Loss	086-0-11.pdf		Yes	No	Fillable Fileable

Line of Business: Disaster Management

Subfunction: Disaster Preparedness and Planning

Privacy Act System of Records
Title: National Flood Insurance Program	FR Citation: 73 FR 77747

Number of Respondents: 3,640	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 81 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	3,640	-1,610	5,250
Annual IC Time Burden (Hours)	255	-113	368
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.