FEMA Form 086-0-22, Application Form for Single Residential Lot or Structure Amendments to National Flood Insurance Program Maps (English)

Revisions to National Flood Insurance Program Maps: Application Forms and Instructions for (C)LOMAs and (C)LOMR-Fs

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1660-0015 can be found here:

Documents and Forms

Document Name Document Type
Form 086-0-22 FEMA Form 086-0-22, Application Form for Single Residential Lot or Structure Amendments to National Flood Insurance Program Maps (English) Form and Instruction
086-0-22 Application Form for Single Residential Lot or Structure FEMA Form 086-0-22 (English).pdf www.fema.gov/plan/prevent/fhm/dl_mt-1.shtm Form and Instruction

Information Collection (IC) Details

IC Title:	FEMA Form 086-0-22, Application Form for Single Residential Lot or Structure Amendments to National Flood Insurance Program Maps (English)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	086-0-22	Application Form for Single Residential Lot or Structure Amendments to National Flood Insurance Program Maps (English)	FEMA Form 086-0-22 (English).pdf	http://www.fema.gov/plan/prevent/fhm/dl_mt-1.shtm	Yes	No	Fillable Printable

Line of Business: Disaster Management

Subfunction: Disaster Preparedness and Planning

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 16,428	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	16,428	16,428
Annual IC Time Burden (Hours)	19,714	19,714
Annual IC Cost Burden (Dollars)	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.