Form FEMA Form 086-0-34 FEMA Form 086-0-34 Floodproofing Certificate

U.S. DEPARTMENT OF HOMELAND SECURITY
FEDERAL EMERGENCY MANAGEMENT AGENCY

FLOODPROOFING CERTIFICATE

OMB No. 1660-0008
Expiration Date: March 31, 2012

FOR NON-RESIDENTIAL STRUCTURES

National Flood Insurance Program

The floodproofing of non-residential buildings may be permitted as an alternative to elevating to or above the Base Flood Elevation;
however, a floodproofing design certification is required. This form is to be used for that certification. Floodproofing of a residential building
does not alter a community’s floodplain management elevation requirements or affect the insurance rating unless the community has been
issued an exception by FEMA to allow floodproofed residential basements. The permitting of a floodproofed residential basement requires a
separate certification specifying that the design complies with the local floodplain management ordinance.
BUILDING OWNER’S NAME

FOR INSURANCE COMPANY USE

STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. Number) OR P.O. ROUTE AND BOX NUMBER

POLICY NUMBER

OTHER DESCRIPTION (Lot and Block Numbers, etc.)

COMPANY NAIC NUMBER

CITY

STATE

ZIP CODE

SECTION I – FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
Provide the following from the proper FIRM:
COMMUNITY NUMBER

PANEL NUMBER

SUFFIX

Indicate elevation datum used for Base Flood Elevation shown above:

DATE OF FIRM INDEX

NGVD 1929

NAVD 1988

FIRM ZONE

BASE FLOOD ELEVATION
(In AO Zones, Use Depth)

Other/Source:

SECTION II – FLOODPROOFING INFORMATION (By a Registered Professional Engineer or Architect)
Elevations are based on:

Construction Drawings

Building Under Construction

Finished Construction

Floodproofing Design Elevation Information:
Building is floodproofed to an elevation of
.
feet (In Puerto Rico only:
.
(Elevation datum used must be the same as that used for the Base Flood Elevation.)
Height of floodproofing on the building above the lowest adjacent grade is

meters).

NGVD 1929

NAVD 1988

feet (In Puerto Rico only:

Other/Source:

meters).

For Unnumbered A Zones Only:
Highest adjacent (finished) grade next to the building (HAG)
NGVD 1929

NAVD 1988

.

feet (In Puerto Rico only:

.

meters)

Other/Source:

(NOTE: For insurance rating purposes, the building’s floodproofed design elevation must be at least 1 foot above the Base Flood Elevation to receive rating credit. If the building
is floodproofed only to the Base Flood Elevation, then the building’s insurance rating will result in a higher premium.)

SECTION III – CERTIFICATION (By a Registered Professional Engineer or Architect)
Non-Residential Floodproofed Construction Certification:
I certify that, based upon development and/or review of structural design, specifications, and plans for construction, the design and methods of construction
are in accordance with accepted standards of practice for meeting the following provisions:
The structure, together with attendant utilities and sanitary facilities, is watertight to the floodproofed design elevation indicated above, with
walls that are substantially impermeable to the passage of water.
All structural components are capable of resisting hydrostatic and hydrodynamic flood forces, including the effects of buoyancy, and anticipated
debris impact forces.
I certify that the information on this certificate represents my best efforts to interpret the data available. I understand that any false statement may be punishable
by fine or imprisonment under 18 U.S. Code, Section 1001.
CERTIFIER’S NAME

LICENSE NUMBER (or Affix Seal)

TITLE

COMPANY NAME

ADDRESS

city

state

signature

date

phone

zip code

Copies should be made of this Certificate for: 1) community official, 2) Insurance agent/company, and 3) building owner.
FEMA Form 086-0-34

Replaces all previous editions

F-056 (3/12)

National Flood Insurance Program

FLOODPROOFING CERTIFICATE
FOR NON-RESIDENTIAL STRUCTURES

Paperwork Reduction Act Notice
General: This information is provided pursuant to Public Law 96-511 (the Paperwork Reduction Act of 1980, as amended), dated December
11, 1980, to allow the public to participate more fully and meaningfully in the Federal paperwork review process.
Authority: Public Law 96-511, amended; 44 U.S.C. 3507; and 5 CFR 1320.
Paperwork Burden Disclosure Notice: Public reporting burden for this data collection is estimated to average 3.25 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 this form. You are not required to respond to this collection of information unless a valid OMB
control number is displayed on this form. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing
the burden to: Information Collections Management, Department of Homeland Security, Federal Emergency Management Agency, 500 C
Street SW, Washington, DC 20472, Paperwork Reduction Project (1660-0008). NOTE: Do not send your completed form to this address.

Privacy Act Statement
Authority: Title 44 CFR § 61.7 and 61.8.
Principal Purpose(s): This information is being collected for the primary purpose of estimate the risk premium rates necessary to provide
flood insurance for new or substantially improved structures in designated Special Flood Hazard Areas.
Routine Use(s): The information on this form may be disclosed as generally permitted under 5 U.S.C. § 552a(b) of the Privacy Act of 1974,
as amended. This includes using this information as necessary and authorized by the routine uses published in DHS/FEMA-003 – National
Flood Insurance Program Files System or Records Notice 73 Fed. Reg. 77747 (December 19, 2008); DHS/FEMA/NFIP/LOMA-1 – National
Flood Insurance Program (NFIP) Letter of Map Amendment (LOMA) System of Records Notice 71 Fed. Reg. 7990 (February 15, 2006); and
upon written request, written consent, by agreement, or as required by law.
Disclosure: The disclosure of information on this form is voluntary; however, failure to provide the information requested may result in
the inability to obtain flood insurance through the National Flood Insurance Program or may be subject to higher premium rates for flood
insurance. Information will only be released as permitted by law.

FEMA Form 086-0-34

F-056 (3/12)