FEMA Form 517-0-1 NFIP Agent Site Registration

National Flood Insurance Program Call Center and Agent Referral Enrollment Form

FEMA Form 517-0-1 (electronic version 6112012

Agent Referral Program Enrollment Form

OMB: 1660-0059

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1660-0059 can be found here:

2015-09-30 - Extension without change of a currently approved collection

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Agent Sign In

O.M.B. No. 1660-0059
Expires June 30, 2012

Paperwork Burden Disclosure Notice

Public reporting burden for this form is estimated to average .033 hour 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 the form. You are not required to respond to this collection of information unless it displays a valid OMB control number. Send comments regarding accuracy of this 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, D.C. 20472, Paperwork Reduction Project (1660-0059). NOTE: Do not send your completed form to this address.

Education & Training

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Register for the FloodSmart Agent Secure site!
Create your profile by entering your agent information below and clicking Submit.

Helpful Hints:

• Create an ID and password that will be easy for you to remember
• Choose an ID and password length between 6 and 36 characters
• For security, use a combination of letters and numbers

Create a User ID *
Password *
Verify Password*
Agent First Name *
Agent Last Name *
Agency Name *
Agency Address *
Address Two
City *
State/Territory *
Zip Code * Zip Plus4			.
Direct Phone Number * exchange line extension			. . ext
General Phone Number exchange line			. .
Mobile Phone Number exchange line			. .
Fax Number exchange line			. .
Email Address *
Re-enter Email Address *
Web Address
NFIP flood insurance is written through these insurance companies:
(At least one flood insurance company is required) Write Through Companies Two
Write Through Companies Three
Are you ANFI certified?			Yes No
Would you like to stay up-to-date on the latest news and programs for agents?			Yes No Why Opt In?

NFIP AGENT SITE REGISTRATION

Proof of flood insurance training must be submitted in order to stay active in the Agent Referral Program.
Trained? Submit proof of training.
Not Trained? Find training locations.

Last Updated:

File Type	application/msword
Author	ljohnso3
Last Modified By	ljohnso3
File Modified	2012-06-12
File Created	2012-06-12