Agent Referral Program Enrollment Form

National Flood Insurance Program Call Center and Agent Referral Enrollment Form

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1660-0059 can be found here:

Documents and Forms

Document Name Document Type
Form FEMA Form 517-0-1 Agent Referral Program Enrollment Form Form
FEMA Form 517-0-1 National Flood Insurance Agent Site Registration FEMA Form 517-0-1 04042012.pdf www.FloodSmart.gov Form
FEMA Form 517-0-1 NFIP Agent Site Registration FEMA Form 517-0-1 (electronic version 6112012.doc www.FloodSmart.gov Form

Information Collection (IC) Details

IC Title:	Agent Referral Program Enrollment Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 44 CFR Part 62 (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	FEMA Form 517-0-1	National Flood Insurance Agent Site Registration	FEMA Form 517-0-1 04042012.pdf	http://www.FloodSmart.gov	Yes	No	Fillable Printable
Form	FEMA Form 517-0-1 (electronc)	NFIP Agent Site Registration	FEMA Form 517-0-1 (electronic version 6112012.doc	http://www.FloodSmart.gov	Yes	Yes	Fillable Fileable

Line of Business: Disaster Management

Subfunction: Disaster Preparedness and Planning

Privacy Act System of Records
Title: National Flood Insurance Program Marketing Files	FR Citation: 73 FR 77793

Number of Respondents: 5,751	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	5,751	-3,028	8,779
Annual IC Time Burden (Hours)	190	-103	293
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.