Form FEMA 086-0-24 FEMA 086-0-24 Residential Basement Floodproofing Certificate

RESIDENTIAL BASEMENT

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

OMB No. 1660-0033
Expiration Date: August 31, 2013

FLOODPROOFING CERTIFICATE

National Flood Insurance Program

For use ONLY in communities that have been granted an exception by FEMA to allow the construction of floodproofed residential basements
in Special Flood Hazard Areas.
BUILDING OWNER’S NAME

FOR INSURANCE COMPANY USE

STREET ADDRESS (Including Apt., Unit 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 FIRM and flood profile (from Flood Insurance Study)
COMMUNITY NUMBER

PANEL NUMBER

SUFFIX

DATE OF FIRM

ZONE

Indicate elevation datum used for Base Flood Elevation shown above:

BASE FLOOD ELEVATION
(In AO Zones, Use Depth)

NGVD 1929

NAVD 1988

Name of flooding source(s) Affecting building

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 for Zones A1-30, AE, AH, AO:
Building is floodproofed to an elevation of
.
feet. (In Puerto Rico only:
(Elevation datum used must be the same as that on the FIRM.)
Elevation of the top of the basement floor is

.

feet. (In Puerto Rico only:

Lowest adjacent (finished) grade next to the building (LAG):
Highest adjacent (finished) grade next to the building (HAG):
Indicate elevation datum used for Section II:

.

NGVD 1929

.

meters)
.

meters)

feet (In Puerto Rico only:
.

feet (In Puerto Rico only:

NAVD 1988

.

meters)
.

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)
Residential Floodproofed Basement Construction Certification:
I certify that, based upon development and/or review of structural design specifications, and plans for construction, including consideration of the depth, velocity,
and duration of flooding and the type and permeability of soils at the site, the design and methods of construction of the floodproofed basement to be used are in
accordance with accepted standards of practice for meeting the following provisions:
•• Basement area, together with attendant utilities and sanitary facilities, is watertight to the floodproofing design elevation with walls that are impermeable
to the passage of water without human intervention; and
•• Basement walls and floor are capable of resisting hydrostatic and hydrodynamic loads and the effects of buoyancy resulting from flooding to the
floodproofing design elevation; and have been designed so that minimal damage will occur from floods that exceed the floodproofing design elevation; and
•• Building design, including the floodproofing design elevation, complies with community requirements.
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

phone No.

date

zip

Copies of this certificate must be given to: 1) the community official; 2) the insurance agent; and 3) the building owner.
FEMA Form 086-0-24

Replaces all previous editions

F-200 (Revised AUG 2010)

National Flood Insurance Program

Residential Basement Floodproofing Certificate
FEMA Form 086-0-24

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 form 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 the form. This collection of information is required to obtain or retain benefits. You are not required to respond
to this collection of information unless a valid OMB control number is displayed in the upper right corner of 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, 1800 South Bell
Street, Arlington VA 20598-3005, Paperwork Reduction Project (1660-0033). 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/FEMA003 – 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-200 (Revised AUG 2010)