National Flood Insurance Program Policy Forms

Forms and Documents

Document Name	Status
Form FEMA Form 086-0-1 Flood Insurance Application Form	Modified
Form FEM Form 086-0-4 V-Zone Risk Factor Rating Form and Instructions Form and Instruction	Modified
Form FEMA Form 086-0-5 Flood Insurance Preferred Risk Policy Application Form	Modified
Form FEMA Form 086-0-3 Flood Insurance General Change Endorsement Form	Modified
Form FEMA Form 086-0-2 Flood Insurance Cancellation / Nullification Request Form	Modified
Supporting Statement 1660-0006 07302013.doc Supporting Statement A	2013-07-30
FEMA Form 086-0-5 Change Table 06242013.docx Supplementary Document	2013-06-25
FEMA Form 086-0-3 Change Table 041913.docx Supplementary Document	2013-07-25
FEMA Form 086-0-2 Change Table 06252013.docx Supplementary Document	2013-06-25
FEMA Form 086-0-1 Change Table 06252013.docx Supplementary Document	2013-06-25
privacy_pia_fema_nfipits_10122012.pdf Supplementary Document	2013-06-25
Pub. 30 Day FRN 06242013.pdf Supplementary Document	2013-06-25
Pub. 60 Day Federal Register Notice.pdf Supplementary Document	2013-06-25
SORN.pdf Supplementary Document	2010-06-09
44-CFR Part 61.pdf Supplementary Document	2009-05-06
Public Law 93-234.pdf Supplementary Document	2009-05-06
Public Law 90-448.pdf Supplementary Document	2009-05-06

IC Document Collections

IC ID	Document Title	Status
43970	Flood Insurance Application Form	Modified
189056	Renewal Premium Notice	Removed
189055	V-Zone Risk Factor Rating Form and Instructions Form and Instruction	Modified
189053	Flood Insurance Preferred Risk Policy Application Form	Modified
189052	Flood Insurance General Change Endorsement Form	Modified
189051	Flood Insurance Cancellation / Nullification Request Form	Modified

ICR Details

OMB Control No: 1660-0006	ICR Reference No: 201306-1660-003
Status: Historical Active	Previous ICR Reference No: 201006-1660-003
Agency/Subagency: DHS/FEMA	Agency Tracking No:
Title: National Flood Insurance Program Policy Forms
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/15/2013
	Date Received in OIRA: 08/01/2013
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2016	36 Months From Approved	11/30/2013
Responses	56,122	0	123,361
Time Burden (Hours)	8,268	0	9,481
Cost Burden (Dollars)	6,500	0	6,387,400

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Abstract: In order to provide for the availability of policies for flood insurance, policies are marketed through the facilities of licensed insurance agents or brokers in the various States. Applications from agents or brokers are forwarded to FEMA. Upon receipt and examination of the application and required premium, FEMA issues the appropriate Federal flood insurance policy.

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Authorizing Statute(s): PL: Pub.L. 90 - 448 1301 Name of Law: Housing and Urban Development Act of 1968
   PL: Pub.L. 93 - 234 6500 Name of Law: Flood Disaster Protection Act of 1973
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	68 FR 21135	04/09/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 38067	06/25/2013
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 5

IC Title	Form No.	Form Name
Flood Insurance Application	FEMA Form 086-0-1	Flood Insurance Application
V-Zone Risk Factor Rating Form and Instructions	FEM Form 086-0-4	V-Zone Risk Factor Rating Form and Instructions
Flood Insurance Cancellation / Nullification Request	FEMA Form 086-0-2	Flood Insurance Cancellation/Nullification Request Form
Flood Insurance Preferred Risk Policy Application	FEMA Form 086-0-5	Flood Insurance Preferred Risk Application
Flood Insurance General Change Endorsement	FEMA Form 086-0-3	Flood Insurance General Change Endorsement
Renewal Premium Notice

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	56,122	123,361	0	-93,514	26,275	0
Annual Time Burden (Hours)	8,268	9,481	0	-4,209	2,996	0
Annual Cost Burden (Dollars)	6,500	6,387,400	0	0	-6,380,900	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: FEMA Form 086-0-5 Preferred Risk Application) – The change in burden hours is due a change in the number of forms submitted and an increase in the burden. The number of forms has increased from 1,090 to 3,662; the burden time has increased from 8 minutes (0.133 hours) to 10 minutes (0.167 hours), due to the addition of questions needed to assure proper policy rating and issuance. Renewal Premium Notice – A correction is being made removing this burden because a Premium Renewal Notice, i.e., a bill for the premium to renew the policy, is not an information collection activity.

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Annual Cost to Federal Government: $10,523,367

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 08/01/2013

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