FEMA Form 086-0-22, Application Form for Single Residential Lot or Structure Amendments to National Flood Insurance Program Maps (English)

Revisions to National Flood Insurance Program Maps: Application Forms and Instructions for (C)LOMAs and (C)LOMR-Fs

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1660-0015 can be found here:

Documents and Forms

Document Name Document Type
Form FEMA Form 086-0-22 FEMA Form 086-0-22, Application Form for Single Residential Lot or Structure Amendments to National Flood Insurance Program Maps (English) Form and Instruction
FEMA Form 086-0-22 Application Form For Single Residential Lot or Structure FEMA Form 086-0-22.pdf www.fema.gov/plan/prevent/fhm/dl_mt-ez.shtm Form and Instruction
FEMA Form 086-0-22 Application Form For Single Residential Lot or Structure FEMA Form 086-0-22A (Spanish).docx www.fema.gov/plan/prevent/fhm/dl_mt-ez.shtm Form and Instruction

Information Collection (IC) Details

IC Title:	FEMA Form 086-0-22, Application Form for Single Residential Lot or Structure Amendments to National Flood Insurance Program Maps (English)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	FEMA Form 086-0-22	Application Form For Single Residential Lot or Structures Amendments to National Flood Insurance Program Maps	FEMA Form 086-0-22.pdf	http://www.fema.gov/plan/prevent/fhm/dl_mt-ez.shtm	Yes	Yes	Fillable Printable
Form and Instruction	FEMA Form 086-0-22A	Application Form For Single Residential Lot or Structures Amendments to National Flood Insurance Program Maps	FEMA Form 086-0-22A (Spanish).docx	http://www.fema.gov/plan/prevent/fhm/dl_mt-ez.shtm	Yes	Yes	Fillable Fileable

Line of Business: Disaster Management

Subfunction: Disaster Preparedness and Planning

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 47,228	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	47,228	30,800	16,428
Annual IC Time Burden (Hours)	56,674	36,960	19,714
Annual IC Cost Burden (Dollars)	21,252,600	13,860,000	7,392,600

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.