Information Collection

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

IC 194913 under ICR 201402-1660-007 · OMB 1660-0015.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 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, Application Form for Single Residential Lot or Structure Amendments to National Flood Insurance Program Maps (English)	Form and Instruction
Form 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, 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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.