Information Collection

National Flood Insurance Program Agent Referral Questionaire

IC 187890 under ICR 201508-1660-002 · OMB 1660-0059.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FEMA Form 512-0-1 National Flood Insurance Program Agent Referral Questionaire	Form and Instruction
FEMA Form 512-0-1 Electronic (online screenshot).docx www.FloodSmart.gov	Other-Screenshot
FEMA Form 512-0-1 National Flood Insurance Program Agent Referral Question FEMA Form 512-0-1.pdf www.FloodSmart.gov	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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

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 512-0-1	National Flood Insurance Program Agent Referral Questionnaire	FEMA Form 512-0-1.pdf	http://www.FloodSmart.gov	Yes	Yes	Fillable Printable
Other-Screenshot			FEMA Form 512-0-1 Electronic (online screenshot).docx	www.FloodSmart.gov	Yes	Yes	Fillable Printable

Line of Business: Disaster Management

Subfunction: Disaster Preparedness and Planning

Privacy Act System of Records

Title: DHS/ALL-002 - Department of Homeland Security (DHS) Mailing and Other Lists System

FR Citation: 73 FR 71659

Number of Respondents: 50,894

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	50,894	50,894
Annual IC Time Burden (Hours)	2,545	2,545
Annual IC Cost Burden (Dollars)	0	0

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.