National Flood Insurance Program Policy Forms

Forms and Documents

Document Name	Status
Form FEMA Form 086-0-1 Flood Insurance Application Form	Modified
Form FEMA 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 and Instruction	Modified
Form FEMA Form 086-0-3 Flood Insurance General Change Endorsement Form and Instruction	Modified
Form FEMA Form 086-0-2 Flood Insurance Cancellation / Nullification Request Form and Instruction	Modified
Supporting_Statement_1660-0006 Final.docx Supporting Statement A	2016-11-30
privacy_pia_fema_nfipits_10122012.pdf Supplementary Document	2013-06-25
30 Day FRN Published.pdf Supplementary Document	2016-11-30
60 Day FRN Published.pdf Supplementary Document	2016-11-30
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
189055	V-Zone Risk Factor Rating Form and Instructions Form and Instruction	Modified
189053	Flood Insurance Preferred Risk Policy Application Form and Instruction	Modified
189052	Flood Insurance General Change Endorsement Form and Instruction	Modified
189051	Flood Insurance Cancellation / Nullification Request Form and Instruction	Modified

ICR Details

OMB Control No: 1660-0006	ICR Reference No: 201611-1660-004
Status: Historical Active	Previous ICR Reference No: 201306-1660-003
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: 04/28/2017
	Date Received in OIRA: 11/30/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2020	36 Months From Approved	04/30/2017
Responses	601,067	0	56,122
Time Burden (Hours)	91,015	0	8,268
Cost Burden (Dollars)	6,500	0	6,500

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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:
	81 FR 14459	03/27/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 84603	11/23/2016
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 General Change Endorsement	FEMA Form 086-0-3	Flood Insurance General Change Endorsement
Flood Insurance Application	FEMA Form 086-0-1	Flood Insurance Application
V-Zone Risk Factor Rating Form and Instructions	FEMA 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

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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	601,067	56,122	0	544,945	0	0
Annual Time Burden (Hours)	91,015	8,268	0	82,747	0	0
Annual Cost Burden (Dollars)	6,500	6,500	0	0	0	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: No

Burden Reduction Due to:

Short Statement: FEMA Form 086-0-1 (Application) – The increase in burden hours is due to a change in the number of forms submitted and the inclusion of forms submitted electronically via the NFIP Direct Servicing Agent web site at https://www.nfipservices.com/. Previously, only the “paper” forms submitted by mail or fax were reported. The number of submitted forms reported has increased from 5,330 to 29,550. The number of burden hours has increased from 1,066 to 5,910. There are proposed formatting changes and changes to the information being collected to comply with the Biggert-Water Flood Insurance Reform Act of 2012 (BW-12) and the Homeowner Flood Insurance Affordability Act of 2014 (HFIAA). The changes do not change the paperwork burden associated with the forms since there is no significant net change to the information required to be collected on the form, i.e., some items have been added, others have been removed. FEMA Form 086-0-2 (Cancellation) – The increase in burden hours is due to a change in the number of forms submitted and the inclusion of forms submitted electronically via the NFIP Direct Servicing Agent web site at https://www.nfipservices.com/. Previously, only the “paper” forms submitted by mail or fax were reported. The number of submitted forms reported has increased from 21,743 to 40,890. The number of burden hours has increased from 2,718 to 5,111. There are no changes to the information being collected. However, there are proposed formatting changes to the form. FEMA Form 086-0-3 (Endorsement) – The increase in burden hours is due to a change in the number of forms submitted and the inclusion of forms submitted electronically via the NFIP Direct Servicing Agent web site at https://www.nfipservices.com/. Previously, only the “paper” forms submitted by mail or fax were reported. The number of submitted forms reported has increased from 25,377 to 510,402. The number of burden hours has increased from 3,807 to 76,560. There are proposed formatting changes and changes to the information being collected to comply with BW-12 and HFIAA. The changes do not change the paperwork burden associated with the forms since there is no significant net change to the information required to be collected on the form, i.e., some items have been added, others have been removed. FEMA Form 086-0-4 (V-Zone Risk Factor Rating Form) – There is no change in the number of burden hours. The number of forms submitted has remained constant 10. The burden hours have remained constant at 65. FEMA Form 086-0-5 Preferred Risk Application) – The increase in burden hours is due a change in the number of forms submitted and the inclusion of forms submitted electronically via the NFIP Direct Servicing Agent web site at https://www.nfipservices.com/. Previously, only the “paper” forms submitted by mail or fax were reported. The number of submitted forms reported has increased from 3,662 to 20,215. The number of burden hours has increased from 612 to 3,370. There are proposed formatting changes and changes to the information being collected to comply with BW-12 and HFIAA. The changes do not change the paperwork burden associated with the forms since there is no significant net change to the information required to be collected on the form, i.e., some items have been added, others have been removed. FEMA Forms 086-0-1 (Application, 086-0-2 (Cancellation), 086-0-3 (Endorsement), 086-0-5 Preferred Risk Policy and Newly Mapped Application – There is no change to the cost burden; there is no cost to the respondent to submit these forms. The only cost is the amount of the insurance premium received by the NFIP Servicing Agent; it is not a cost to the respondents due to the data collection activity. FEMA Form 086-0-4 (V-Zone Risk Factor Rating Form) – The cost burden has remained the same because there is no change in usage, i.e., the number of forms submitted has remained constant at 10.

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Annual Cost to Federal Government: $9,782,601

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: 11/30/2016

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