Cause of Loss and Subrogation Report

National Flood Insurance Program Claims Forms

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1660-0005 can be found here:

Documents and Forms

Document Name Document Type
Form 086-0-16 Cause of Loss and Subrogation Report Form
086-0-16 Cause of Loss and Subrogation Report FEMA FORM 086-0-16 Draft version 12-21-2016.pdf Form

Information Collection (IC) Details

IC Title:	Cause of Loss and Subrogation Report	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	086-0-16	Cause of Loss and Subrogation Report	FEMA FORM 086-0-16 Draft version 12-21-2016.pdf		Yes	Yes	Fillable Fileable

Line of Business: Disaster Management

Subfunction: Disaster Preparedness and Planning

Privacy Act System of Records
Title: National Flood Insurance Program	FR Citation: 79 FR 28747

Number of Respondents: 715	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 81 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	715	-319	1,034
Annual IC Time Burden (Hours)	715	-319	1,034
Annual IC Cost Burden (Dollars)	0	0	0

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.