Information Collection

Manufactured (Mobile) Home/Travel Trailer Worksheet

IC 180858 under ICR 201704-1660-001 · OMB 1660-0005.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 086-0-17 Manufactured (Mobile) Home/Travel Trailer Worksheet	Form
086-0-17 Manufactured (Mobile) Home/Travel Trailer Worksheet FEMA FORM 086-0-17 Draft version 12-22-2016.pdf www.fema.gov/national-flood-insurance-program/claims-adjuster-forms	Form

IC Title:

Manufactured (Mobile) Home/Travel Trailer Worksheet

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

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	086-0-17	Manufactured (Mobile) Home/Travel Trailer Worksheet	FEMA FORM 086-0-17 Draft version 12-22-2016.pdf	http://www.fema.gov/national-flood-insurance-program/claims-adjuster-forms	Yes	Yes	Fillable Printable

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: 392

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 81 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	392	-199	591
Annual IC Time Burden (Hours)	196	-100	296
Annual IC Cost Burden (Dollars)	0	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.