National Flood Insurance Program Claims Forms

Forms and Documents

Document Name	Status
Form FEMA Form 086-0-25 NFIP Flood Insurance Claims Handbook Form and Instruction	New
Form FEMA Form 086-0-24 Advance Payment Request - Increased Cost of Compliance (ICC) Form and Instruction	New
Form FEMA Form 086-0-23 Advance Payment Request - Building & Contents Form and Instruction	New
Form 086-0-06 National Flood Insurance Program Worksheet - Contents - Personal Property Form	Modified
Form 086-0-21 Adjuster Certification Application Form	Removed
Form 086-0-20 Adjuster Preliminary Damage Assessment Form	Removed
Form 086-0-19 Increased Cost of Compliance (ICC) Adjuster Report Form	Removed
Form 086-0-18 Manufactured (Mobile) Home/Travel Trailer Worksheet (Continued) Form	Removed
Form 086-0-17 Manufactured (Mobile) Home/Travel Trailer Worksheet Form	Modified
Form 086-0-16 Cause of Loss and Subrogation Report Form	Removed
Form 086-0-15 National Flood Insurance Program Narrative Report Form	Removed
Form 086-0-14 National Flood Insurance Program Final Report Form	Removed
Form 086-0-13 National Flood Insurance Program Preliminary Report Form	Removed
Form 086-0-11 Notice of Loss Form	Modified
Form 086-0-10 Increase of Compliance Proof of Loss Form	Modified
Form 086-0-9 Proof of Loss Form	Modified
Form 086-0-08 Worksheet - Building (Continued) Form	Removed
Form 086-0-07 Worksheet - Building Form	Modified
1660-0005 FRN Template (30-Day)(draft).docx Supplementary Document	2020-07-31
1660-0005 FRN Template (60-Day)(draft).docx Supplementary Document	2020-07-31
Supporting Statement 1660-0005 FINAL.docx Supporting Statement A	2020-07-31
The National Flood Insurance Act of 1968.pdf Supplementary Document	2017-04-27
National Flood Insurance Reform Act of 1994.pdf Supplementary Document	2017-04-27
108th Congress Public Law 108-264.pdf Supplementary Document	2017-04-12
42 USC 4102a.pdf Supplementary Document	2017-04-12
Public Law 93-234.pdf Supplementary Document	2017-04-12
Public Law 90-448.pdf Supplementary Document	2017-04-12
44 CFR 62 20.pdf Supplementary Document	2013-10-23
privacy_pia_fema_nfipits_10122012_0.pdf Supplementary Document	2017-04-12
SORN DHS-2014-0028-0001.pdf Supplementary Document	2017-04-12
42 USC 4001.pdf Supplementary Document	2010-07-29

IC Document Collections

IC ID	Document Title	Status
242937	Remote Video Telephony Housing Inspection	New
242931	Remote Voice Telephony Housing Inspection	New
242930	Onsite Housing Inspection	New
242929	NFIP Flood Insurance Claims Handbook Form and Instruction	New
242917	Advance Payment Request - Increased Cost of Compliance (ICC) Form and Instruction	New
242916	Advance Payment Request - Building & Contents Form and Instruction	New
242915	Proof of Loss - Building & Contents (Adjuster-Prepared)	New
21044	National Flood Insurance Program Worksheet - Contents - Personal Property Form	Modified
208986	NFIP Claims Appeal Other-Manual	Unchanged
180864	Adjuster Certification Application Form	Removed
180862	Adjuster Preliminary Damage Assessment Form	Removed
180861	Increased Cost of Compliance (ICC) Adjuster Report Form	Removed
180859	Manufactured (Mobile) Home/Travel Trailer Worksheet (Continued) Form	Removed
180858	Manufactured (Mobile) Home/Travel Trailer Worksheet Form	Modified
180856	Cause of Loss and Subrogation Report Form	Removed
180855	National Flood Insurance Program Narrative Report Form	Removed
180854	National Flood Insurance Program Final Report Form	Removed
180852	National Flood Insurance Program Preliminary Report Form	Removed
180849	Notice of Loss Form	Modified
180848	Increase of Compliance Proof of Loss Form	Modified
180847	Proof of Loss Form	Modified
180846	Worksheet - Building (Continued) Form	Removed
180842	Worksheet - Building Form	Modified

ICR Details

OMB Control No: 1660-0005	ICR Reference No: 202007-1660-003
Status: Received in OIRA	Previous ICR Reference No: 201704-1660-001
Agency/Subagency: DHS/FEMA	Agency Tracking No:
Title: National Flood Insurance Program Claims Forms
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 07/31/2020

	Requested	Previously Approved
Expiration Date	36 Months From Approved	01/31/2021
Responses	313,226	49,423
Time Burden (Hours)	316,549	31,633
Cost Burden (Dollars)	0	0

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Abstract: The Claims Forms used for the National Flood Insurance Program are used by policyholders and adjusters to collect the information needed to investigate, document, evaluate, and settle claims against National Flood Insurance Program policies for flood damage to their insured property or qualification for benefits under Increased Cost of Compliance coverage.

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Authorizing Statute(s): US Code: 42 USC 4001 Name of Law: The National Flood Insurance Act of 1968
   US Code: 42 USC 4102a Name of Law: National Flood Insurance
   EO: EO 1361 Name/Subject of EO: The National Flood Insurance Act of 1968
   PL: Pub.L. 108 - 264 205 Name of Law: The Bunning-Bereuter-Blumenauer Flood Insurance Reform Act (FIRA) of 2004
   PL: Pub.L. 90 - 448 1301 Name of Law: The Housing ans Urban Development Act of 1968
   PL: Pub.L. 93 - 234 2 Name of Law: The Flood Disaster Protection Act of 1973
   EO: EO 44 Name/Subject of EO: CFR 62.20 Claims Appeals
   PL: Pub.L. 103 - 325 555 Name of Law: National Flood Insurance Reform Act
  

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:
	85 FR 28968	05/14/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 46146	07/31/2020
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 14

IC Title	Form No.	Form Name
Worksheet - Building	086-0-07	Building - Worksheet
Increase of Compliance Proof of Loss	086-0-10	Increase Of Compliance Proof of Loss
Notice of Loss	086-0-11	Notice of Loss
Proof of Loss	086-0-9	Proof of Loss
Manufactured (Mobile) Home/Travel Trailer Worksheet	086-0-17	Manufactured (Mobile) Home/Travel Trailer Worksheet
National Flood Insurance Program Worksheet - Contents - Personal Property	086-0-06	National Flood Insurance Program Worksheet - Contents - Personal Property
NFIP Claims Appeal
National Flood Insurance Program Preliminary Report	086-0-13	National Flood Insurance Program Preliminary Report
Worksheet - Building (Continued)	086-0-08	NFIP Worksheet Building
National Flood Insurance Program Final Report	086-0-14	National Flood Insurance Program Final Report
National Flood Insurance Program Narrative Report	086-0-15	National Flood Insurance Program Narrative Report
Cause of Loss and Subrogation Report	086-0-16	Cause of Loss and Subrogation Report
Manufactured (Mobile) Home/Travel Trailer Worksheet (Continued)	086-0-18	Manufactured (Mobile) Home/Travel Trailer Worksheet (Continued)
Increased Cost of Compliance (ICC) Adjuster Report	086-0-19	Increased Cost of Compliance (ICC) Adjuster Report
Adjuster Preliminary Damage Assessment	086-0-20	Adjuster Preliminary Damage Assessment
Adjuster Certification Application	086-0-21	Adjuster Certification Application
Proof of Loss - Building & Contents (Adjuster-Prepared)
Advance Payment Request - Building & Contents	FEMA Form 086-0-23	Advance Payment Request - Building & Contents
Advance Payment Request - Increased Cost of Compliance (ICC)	FEMA Form 086-0-24	Advance Payment Request - Increased Cost of Compliance (ICC)
NFIP Flood Insurance Claims Handbook	FEMA Form 086-0-25	NFIP Flood Insurance Claims Handbook
Onsite Housing Inspection
Remote Voice Telephony Housing Inspection
Remote Video Telephony Housing Inspection

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ICR Summary of Burden

	Total Request	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	313,226	49,423	0	276,707	-12,904	0
Annual Time Burden (Hours)	316,549	31,633	0	291,174	-6,258	0
Annual Cost Burden (Dollars)	0	0	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: Yes

Burden Reduction Due to: Using Information Technology

Short Statement: Due to the changes of information collection related to the new and revised forms, the “Type of Respondent” warrants these changes.

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Annual Cost to Federal Government: $103,715,613

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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? Yes

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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: 07/31/2020

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