Published 30 Day

Billing Code: [XXXX-XX-P] [use the same code as the 60-day notice. The BAC number must be confirmed with FEMA’s printing office]

DEPARTMENT OF HOMELAND SECURITY

Federal Emergency Management Agency

[Docket ID: FEMA-XXXX-XXXX [use the same docket ID as the 60-day notice]; OMB No. 1660-XXXX]

Agency Information Collection Activities: Submission for OMB Review; Comment Request; National Flood Insurance Program Claim Forms

AGENCY: Federal Emergency Management Agency, DHS.

ACTION: Notice and request for comments.

SUMMARY: The Federal Emergency Management Agency (FEMA) will submit the information collection abstracted below to the Office of Management and Budget for review and clearance in accordance with the requirements of the Paperwork Reduction Act of 1995. The submission will describe the nature of the information collection, the categories of respondents, the estimated burden (i.e., the time, effort and resources used by respondents to respond) and cost, and the actual data collection instruments FEMA will use.

DATES: Comments must be submitted on or before [INSERT DATE 30 DAYS AFTER DATE OF PUBLICATION IN THE FEDERAL REGISTER]. [Note: do not alter the words in the brackets – the caps are an instruction to the Federal Register]

ADDRESSES: Submit written comments on the proposed information collection to the Office of Information and Regulatory Affairs, Office of Management and Budget. Comments should be addressed to the Desk Officer for the Department of Homeland Security, Federal Emergency Management Agency, and sent via electronic mail to [email protected].

FOR FURTHER INFORMATION CONTACT: Requests for additional information or copies of the information collection should be made to the Forms & Information Collections Manager, Information Management Division, 500 C Street, SW., Washington, DC 20472, e-mail address [email protected].

SUPPLEMENTARY INFORMATION: This proposed information collection previously published in the Federal Register on [Insert date] at [Insert Federal Register citation] with a 60 day public comment period. [Pick one: No comments were received. OR FEMA received [insert number] comment(s). Address comments and responses here if necessary]. The purpose of this notice is to notify the public that FEMA will submit the information collection abstracted below to the Office of Management and Budget for review and clearance.

Collection of Information

Title: National Flood Insurance Program Claims Forms.

Type of information collection: Revision of a currently approved information collection.

OMB Number: 1660-0005.

Form Titles and Numbers: FEMA Form 086-0-6; Personal Property (Contents) Worksheet, FEMA Form 086-0-7; Building Property Worksheet, FEMA Form 086-0-8; Worksheet - Building (Continued), FEMA Form 086-0-9; Proof of Loss - Building & Contents (Policyholder-Prepared), FEMA Form 086-0-10; Proof of Loss - Increased Cost of Compliance (ICC), FEMA Form 086-0-11; First Notice of Loss, FEMA Form 086-0-17; Manufactured (Mobile) Home-Travel Trailer Worksheet, FEMA Form XXX-X-XX; Advance Payment Request - Building & Contents, FEMA Form XXX-X-XX; Advance Payment Request - Increased Cost of Compliance (ICC), FEMA Form XXX-X-XX; Proof of Loss - Building & Contents (Adjuster-Prepared), FEMA Form XXX-X-XX; Claim Appeal.

Abstract: The claims forms used for the National Flood Insurance Program are used by policyholders 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.

Affected Public: Individuals or households, businesses or other for profit.

Estimated Number of Respondents: 25,836.

Estimated Number of Responses: 25,836.

Estimated Total Annual Burden Hours: 21,363.

Estimated Total Annual Respondent Cost: $226,234

Estimated Respondents’ Operation and Maintenance Costs: $3,162,300.

Estimated Respondents’ Capital and Start-Up Costs: $0.00.

Estimated Total Annual Cost to the Federal Government: $3,388,534.00.

Comments

Comments may be submitted as indicated in the ADDRESSES caption above. Comments are solicit­ed to (a) evaluate whether the proposed data col­lec­tion is necessary for the proper performance of the agency, including whether the informa­tion shall have practi­cal utility; (b) evaluate the accuracy of the agency's estimate of the burden of the proposed collec­tion of informa­tion, including the validity of the methodology and assumptions used; (c) enhance the quality, utility, and clarity of the informa­tion to be collected; and (d) minimize the burden of the collec­tion of informa­tion on those who are to respond, including through the use of appropriate automated, electronic, mechanical, or other techno­logical collec­tion tech­niques or other forms of information technol­o­gy, e.g., permitting electronic submission of responses.

[As per the Federal Register Document Drafting Handbook, Chapter 1, do not place a signature block on a page by itself. Placing text on the signature page helps to ensure the integrity of the document.]

_________________________________

Rachel Frier,

Records Management Branch Chief,

Office of the Chief Administrative Officer,

Mission Support,

Federal Emergency Management Agency,

Department of Homeland Security.

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