Manufactured (Mobile) Home/Travel Trailer Worksheet

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⚠️ Notice: This information collection may be referencing outdated material.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 086-0-17 Manufactured (Mobile) Home/Travel Trailer Worksheet Form
086-0-17 Manufactured (Mobile) Home/Travel Trailer Worksheet FEMA Form 086-0-17.pdf www.fema.gov/national-flood-insurance-program/claims-adjuster-forms Form
086-0-17 Manufactured (Mobile) Home/Travel Trailer Worksheet FEMA Form 086-0-17.pdf www.fema.gov/national-flood-insurance-program/claims-adjuster-forms Form

Information Collection (IC) Details

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:

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.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: 320	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	320	-72	392
Annual IC Time Burden (Hours)	480	284	196
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.