National Flood Insurance Program Policy Forms

Forms and Documents

Document Name	Status
Form FEMA Form 086-0-5T Temporary Preferred Risk Policy and Newly Mapped Application Form and Instruction	Modified
Form FEMA Form 086-0-3T Temporary Flood Insurance General Change Endorsement Form and Instruction	Modified
Form FEMA Form 086-0-2T Temporary Flood Insurance Cancellation / Nullification Request Form Form and Instruction	Modified
Form FEMA Form 086-0-1T Temporary Flood Insurance Application Form	Modified
C1-2021-06875.pdf Supplementary Document	2021-04-13
Narrative of Changes Table 1660-0006 3.3.21.docx Supplementary Document	2021-04-05
1660-0006 Reinstatement Supporting Statement A Final.docx Supporting Statement A	2021-04-29
1660-0006 Published 30 Day FRN - 2021 04 05.pdf Supplementary Document	2021-04-13
1660-0006 Published 60 Day FRN.pdf Supplementary Document	2021-03-29
PLAW-113publ89.pdf Supplementary Document	2021-03-29
Public Law 93-234 (87 Stat 975).pdf Supplementary Document	2021-03-29
USCODE-2010-title42-chap50.pdf Supplementary Document	2021-03-29
Public Law 90-448 (82 Stat 476).pdf Supplementary Document	2021-03-29

IC Document Collections

IC ID	Document Title	Status
246636	Temporary Preferred Risk Policy and Newly Mapped Application Form and Instruction	Modified
246635	Temporary Flood Insurance General Change Endorsement Form and Instruction	Modified
246634	Temporary Flood Insurance Cancellation / Nullification Request Form Form and Instruction	Modified
246633	Temporary Flood Insurance Application Form	Modified

ICR Details

OMB Control No: 1660-0006	ICR Reference No: 202104-1660-001
Status: Received in OIRA	Previous ICR Reference No: 202103-1660-001
Agency/Subagency: DHS/FEMA	Agency Tracking No:
Title: National Flood Insurance Program Policy Forms
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 04/29/2021

	Requested	Previously Approved
Expiration Date	36 Months From Approved	04/30/2024
Responses	409,781	409,781
Time Burden (Hours)	62,196	62,196
Cost Burden (Dollars)	0	0

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Abstract: In order to provide for the availability of policies for flood insurance, policies are marketed through the facilities of licensed insurance agents or brokers in the various States. Applications from agents or brokers are forwarded to FEMA. Upon receipt and examination of the application and required premium, FEMA issues the appropriate Federal flood insurance policy.

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Authorizing Statute(s): PL: Pub.L. 93 - 234 6500 Name of Law: Flood Disaster Protection Act of 1973
   PL: Pub.L. 90 - 448 1301 Name of Law: Housing and Urban Development Act of 1968
  

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 81481	12/16/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 17615	04/05/2021
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 4

IC Title	Form No.	Form Name
Temporary Flood Insurance Application	FEMA Form 086-0-1T, FF 086-0-1 F-050	Flood Insurance Application ,   Flood Insurance Application
Temporary Flood Insurance Cancellation / Nullification Request Form	FEMA Form 086-0-2T, FF 086-0-2	Flood Insurance Cancellation/Nullification Request ,   Cancellation and Nullification Request Form
Temporary Flood Insurance General Change Endorsement	FEMA Form 086-0-3T, FF 086-0-3	Flood Insurance General Change Endorsement ,   General Change Endorsement
Temporary Preferred Risk Policy and Newly Mapped Application	FF 086-0-5, FEMA Form 086-0-5T	Preferred Risk Policy and Newly Mapped Application ,   Preferred Risk Policy and Newly Mapped Application

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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	409,781	409,781	0	0	0	0
Annual Time Burden (Hours)	62,196	62,196	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $9,360,407

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.     Yes

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? No

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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: 04/29/2021

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