Privacy Act Notice (PN)

PRIVACY ACT NOTICE
Authority:
FEMA is authorized to collect the information requested on this form pursuant to the National
Flood Insurance Act of 1968, as amended, 42 U.S.C. 4011 et seq. which will enable interested
persons to purchase insurance against loss resulting from physical damage to or loss of real
property or personal property related thereto arising from any flood occurring in the
United States. 42 U.S. Code § 4102- Criteria for land management and use.42 U.S. Code § 4104c
- Mitigation assistance.
Purpose:
The purpose of the information requested on this document and any supporting documents is to
issue flood insurance policies provided through the National Flood Insurance Program.
Routine Uses:
The information requested on this form may be shared externally as a “routine use” to other
federal agencies, state governments, local governments, tribal governments, certain non-profit
entities, private insurance companies participating in the Write Your Own Program, and their
contractors to implement the National Flood Insurance Act of 1968. A complete list of the routine
uses can be found in the system of records notice associated with this form, “DHS/FEMA-003
National Flood Insurance Program Files” (79 FR 28747). The Department’s full list of system of
records notices can be found on the Department’s website at http://www.dhs.gov/system-recordsnotices-sorns.
Disclosure: Furnishing this information is voluntary. However, failure to furnish the requested
information may delay or prevent the issuance of a flood insurance policy.