Form 81-69 Community Visit Report

DEPARTMENT OF HOMELAND SECURITY
FEDERAL EMERGENCY MANAGEMENT AGENCY

O.M.B. No. 1660-0023
Expires September 30, 2007

COMMUNITY CONTACT REPORT

PAPERWORK BURDEN DISCLOSURE NOTICE
Public reporting burden for this form is estimated to average 1 hour per response. The burden estimate includes the time for National Flood
Insurance Program (NFIP) community officals to search existing data sources, gather the data needed, provide information to a FEMA, or
State representative who will subsequently complete the form. The information is used by FEMA to assess the effectiveness of a community's
implementation of NFIP and to offer assistance to the community where such a need is identified. You are not required to respond to this
collection of information unless a vaild OMB control number appears in the upper right corner of this form. Send comments regarding the
accuracy of the burden estimate and any suggestions for reducing this burden to: Information Collections Management, Department of
Homeland Security, Federal Emergency Management Agency, 500 C Street, SW, Washington, DC, 20472, Paperwork Reduction Project
(1660-0023). NOTE: Do not send your completed survey to the above address.
INSTURCTIONS
A community Contact Report indicating the findings must be completed after each community contact. The report should not be completed
during the meeting with the local officials or provided to the local officials to complete. The Community Contact Report and any other relevant
documentation should be completed and on file in the FEMA regional office within 30 days from the date of the contact.
Section I - Self-explantory.
Section II - "Name of Local Official" is the name of the designated local official with responsibility, authority, and means to implement the NFIP
requirements. "Address" and "Telephone Number" is the address and telephone number of the local official. Attach list of all attendees.
Section II and IV - Self-explantory.
Section V - This section indicates the date that the CAC is closed. A CAC can be considered closed when all program deficiences have been
corrected and violations identified have been remedied to the maximum extent possible, and all follow-up action(s) has/have been completed.
The date the CAC is closed shall be completed and initialed by the FEMA regional office ONLY.
Attach any other documentation related to the contact, e.g., chronology of contacts, correspondence, resolutions of issues,
community ordinances.
SECTION I
1. NAME OF COMMUNITY

2. STATE

5. CONTACT CONDUCTED BY

6. AGENCY

3. COMMUNITY ID NUMBER

4. COUNTY

8. TYPE OF CONTACT
Telephone call only

7. DATE OF CONTACT

Brief Visit
SECTION II
9. NAME OF LOCAL OFFICIAL

10. TELEPHONE NUMBER

ATTACH LIST OF THE
ATTENDEES

11. ADDRESS OF LOCAL OFFICIAL

SECTION III - FINDINGS
PART A : Refer to subparagraph 3-4b in the NFIP Guidance for Conducting CAC's and CAV's for guidance in completing questions 1-4. Check appropriate
response.
1. Are there any problems with the communities floodplain management regulations?

SERIOUS

MINOR

NONE

2. Are there problems with the communities administrative and enforcement procedures?

SERIOUS

MINOR

NONE

3. Are there engineering or other problems with the maps or flood insurance study?

SERIOUS

MINOR

NONE

4. Are there any other problems in the community's floodplain management program?

SERIOUS

MINOR

NONE

5. Are there any problems with the Biennial Report data? (Attach a copy of the Biennial report noting the changes in the information)

YES

NO

6. Have the potential violation(s) been identified or are any suspected?

YES

NO

FEMA Form 81-69, NOV O5

SECTION III - CONTINUED
PART B: (Narrative) - Attach a brief narrative statement addressing items 1-4. Identify each page of the narrative with the following: name of community, date
of CAC, and name of person conducting the CAC.
1. Background. Include in this section any revelant background information sush as the history of the community's floodplain management program, history of
flooding in the community, a general description of the character of the flood hazard and floodplain development, availability of sites for development outside the
SFHA.
2. Reference Part A, Questions 1-4 and 6. Porvide a narrative statement of the findings for any serious, minor, or yes answers in questions 1-4 and 6, or
describe any of ther issues related to the communit's floodplain management program including any unique or innovative floodplain management procedures or
program.
3. Follow - Up. Provide a narrative statement as to the type of follow-up provided at the time of the CAC or any additional follow-up which is needed to assist the
communnity in resolving or perventing any further program deficiencies or violations, e.g., community needs assistance in revising its floodplain management
regulations, local floodproofing workshop is needed, local officials need assistance in updating the communities permit procedures. Include a schedule for
completing any follow-up promised to the community, e.g., recommended date for conducting a workshop.
4. Community Action Needed. Provide a narrative statement as to the appropriate community action that should take place to resolve the particular issue or
problems. e.g., revise floodplain management permit form, update floodplain management regulation. Include a schedule setting out the expected time for the
community to resolve the problem or issue, or for which some type of action is expected, e.g., expected date for adoption of the local floodplain management
regulation.
SECTION IV - RECOMMENDED FOLLOW - UP ACTION BY THE COMMUNITY
IS A COMMUNITY ASSISTANCE VISIT NEED? (If yes, give the recommended date and the reason for the needed visit)
YES

NO

Year

REASON:

SECTION V - COMPLETED BY THE FEMA REGIONAL OFFICE
DATE CLOSED

INITIALS