National Flood Insurance Program Policy Forms

Forms and Documents

Document Name	Status
Form FEMA Form 086-0-1 Flood Insurance Application Form	Modified
Form FEMA Form 086-0-4 V-Zone Risk Factor Rating Form and Instructions Form and Instruction	Removed
Form FEMA Form 086-0-5 Flood Insurance Preferred Risk Policy Application Form and Instruction	Modified
Form FEMA Form 086-0-3 Flood Insurance General Change Endorsement Form and Instruction	Modified
Form FEMA Form 086-0-2 Flood Insurance Cancellation / Nullification Request Form and Instruction	Modified
Supporting Statement for ICR 1660-0006 Clean 6-27-2020.docx Supporting Statement A	2020-06-27
Published 30 Day FRN for ICR 1660-0006 5-22-2020.pdf Supplementary Document	2020-06-27
Published 60 Day FRN for ICR 1660-0006 2-24-2020.pdf Supplementary Document	2020-06-27
SORN.pdf Supplementary Document	2010-06-09
44-CFR Part 61.pdf Supplementary Document	2009-05-06
Public Law 93-234.pdf Supplementary Document	2009-05-06
Public Law 90-448.pdf Supplementary Document	2009-05-06

IC Document Collections

IC ID	Document Title	Status
43970	Flood Insurance Application Form	Modified
189055	V-Zone Risk Factor Rating Form and Instructions Form and Instruction	Removed
189053	Flood Insurance Preferred Risk Policy Application Form and Instruction	Modified
189052	Flood Insurance General Change Endorsement Form and Instruction	Modified
189051	Flood Insurance Cancellation / Nullification Request Form and Instruction	Modified

ICR Details

OMB Control No: 1660-0006	ICR Reference No: 202006-1660-008
Status: Received in OIRA	Previous ICR Reference No: 201611-1660-004
Agency/Subagency: DHS/FEMA	Agency Tracking No:
Title: National Flood Insurance Program Policy Forms
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 03/04/2021

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	409,781	0
Time Burden (Hours)	62,195	0
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. 90 - 448 1301 Name of Law: Housing and Urban Development Act of 1968
   PL: Pub.L. 93 - 234 6500 Name of Law: Flood Disaster Protection Act of 1973
  

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 10458	02/24/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 31202	05/22/2020
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
V-Zone Risk Factor Rating Form and Instructions	FEMA Form 086-0-4	V-Zone Risk Factor Rating Form and Instructions
Flood Insurance General Change Endorsement	FEMA Form 086-0-3	Flood Insurance General Change Endorsement
Flood Insurance Application	FEMA Form 086-0-1	Flood Insurance Application
Flood Insurance Cancellation / Nullification Request	FEMA Form 086-0-2	Flood Insurance Cancellation/Nullification Request Form
Flood Insurance Preferred Risk Policy Application	FEMA Form 086-0-5	Flood Insurance Preferred Risk 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	0	0	0	-191,286	601,067
Annual Time Burden (Hours)	62,195	0	0	0	-28,820	91,015
Annual Cost Burden (Dollars)	0	0	0	0	-6,500	6,500

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: FEMA Form 086-0-1 (Application) – The decrease in burden hours is due to a change in the number of forms submitted. The number of submitted forms reported has decreased from 29,550 to 17,593. The number of burden hours has decreased from 5,910 to 3,519. There are minor proposed changes to the information being collected. FEMA Form 086-0-2 (Cancellation) – The decrease in burden hours is due to a change in the number of forms submitted. The number of submitted forms reported has decreased from 40,890 to 30,964. The number of burden hours has increased from 5,111 to 3,871. However, there are proposed formatting changes to the form. FEMA Form 086-0-3 (Endorsement) – The decrease in burden hours is due to a change in the number of forms submitted. The number of submitted forms reported has decreased from 510,402 to 323,865. The number of burden hours has decreased from 76,560 to 48,595. There are no changes to the information being collected. FEMA Form 086-0-4 (V-Zone Risk Factor Rating Form) – This form is being eliminated because our system of record shows no instances of active policies using this form. The number of forms submitted has decreased to 0. FEMA Form 086-0-5 Preferred Risk Application) – The increase in burden hours is due a change in the number of forms submitted. The number of submitted forms reported has increased from 20,215 to 37,259. The number of burden hours has increased from 3,370 to 6,210.

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Annual Cost to Federal Government: $9,356,398

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.     No

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: 03/04/2021

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