Notice of Loss

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⚠️ Notice: This information collection may be referencing outdated material.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 086-0-11 Notice of Loss Form
086-0-11 Notice of Loss FEMA FORM 086-0-11 Draft version 2-28-2017.pdf Form
086-0-11 Notice of Loss FEMA FORM 086-0-11 Draft version 2-28-2017.pdf Form

Information Collection (IC) Details

IC Title:	Notice of Loss	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	086-0-11	Notice of Loss	FEMA FORM 086-0-11 Draft version 2-28-2017.pdf		Yes	No	Fillable Fileable

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: 5,593	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	5,593	-1,528	7,121
Annual IC Time Burden (Hours)	951	476	475
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.