It's no secret that the Federal Emergency Management Agency, or FEMA, has been under fire in recent years for its handling of various disasters. But what many people don't know is that FEMA also provides assistance to individuals and businesses who have suffered a loss or damage as a result of a disaster. One such program is the Individual and Business Disaster Assistance Program, which provides funding for temporary housing, home repairs, and other needs. If you need help from FEMA, be sure to submit a Cancellation Form.
Question | Answer |
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Form Name | Fema Cancellation Form |
Form Length | 2 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 30 sec |
Other names | fema cancellation, flood cancellation form, flood reason fema latest, form flood federal |
U.S. DEPARTMENT OF HOMELAND SECURITY |
O.M.B. No. |
FEDERAL EMERGENCY MANAGEMENT AGENCY |
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National Flood Insurance Program |
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FLOOD INSURANCE CANCELLATION/NULLIFICATION REQUEST FORM |
POLICY #: |
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IMPORTANT – PLEASE PRINT OR TYPE; ENTER DATES AS MM/DD/YYYY. |
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POLICY |
PERIOD |
POLICY PERIOD IS FROM |
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TO |
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CANCELLATION EFFECTIVE DATE: |
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AGENT/PRODUCER |
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NAME AND MAILING ADDRESS OF AGENT/PRODUCER ON THE POLICY BEING CANCELED. |
INFORMATIONINSURED |
NAME AND MAILING ADDRESS OF INSURED FOR MAILING REFUND: |
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INFORMATION |
AGENCY NO.: |
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AGENT’S TAX ID: |
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PHONE NO.: |
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FAX NO.: |
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EMAIL ADDRESS: |
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1STMORTGAGEE/ |
MORTGAGEEOTHER |
NAME AND MAILING ADDRESS OF FIRST MORTGAGEE: |
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LOCATIONPROPERTY |
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PHONE NO.: |
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INSURED PROPERTY LOCATION: |
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LOAN NO.: |
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NAME AND MAILING ADDRESS OF OTHER PARTIES NOTIFIED: |
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2ND |
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N
F
I
CANCELLATION REASON CODES
CANCELLATION REASON CODE:
1.BUILDING SOLD OR REMOVED, DESTROYED OR PHYSICALLY ALTERED TO NO LONGER MEET THE DEFINITION OF AN ELIGIBLE BUILDING
2.CONTENTS SOLD OR REMOVED
3.POLICY CANCELED AND REWRITTEN TO ESTABLISH COMMON EXPIRATION DATE WITH OTHER INSURANCE COVERAGE
4.DUPLICATE NFIP POLICIES
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6.RISK NOT ELIGIBLE FOR COVERAGE
7.PROPERTY CLOSING DID NOT OCCUR (NO INSURABLE INTEREST)
8.POLICY OBTAINED FOR PROPERTY CLOSING, BUT NOT REQUIRED BY MORTGAGEE AS PROPERTY NOT IN SFHA
9.INSURANCE NO LONGER REQUIRED BY MORTGAGEE; PROPERTY NO LONGER IN SFHA BECAUSE OF PHYSICAL MAP REVISION
10.CONDOMINIUM POLICY (UNIT OR ASSOCIATION) CONVERTING TO RCBAP
12.MORTGAGE PAID OFF
13.VOIDANCE PRIOR TO EFFECTIVE DATE
15.INSURANCE NO LONGER REQUIRED BASED ON FEMA REVIEW OF LENDER’S SFHA DETERMINATION (LODR)
18.MORTGAGE PAID OFF ON AN MPPP POLICY
19.INSURANCE NO LONGER REQUIRED BY THE MORTGAGEE BECAUSE THE BUILDING HAS BEEN REMOVED FROM THE SFHA BY MEANS OF A LOMA
20.POLICY WRITTEN TO WRONG FACILITY (SEVERE REPETITIVE LOSS PROPERTY)
21.OTHER: CONTINUOUS LAKE FLOODING OR CLOSED BASIN LAKES
22.CANCEL/REWRITE DUE TO MISRATING
23.FRAUD (FEMA APPROVAL REQUIRED)
24.CANCEL/REWRITE DUE TO MAP REVISION, LOMA, OR LOMR
25.CANCEL/REWRITE TO PROCESS HFIAA REFUND
P
C O P Y
REFUND |
MAIL REFUND TO (CHECK ONE): |
INSURED |
PAYOR |
AGENT (REASON 5 |
ABOVE OR AT REQUEST OF INSURED) |
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MAKE REFUND PAYABLE TO (CHECK ONE): |
INSURED |
PAYOR |
AGENT (REASON 5 |
ABOVE ONLY) |
THE ABOVE STATEMENTS ARE CORRECT TO THE BEST OF MY KNOWLEDGE. I UNDERSTAND THAT ANY FALSE STATEMENTS MAY BE PUNISHABLE BY FINE AND/OR IMPRISONMENT UNDER APPLICABLE FEDERAL LAW. SEE REVERSE SIDE OF COPIES 2, 3, AND 4.
SIGNATURE |
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SIGNATURE OF INSURED |
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DATE (MM/DD/YYYY) |
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(NOT REQUIRED FOR REASON 5, 6, 22, OR 25) |
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SIGNATURE OF OTHER INSURED |
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DATE (MM/DD/YYYY) |
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SIGNATURE OF AGENT/PRODUCER |
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DATE (MM/DD/YYYY) |
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FEMA Form |
Previously FEMA Form |
PLEASE ATTACH ALL REQUIRED DOCUMENTS TO NFIP COPY OF CANCELLATION/ NULLIFICATION REQUEST FORM.
SPECIAL NOTE TO INSURANCE AGENT/PRODUCER: SEND ORIGINAL TO NFIP, KEEP SECOND COPY FOR YOUR RECORDS, GIVE THIRD COPY TO THE INSURED, AND FOURTH COPY TO MORTGAGEE.
National Flood Insurance Program
FLOOD INSURANCE CANCELLATION/NULLIFICATION REQUEST FORM
FEMA FORM
NONDISCRIMINATION
No person or organization shall be excluded from participation in, denied the benefits of, or subjected to discrimination under the Program authorized by the Act, on the grounds of race, color, creed, sex, age or national origin.
PRIVACY ACT
The information requested is necessary to process your Flood Insurance Application for a flood insurance policy. The authority to collect the information is Title 42, U.S. Code, Sections 4001 to 4028. Disclosures of this information may be made: to federal, state, tribal, and local government agencies, fiscal agents, your agent, mortgage servicing companies, insurance or other companies, lending institutions, and contractors working for us, for the purpose of carrying out the National Flood Insurance Program; to current Severe Repetitive Loss property owners and Preferred Risk Policy owners for the purpose of property loss history evaluation; to the American Red Cross for verification of nonduplication of benefits following a flooding event or disaster; to law enforcement agencies or professional organizations when there may be a violation or potential violation of law; to a federal, state or local agency when we request information relevant to an agency decision concerning issuance of a grant or other benefit, or in certain circumstances when a federal agency requests such information for a similar purpose from us; to a Congressional office in response to an inquiry made at the request of an individual; to the Office of Management and Budget (OMB) in relation to private relief legislation under OMB Circular
GENERAL
This information is provided pursuant to Public Law
AUTHORITY
Public Law
PAPERWORK BURDEN DISCLOSURE NOTICE
Public reporting burden for this form is estimated to average 7.5 minutes per response. The burden estimate includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and submitting the form. This collection of information is required to obtain or retain benefits. You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing the burden to: Information Collections Management, Department of Homeland Security, Federal Emergency Management Agency, 500 C Street SW, Washington, DC 20742, Paperwork Reduction Project