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U.S. DEPARTMENT OF HOMELAND SECURITY	O.M.B. No. 1660-0006 Expires April 30, 2020
FEDERAL EMERGENCY MANAGEMENT AGENCY

National Flood Insurance Program

FLOOD INSURANCE APPLICATION, PAGE 1 (OF 2)

IMPORTANT—PLEASE PRINT OR TYPE; ENTER DATES AS MM/DD/YYYY.

NEW RENEWAL TRANSFER (NFIP ONLY)

PRIOR POLICY #:

BILLING	FOR RENEWAL, BILL:
BILLING	INSURED	LOSS PAYEE
	FIRST MORTGAGEE	OTHER (AS SPECIFIED IN THE “2ND
	SECOND MORTGAGEE	MORTGAGEE/OTHER” BOX BELOW)

	NAME AND MAILING ADDRESS OF AGENT/PRODUCER:
AGENT/PRODUCER INFORMATION	AGENCY NO.:	AGENT’S TAX ID:
	AGENCY NO.:	AGENT’S TAX ID:
	PHONE NO.:		FAX NO.:
	EMAIL ADDRESS:

NOTE: ONE BUILDING PER POLICY — BLANKET COVERAGE NOT PERMITTED.

IS INSURED PROPERTY LOCATION SAME AS INSURED’S MAILING ADDRESS? YES NO IF NO, ENTER PROPERTY ADDRESS. IF RURAL, ENTER LEGAL DESCRIPTION, OR GEOGRAPHIC LOCATION OF PROPERTY (DO NOT USE P.O. BOX).

IDENTIFY ADDRESS TYPE: STREET LEGAL DESCRIPTION* GEOGRAPHIC LOCATION LOCATIONPROPERTY FOR AN ADDRESS WITH MULTIPLE BUILDINGS AND/OR FOR A BUILDING WITH ADDITIONS OR

EXTENSIONS, DESCRIBE THE INSURED BUILDING:

*LEGAL DESCRIPTION MAY BE USED ONLY WHILE A BUILDING OR SUBDIVISION IS IN THE COURSE OF CONSTRUCTION OR PRIOR TO ESTABLISHING A STREET ADDRESS.

DISASTER ASSISTANCE

CASE FILE NO.:

IS INSURANCE REQUIRED FOR DISASTER ASSISTANCE?

YES

IF YES, CHECK THE GOVERNMENT AGENCY:

SBA

FEMA

FHA

OTHER (SPECIFY):

GRANDFATHERING INFORMATION

GRANDFATHERED?

YES

IF YES,

BUILT IN COMPLIANCE OR

CONTINUOUS COVERAGE (PROVIDE PRIOR POLICY NUMBER IN BOX ABOVE)

COMMUNITY

RATING MAP INFORMATION

NAME OF COUNTY/PARISH:

COMMUNITY NO./PANEL NO. AND SUFFIX:

–

FIRM ZONE:

MAP DATE:

COMMUNITY PROGRAM TYPE IS:

REGULAR

EMERGENCY

CURRENT MAP INFORMATION

CURRENT COMMUNITY NO./PANEL NO. AND SUFFIX:

–

CURRENT FIRM ZONE:

CURRENT BFE:

MAP DATE:

POLICY PERIOD IS FROM

PERIOD

STANDARD 30-DAY

12:01 A.M. LOCAL TIME AT THE INSURED PROPERTY LOCATION.

POLICY

WAITING PERIOD:

REQUIRED FOR LOAN TRANSACTION — NO WAITING PERIOD

MAP REVISION (ZONE CHANGE FROM NON-SFHA TO SFHA) — 1 DAY

TRANSFER (NFIP ONLY) — NO WAITING PERIOD

INDICATE THE PROPERTY PURCHASE DATE:

NAME AND MAILING ADDRESS OF INSURED:

INSURED INFORMATION

PHONE NO.:

IS THE INSURED A SMALL BUSINESS?

YES

IS THE INSURED A NON-PROFIT ENTITY?

YES

NAME AND MAILING ADDRESS OF FIRST MORTGAGEE:

1ST MORTGAGEE

LOAN NO.:

IS INSURANCE REQUIRED UNDER MANDATORY PURCHASE?

YES

MORTGAGEE/OTHER

NAME AND MAILING ADDRESS OF:

2ND MORTGAGEE

LOSS PAYEE

OTHER

IF OTHER, SPECIFY:

2ND

LOAN NO.:

IS INSURANCE REQUIRED UNDER MANDATORY PURCHASE?

YES

COMPLETE THIS SECTION ONLY FOR PRE-FIRM BUILDINGS LOCATED IN AN SFHA.

COVERAGE

HAS THE APPLICANT HAD A PRIOR NFIP POLICY FOR THIS PROPERTY?

YES

2. WAS THE POLICY REQUIRED BY THE LENDER UNDER MANDATORY PURCHASE?

YES

3. IF YES, HAS THE PRIOR NFIP POLICY EVER LAPSED WHILE COVERAGE WAS REQUIRED

NFIP

UNDER MANDATORY PURCHASE BY THE LENDER?

YES

IF YES, WAS THE LAPSE THE RESULT OF A COMMUNITY SUSPENSION?

YES

PRIOR

IF YES, WHAT IS THE SUSPENSION DATE?

WHAT IS THE REINSTATEMENT DATE?

5. WILL THIS POLICY BE EFFECTIVE WITHIN 180 DAYS OF THE COMMUNITY REINSTATEMENT

AFTER SUSPENSION REFERRED TO IN (4) ABOVE?

YES

C O P Y

ALL BUILDINGS

1. BUILDING PURPOSE

100% RESIDENTIAL

100% NON-RESIDENTIAL MIXED-USE — SPECIFY PERCENTAGE OF

RESIDENTIAL USE:

2. BUILDING OCCUPANCY

SINGLE FAMILY 2–4 FAMILY OTHER RESIDENTIAL

NON-RESIDENTIAL BUSINESS OTHER NON-RESIDENTIAL

3.IS THE BUILDING A HOUSE OF WORSHIP?

YES NO

4.IS THE BUILDING AN AGRICULTURAL

STRUCTURE? YES NO

5.BUILDING DESCRIPTION (CHECK ONE)

MAIN HOUSE

DETACHED GUEST HOUSE

DETACHED GARAGE

BARN

APARTMENT BUILDING

APARTMENT – UNIT

COOPERATIVE BUILDING

COOPERATIVE – UNIT

WAREHOUSE

TOOL/STORAGE SHED

POOLHOUSE, CLUBHOUSE, RECREATION BUILDING

OTHER:

6. CONDOMINIUM INFORMATION

IS BUILDING IN A CONDOMINIUM FORM

OF OWNERSHIP?			YES	NO
IS COVERAGE FOR THE ENTIRE BUILDING?
YES	NO
TOTAL NUMBER OF UNITS:
HIGH-RISE		LOW-RISE
IS COVERAGE FOR A CONDOMINIUM UNIT?
YES	NO

7.ADDITIONS AND EXTENSIONS (IF APPLICABLE)

DOES THE BUILDING HAVE ANY ADDITIONS

OR EXTENSIONS? YES NO (ADDITIONS AND EXTENSIONS MAY BE SEPARATELY INSURED.)

COVERAGE IS FOR:

BUILDING INCLUDING ADDITION(S) AND EXTENSION(S)

BUILDING EXCLUDING ADDITION(S) AND EXTENSION(S) PROVIDE POLICY NUMBER FOR ADDITION OR EXTENSION:

ADDITION OR EXTENSION ONLY (INCLUDE DESCRIPTION IN THE PROPERTY LOCATION BOX ABOVE). PROVIDE POLICY NUMBER FOR BUILDING EXCLUDING ADDITION(S) OR EXTENSION(S):

8.PRIMARY RESIDENCE, RENTAL PROPERTY, TENANT’S COVERAGE

IS BUILDING INSURED’S PRIMARY

RESIDENCE? YES NO IS BUILDING A RENTAL PROPERTY?

YES NO

IS THE INSURED A TENANT? YES NO IF YES, IS THE TENANT REQUESTING BUILDING

COVERAGE? YES NO

IF YES, SEE NOTICE IN SIGNATURE BLOCK ON PAGE 2.

9. BUILDING INFORMATION

IS BUILDING IN THE COURSE OF

CONSTRUCTION? YES NO IS BUILDING WALLED AND ROOFED?

YES NO

IS BUILDING OVER WATER?

NO PARTIALLY ENTIRELY

IS BUILDING LOCATED ON FEDERAL LAND?

YES

IS BUILDING A SEVERE REPETITIVE LOSS

PROPERTY? YES NO

10.IS BUILDING ELEVATED? YES NO

11.BASEMENT, ENCLOSURE, CRAWLSPACE

NONE

FINISHED BASEMENT/ENCLOSURE CRAWLSPACE

UNFINISHED BASEMENT/ENCLOSURE SUBGRADE CRAWLSPACE

IS THE BASEMENT/SUBGRADE CRAWLSPACE FLOOR BELOW GRADE ON ALL SIDES?

YES NO

12.NUMBER OF FLOORS IN BUILDING (INCLUDING BASEMENT/ENCLOSED AREA, IF ANY) OR BUILDING TYPE

3 OR MORE

SPLIT LEVEL TOWNHOUSE/ROWHOUSE (RCBAP LOW-RISE ONLY)

MANUFACTURED (MOBILE) HOME/TRAVEL TRAILER ON FOUNDATION

NON-ELEVATED BUILDINGS

1. GARAGE

IS A GARAGE ATTACHED TO THE BUILDING?

YES NO

TOTAL NET AREA OF THE GARAGE:

SQUARE FEET.

ARE THERE ANY OPENINGS (EXCLUDING DOORS) THAT ARE DESIGNED TO ALLOW THE PASSAGE OF FLOODWATERS THROUGH THE

GARAGE? YES NO

IF YES, NUMBER OF PERMANENT FLOOD OPENINGS WITHIN 1 FOOT ABOVE THE

ADJACENT GRADE: .

TOTAL AREA OF ALL PERMANENT OPENINGS: SQUARE INCHES.

IS THE GARAGE USED SOLELY FOR PARKING OF VEHICLES, BUILDING ACCESS, AND/OR

STORAGE?

YES

IF YES, DOES THE GARAGE CONTAIN MACHINERY AND/OR EQUIPMENT?

YES NO

2. BASEMENT/SUBGRADE CRAWLSPACE

DOES THE BASEMENT/SUBGRADE CRAWLSPACE CONTAIN MACHINERY AND/OR

EQUIPMENT? YES NO

IF YES, SELECT THE VALUE BELOW:

UP TO $10,000

$10,001 TO $20,000

IF GREATER THAN $20,000 – INDICATE THE AMOUNT:

DOES THE BASEMENT/SUBGRADE CRAWLSPACE CONTAIN A WASHER, DRYER

OR FOOD FREEZER?

YES

IF YES, SELECT THE VALUE BELOW:

UP TO $5,000

$5,001 TO $10,000

IF GREATER THAN $10,000 – INDICATE THE AMOUNT:

FEMA Form 086-0-1

Previously FEMA Form 81-16

F-050 (FEB 2015)

PLEASE SUBMIT TOTAL AMOUNT DUE AND ALL REQUIRED CERTIFICATIONS WITH THE NFIP COPY OF THIS APPLICATION.

IF PAYING BY CHECK OR MONEY ORDER, MAKE PAYABLE TO THE NATIONAL FLOOD INSURANCE PROGRAM.

IMPORTANT — COMPLETE PAGE 1 AND PAGE 2 BEFORE SENDING APPLICATION TO THE NFIP. — IMPORTANT

U.S. DEPARTMENT OF HOMELAND SECURITY	O.M.B. No. 1660-0006 Expires April 30, 2020
U.S. DEPARTMENT OF HOMELAND SECURITY
FEDERAL EMERGENCY MANAGEMENT AGENCY
National Flood Insurance Program	FLOOD INSURANCE APPLICATION, PAGE 2 (OF 2)

IMPORTANT—PLEASE PRINT OR TYPE; ENTER DATES AS MM/DD/YYYY.		NEW	RENEWAL	TRANSFER (NFIP ONLY)
IMPORTANT—PLEASE PRINT OR TYPE; ENTER DATES AS MM/DD/YYYY.
ALL DATA PROVIDED BY THE INSURED OR OBTAINED FROM THE ELEVATION CERTIFICATE SHOULD

BE REVIEWED AND TRANSCRIBED BELOW. THIS PART OF THE APPLICATION MUST BE COMPLETED	PRIOR POLICY #:
FOR ALL BUILDINGS.
FOR ALL BUILDINGS.

ELEVATED BUILDINGS

ELEVATED BUILDINGS (INCLUDING MANUFACTURED [MOBILE] HOMES/ TRAVEL TRAILERS)

1.IF THE BUILDING IS ELEVATED, IS THE AREA BELOW

FREE OF OBSTRUCTION

WITH OBSTRUCTION

2. ELEVATING FOUNDATION TYPE

PIERS, POSTS, OR PILES REINFORCED MASONRY PIERS OR CONCRETE PIERS OR COLUMNS REINFORCED CONCRETE SHEAR WALLS WOOD SHEAR WALLS

SOLID FOUNDATION WALLS

3. MACHINERY AND/OR EQUIPMENT

DOES THE AREA BELOW THE ELEVATED FLOOR CONTAIN MACHINERY AND/OR

EQUIPMENT?

YES

IF YES, SELECT THE VALUE BELOW:

UP TO $10,000

$10,001 TO $20,000

IF GREATER THAN $20,000 – INDICATE THE AMOUNT:

DOES THE AREA BELOW THE ELEVATED FLOOR CONTAIN A WASHER, DRYER OR

FOOD FREEZER?

YES

IF YES, SELECT THE VALUE BELOW:

UP TO $5,000

$5,001 TO $10,000

IF GREATER THAN $10,000 – INDICATE THE AMOUNT:

4. AREA BELOW THE ELEVATED FLOOR

IS THE AREA BELOW THE ELEVATED FLOOR

ENCLOSED?

YES

IF YES, CHECK ONE OF THE FOLLOWING:

FULLY PARTIALLY

IS THERE A GARAGE? (CHECK ONE)

NO GARAGE

BENEATH THE LIVING SPACE

NEXT TO THE LIVING SPACE

DOES THE AREA BELOW THE ELEVATED FLOOR CONTAIN ELEVATORS?

YES NO

IF YES, HOW MANY?

IF THE ANSWER TO ANY OF THE QUESTIONS REGARDING THE AREA BELOW THE ELEVATED FLOOR IS YES, OR THERE IS A GARAGE, ANSWER ALL THE FOLLOWING.

INDICATE MATERIAL USED FOR ENCLOSURE:

INSECT SCREENING

LIGHT WOOD LATTICE

SOLID WOOD FRAME WALLS (BREAKAWAY)

SOLID WOOD FRAME WALLS (NON- BREAKAWAY)

MASONRY WALLS (IF BREAKAWAY, SUBMIT CERTIFICATION DOCUMENTATION)

MASONRY WALLS (NON-BREAKAWAY)

OTHER (DESCRIBE):

IF ENCLOSED WITH A MATERIAL OTHER THAN INSECT SCREENING OR LIGHT WOOD LATTICE, PROVIDE THE SIZE OF ENCLOSED AREA:

SQUARE FEET

IS THE ENCLOSED AREA/CRAWLSPACE USED FOR ANY PURPOSE OTHER THAN SOLELY FOR

PARKING OF VEHICLES, BUILDING ACCESS

AND/OR STORAGE?	YES	NO
IF YES, DESCRIBE:

DOES THE ENCLOSED AREA HAVE MORE THAN 20 LINEAR FEET OF FINISHED INTERIOR WALL, PANELING, ETC.?

YES NO

5. FLOOD OPENINGS

IS THE ENCLOSED AREA/CRAWLSPACE CONSTRUCTED WITH OPENINGS (EXCLUDING DOORS) TO ALLOW THE PASSAGE OF FLOODWATERS THROUGH THE

ENCLOSED AREA?		YES	NO
IF YES, INDICATE NUMBER OF PERMANENT
FLOOD OPENINGS WITHIN 1 FOOT
ABOVE ADJACENT GRADE:				.
TOTAL AREA OF ALL PERMANENT
FLOOD OPENINGS:
		SQUARE INCHES.

ARE FLOOD OPENINGS ENGINEERED?
YES	NO
IF YES, SUBMIT CERTIFICATION.

MANUFACTURED (MOBILE) HOMES/ TRAVEL TRAILERS

NOTE: WHEELS MUST BE REMOVED FOR TRAVEL TRAILER TO BE INSURABLE.

1. MANUFACTURED (MOBILE) HOME/TRAVEL TRAILER DATA

YEAR OF MANUFACTURE:

MAKE:

MODEL NUMBER:

SERIAL NUMBER:

DIMENSIONS:

FEET

ARE THERE ANY PERMANENT ADDITIONS AND/OR EXTENSIONS?

YES

IF YES, THE DIMENSIONS ARE:

FEET

2. ANCHORING

THE MANUFACTURED (MOBILE) HOME/TRAVEL TRAILER ANCHORING SYSTEM UTILIZES: (CHECK ALL THAT APPLY.)

OVER-THE-TOP TIES		GROUND ANCHORS
FRAME TIES		SLAB ANCHORS
FRAME CONNECTORS
OTHER (DESCRIBE):

3. INSTALLATION

THE MANUFACTURED (MOBILE) HOME/TRAVEL TRAILER WAS INSTALLED IN ACCORDANCE WITH: (CHECK ALL THAT APPLY.)

MANUFACTURER’S SPECIFICATIONS

LOCAL FLOODPLAIN MANAGEMENT STANDARDS

STATE AND/OR LOCAL BUILDING STANDARDS

CHECK ONE OF THE FOLLOWING AND ENTER DATE FOR ORIGINAL CONSTRUCTION:

CONTENTS LOCATED IN:*

CONSTRUCTION INFORMATION

BUILDING PERMIT

CONSTRUCTION

BASEMENT/ENCLOSURE

BASEMENT/ENCLOSURE AND ABOVE

CONTENTS

LOWEST FLOOR ONLY ABOVE GROUND LEVEL

CHECK IF BUILDING HAS BEEN SUBSTANTIALLY IMPROVED AND ENTER DATE:

LOWEST FLOOR ABOVE GROUND LEVEL AND HIGHER

SUBSTANTIAL IMPROVEMENT

ABOVE GROUND LEVEL MORE THAN 1 FULL FLOOR

CHECK ONE OF THE FOLLOWING FOR MANUFACTURED (MOBILE) HOMES/TRAVEL TRAILERS:

IS PERSONAL PROPERTY HOUSEHOLD CONTENTS?

YES

LOCATED OUTSIDE A MOBILE HOME PARK OR SUBDIVISION: DATE OF PERMANENT PLACEMENT

LOCATED INSIDE A MOBILE HOME PARK OR SUBDIVISION: CONSTRUCTION DATE OF MOBILE

IF NO, DESCRIBE:

*IF SINGLE FAMILY, CONTENTS ARE RATED THROUGHOUT THE BUILDING.

HOME PARK OR SUBDIVISION FACILITIES

IS BUILDING POST-FIRM CONSTRUCTION?

ELEVATION CERTIFICATION DATE:

ELEVATION DATA

YES

BUILDING DIAGRAM NO.:

LOWEST ADJACENT GRADE (LAG):

CONSTRUCTION IS ELEVATION RATED,

(IF POST-FIRM CONSTRUCTION IN

ZONES A1–A30, AE, AO, AH, V,

LOWEST FLOOR ELEVATION:

(−)

BASE FLOOD ELEVATION:

(=) DIFFERENCE TO NEAREST FOOT:

(+ OR −)

V1–V30, VE, OR IF PRE-FIRM

IN ZONES V AND V1–V30 ONLY, DOES BASE FLOOD ELEVATION INCLUDE EFFECTS OF WAVE ACTION?

YES

ATTACH ELEVATION CERTIFICATE.)

IS BUILDING FLOODPROOFED?

YES

(SEE THE NFIP FLOOD INSURANCE MANUAL FOR CERTIFICATION REQUIREMENTS.)

ESTIMATED BUILDING REPLACEMENT COST (INCLUDING FOUNDATION): $

DEDUCTIBLE:

BUILDING $

CONTENTS $

ADDITIONAL LIMITS

RATING

BASIC LIMITS

(REGULAR PROGRAM ONLY)

DEDUCTIBLE

INSURANCE

TOTAL AMOUNT

TOTAL

AMOUNT OF

ANNUAL

AMOUNT OF

ANNUAL

COVERAGE

OF INSURANCE

INSURANCE

RATE

PREMIUM

INSURANCE

RATE

PREMIUM

PREMIUM REDUCTION/INCREASE

PREMIUM

AND

BUILDING

.00

COVERAGE

CONTENTS

.00

RATE CATEGORY:

PAYMENT METHOD:

ANNUAL SUBTOTAL

MANUAL

SUBMIT FOR RATE

PROVISIONAL RATING

CHECK

CREDIT CARD

ICC PREMIUM

INDICATE THE RATE TABLE USED:

OTHER:

SUBTOTAL

NOTICE: BUILDING COVERAGE BENEFITS — EXCEPT FOR A RESIDENTIAL CONDOMINIUM BUILDING — ARE NOT AVAILABLE IF OTHER NFIP

CRS PREMIUM DISCOUNT

BUILDING COVERAGE HAS BEEN PURCHASED BY THE APPLICANT OR ANY OTHER PARTY FOR THE SAME BUILDING.

SUBTOTAL

THE ABOVE STATEMENTS ARE CORRECT TO THE BEST OF MY KNOWLEDGE. I UNDERSTAND THAT ANY FALSE STATEMENTS MAY BE

RESERVE FUND

PUNISHABLE BY FINE AND/OR IMPRISONMENT UNDER APPLICABLE FEDERAL LAW. SEE REVERSE SIDE OF COPIES.

SIGNATURE

SUBTOTAL

PROBATION SURCHARGE

HFIAA SURCHARGE

SIGNATURE OF INSURANCE AGENT/PRODUCER

DATE (MM/DD/YYYY)

FEDERAL POLICY FEE

TOTAL AMOUNT DUE

SIGNATURE OF INSURED (OPTIONAL)

DATE (MM/DD/YYYY)

C O P Y

FEMA Form 086-0-1

Previously FEMA Form 81-16

F-050 (FEB 2015)

PLEASE SUBMIT TOTAL AMOUNT DUE AND ALL REQUIRED CERTIFICATIONS WITH THE NFIP COPY OF THIS APPLICATION.

IF PAYING BY CHECK OR MONEY ORDER, MAKE PAYABLE TO THE NATIONAL FLOOD INSURANCE PROGRAM.

IMPORTANT — COMPLETE PAGE 1 AND PAGE 2 BEFORE SENDING APPLICATION TO THE NFIP. — IMPORTANT

National Flood Insurance Program

FLOOD INSURANCE APPLICATION

FEMA FORM 086-0-1

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 A-19; and to the National Archives and Records Administration in records management inspections. Providing the information is voluntary, but failure to do so may delay or prevent issuance of the flood insurance policy.

GENERAL

This information is provided pursuant to Public Law 96-511 (Paperwork Reduction Act of 1980, as amended), dated December 11, 1980, to allow the public to participate more fully and meaningfully in the Federal paperwork review process.

AUTHORITY

Public Law 96-511, amended, 44 U.S.C. 3507; and 5 CFR 1320.

PAPERWORK BURDEN DISCLOSURE NOTICE

Public reporting burden for this form is estimated to average 12 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 (1660-0033). NOTE: Do not send your completed form to this address.

Question	Answer
Form Name	Fema Form 086 0 1
Form Length	3 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	45 sec
Other names	fema form 086 0 22, form flood fillable pdf, fema form 086 0 26b, 086 0 1

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