Fema Form 086-0-33 - Elevation Certificate - U.s. Department Of Homeland Security (Page 23 of 23) in pdf

National Flood Insurance Program

FLOODPROOFING CERTIFICATE

FOR NON-RESIDENTIAL STRUCTURES

Paperwork Reduction Act Notice

General: This information is provided pursuant to Public Law 96-511 (the 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 data collection is estimated to average 3.25 hours 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 this form. You are not required to respond to this collection of information unless a valid

OMB control number is displayed on 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,

1800 South Bell Street, Arlington, VA 20598-3005, Paperwork Reduction Project (1660-0008). NOTE: Do not send your completed form

to this address.

Privacy Act Statement

Authority: Title 44 CFR § 61.7 and 61.8.

Principal Purpose(s): This information is being collected for the primary purpose of estimate the risk premium rates necessary to provide

flood insurance for new or substantially improved structures in designated Special Flood Hazard Areas.

Routine Use(s): The information on this form may be disclosed as generally permitted under 5 U.S.C. § 552a(b) of the Privacy Act of 1974,

as amended. This includes using this information as necessary and authorized by the routine uses published in DHS/FEMA-003 – National

Flood Insurance Program Files System or Records Notice 73 Fed. Reg. 77747 (December 19, 2008); DHS/FEMA/NFIP/LOMA-1 – National

Flood Insurance Program (NFIP) Letter of Map Amendment (LOMA) System of Records Notice 71 Fed. Reg. 7990 (February 15, 2006); and

upon written request, written consent, by agreement, or as required by law.

Disclosure: The disclosure of information on this form is voluntary; however, failure to provide the information requested may result in

the inability to obtain flood insurance through the National Flood Insurance Program or may be subject to higher premium rates for flood

insurance. Information will only be released as permitted by law.

FEMA Form 086-0-34 (7/12)

F-056

Fema Form 086-0-33 - Elevation Certificate - U.s. Department Of Homeland Security Page 23