Fema Form 086-0-14 - National Flood Insurance Program Final Report - 2013 Page 2
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1
2Privacy Act Statement
The information requested is necessary to process the subject loss. The authority to collect the information is Title 42, U.S. Code, Section
4001 to 4028. It is voluntary on your part to furnish the information. However, omission of an item may preclude processing of the form. The
information will not be disclosed outside of the Federal Emergency Management Agency, except to the servicing agent, acting as the
government's fiscal agent; to claims adjusters to enable them to confirm coverage and the location of insured property; to certain Federal,
State, and Local Government agencies for determining eligibility for benefits and for verification of agencies for acquisition and relocation-
related projects, consistent with the National Flood Insurance Program and consistent with the routine uses described in the program's
system of record. Failure by you to provide some or all of the information may result in delay in processing or denial of this claim and/or
application.
PAPERWORK BURDEN DISCLOSURE NOTICE
Public reporting burden for the collection of information titled Claims for National Flood Insurance Program (NFIP) is estimated to average 6
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 these forms. You are not required to respond to this collection of information
unless a currently valid OMB control number and expiration date is displayed in the upper right corner of the these forms. Send comments
regarding the accuracy of the burden estimate and suggestions for reducing the burden to: Information Collections Management,
Department of Homeland Security, Federal Emergency Management Agency, 500 C Street, S.W., Washington, DC 20472, Paperwork
Reduction Project (1660-0005). NOTE: Do not send your completed form to this address.
FEMA Form No.
Title
Burden Hours
086-0-6
Worksheet-Contents-Personal Property
2.5 Hours
086-0-7
Worksheet-Building
2.5 Hours
086-0-8
Worksheet-Building (Continued)
1 Hours
086-0-9
Proof of Loss
.08 Hours
086-0-10
Increased Cost of Compliance
2 Hours
086-0-11
Notice of Loss
.07 Hours
086-0-12
Statement as to Full Cost to Repair or Replacement
.10 Hours
Cost Coverage, Subject to the Terms and Conditions
of this Policy
086-0-13
National Flood Insurance Program Preliminary Report
.07 Hours
086-0-14
National Flood Insurance Program Final Report
.07 Hours
086-0-15
National Flood Insurance Program Narrative Report
.08 Hours
086-0-16
Cause of Loss and Subrogation Report
1 Hour
086-0-17
Manufactured (Mobile) Home/Travel Trailer Worksheet
.50 Hours
086-0-18
Mobile Home/Travel Trailer Worksheet (Continued)
.25 Hours
086-0-19
Increased Cost of Compliance (ICC) Adjuster Report
.42 Hours
086-0-20
Adjuster Preliminary Damage Assessment
.25 Hours
086-0-21
Adjuster Certification Application
.25 Hours
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