Fema Form 086-0-27 - Overview & Concurrence Form - 2011-2014

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U.S. DEPARTMENT OF HOMELAND SECURITY
O.M.B No. 1660-0016
FEDERAL EMERGENCY MANAGEMENT AGENCY
Expires February 28, 2014
OVERVIEW & CONCURRENCE FORM
PAPERWORK BURDEN DISCLOSURE NOTICE
Public reporting burden for this form is estimated to average 1 hours per response. The burden estimate includes the time for reviewing instructions,
searching existing data sources, gathering and maintaining the needed data, and completing, reviewing, and submitting the form. You are not required
to respond to this collection of information unless it displays a valid OMB control number. Send comments regarding the accuracy of the burden
estimate and any suggestions for reducing this burden to: Information Collections Management, Department of Homeland Security, Federal Emergency
Management Agency, 1800 South Bell Street, Arlington, VA 20958-3005, Paperwork Reduction Project (1660-0016). Submission of the form is required
to obtain or retain benefits under the National Flood Insurance Program. Please do not send your completed survey to the above address.
PRIVACY ACT STATEMENT
AUTHORITY: The National Flood Insurance Act of 1968, Public Law 90-448, as amended by the Flood Disaster Protection Act of 1973, Public Law 93-
234.
PRINCIPAL PURPOSE(S): This information is being collected for the purpose of determining an applicant's eligibility to request changes to National
Flood Insurance Program (NFIP) Flood Insurance Rate Maps (FIRM).
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/NFIP/LOMA-1 National Flood
Insurance Program (NFIP); Letter of Map Amendment (LOMA) February 15, 2006, 71 FR 7990.
DISCLOSURE: The disclosure of information on this form is voluntary; however, failure to provide the information requested may delay or prevent
FEMA from processing a determination regarding a requested change to a (NFIP) Flood Insurance Rate Maps (FIRM).
A. REQUESTED RESPONSE FROM DHS-FEMA
This request is for a (check one):
CLOMR:
A letter from DHS-FEMA commenting on whether a proposed project, if built as proposed, would justify a map revision, or
proposed hydrology changes (See 44 CFR Ch. 1, Parts 60, 65 & 72).
LOMR:
A letter from DHS-FEMA officially revising the current NFIP map to show the changes to floodplains, regulatory floodway or flood
elevations. (See 44 CFR Ch. 1, Parts 60, 65 & 72)
B. OVERVIEW
1.
The NFIP map panel(s) affected for all impacted communities is (are):
Community No.
Community Name
State
Map No.
Panel No.
Effective Date
Example: 480301
City of Katy
TX
48473C
0005D
02/08/83
480287
Harris County
TX
48201C
0220G
09/28/90
2.
a. Flooding Source:
b. Types of Flooding:
Riverine
Coastal
Shallow Flooding (e.g., Zones AO and AH)
Alluvial fan
Lakes
Other (Attach Description)
3.
Project Name/Identifier:
4.
FEMA zone designations affected:
(choices: A, AH, AO, A1-A30, A99, AE, AR, V, V1-V30, VE, B, C, D, X)
5.
Basis for Request and Type of Revision:
a.
The basis for this revision request is (check all that apply)
Physical Change
Improved Methodology/Data
Regulatory Floodway Revision
Base Map Changes
Coastal Analysis
Hydraulic Analysis
Hydrologic Analysis
Corrections
Weir-Dam Changes
Levee Certification
Alluvial Fan Analysis
Natural Changes
New Topographic Data
Other (Attach Description)
Note: A photograph and narrative description of the area of concern is not required, but is very helpful during review.
FEMA Form 086-0-27, (2/2011)
Previously FEMA Form 81-89
MT-2 Form 1
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