|
U.S. DEPARTMENT OF HOMELAND SECURITY 0 OOIG
<br />B No, 0. ALB 166
<br />FEDERAL EMERGENCY MANAGEMENT AGENCY Expires F'ebrr166028, 2014
<br />OVERVIEW & CONCURRENCE FORM
<br />PAPERWORK BURDEN DISCLOSURE NOTICE
<br />Public reporting burden for this form is estimated to average 1 hours per response. The burden estimate includes the time for reviewing instructions,
<br />searching existing data sources, gathering and maintaining the needed data, and completing, reviewing, and submitting the form. You are not required
<br />to respond to this collection of information unless it displays a valid OMB control number. Send comments regarding the accuracy of the burden
<br />estimate and any suggestions for reducing this burden to: information Collections Management, Department of Homeland Security, Federal Emergency
<br />Management Agency, 1800 South Bell Street, Arlington, VA 20958-3005, Paperwork Reduction Project (1660-0016). Submission of the fort is required
<br />to obtain or retain benefits under the National Flood Insurance Program. Please do not send your comoteted survev to the above address.
<br />PRIVACY ACT STATEMENT
<br />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-
<br />234.
<br />PRINCIPAL PURPOSE(S): This Information is being collected for the purpose of determining an applicant's eligibility to request changes to National
<br />Flood Insurance Program (NFIP) Flood Insurance Rate Maps (FIRM).
<br />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
<br />amended, This includes using this information as necessary and authorized by the routine uses published in DHSIFEMAINFIPILOMA-1 National Flood
<br />Insurance Program (NFIP); Letter of Map Amendment (LOMA) February 15, 2006, 71 FR 7990.
<br />DISCLOSURE: The disclosure of information on this form is voluntary; however, failure to provide the information requested may delay or prevent
<br />FEMA from processing a determination regarding a requested change to a (NFIP) Flood Insurance Rate Maps (FIRM).
<br />A. REQUESTED RESPONSE FROM DHS -FEMA
<br />This request is for a (check one):
<br />❑ CLOMR: A letter from DHS -FEMA commenting on whether a proposed project, If built as proposed, would justify a map revision, or
<br />proposed hydrology changes (See 44 CFR Ch. I. Parts 60, 65 8 72),
<br />® LOMR: A letter from DNS -FEMA officially revising the current NFIP map to show the changes to floodplain, regulatory floodway or flood
<br />elevations. (See 44 CFR Ch. 1, Parts 60,65 8 72)
<br />B. OVERVIEW
<br />1. The NFIP map panel(s) affected for all Impacted communities is (are):
<br />Community No.
<br />Community Name
<br />State
<br />Map No.
<br />Panel No.
<br />Effective Date
<br />Example: 480301
<br />City of Katy
<br />TX
<br />48473C
<br />0005D
<br />02/08/83
<br />480267
<br />Hams County
<br />TX
<br />48201C
<br />022OG
<br />09/28/90
<br />530095
<br />Kittit is County (Unicarporated Areas)
<br />WA
<br />530095
<br />04378
<br />05/05181
<br />530234
<br />City of Ellensburg
<br />WA
<br />530234
<br />Boole
<br />05/05/81
<br />2. a. Flooding Source: Whiksay and Mercer Creeks
<br />b. Types of Flooding: ® Riverine ❑ Coastal ❑ Shallow Flooding (e.g., Zones AO and AH)
<br />❑ Alluvial fan ❑ Lakes ❑ Other (Attach Description)
<br />3. Project Namelldentifier: Whiskey and Mercer Creeks Hydraulic Study
<br />4. FEMA zone designations affected: A, A2, AO (choices: A, AH, AO, Al -A30, A99, AE, AR, V, Vi -V30, VE, B, C.
<br />D, X)
<br />S. Basis for Request and Type of Revision:
<br />a. The basis for this revision request is (check all that apply)
<br />❑ Physical Change ® Improved MethadologylData ❑ Regulatory Floodway Revision ❑ Base Map Changes
<br />❑ Coastal Analysis ® Hydraulic Analysis ® Hydrologic Analysis ❑ Corectlons
<br />❑ Weir -Dam Changes ❑ Levee Certification ❑ Alluvial Fan Analysis ❑ Natural Changes
<br />® New Topographic Data ❑ Other (Attach Description)
<br />Note: A photograph and narrative description of the area of concern is not required, but is very helpful during review.
<br />FEMA Form 086-0-27, (212011) Previously FEMA Form 81-89 MT -2 Form 1 Page 1 of 3
<br />
|