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Get Fema Form 81 64 2012-2024

3 b 60. 3 c 60. 3 d 5. CHECK APPROPRIATE BOX 60. 3 e EMERGENCY PHASE REGULAR PHASE IF REGULAR PROGRAM SPECIFY FIRM INDEX DATE. IF USING ANOTHER COMMUNITY S FIRM GIVE COMMUNITY NAME CID FIRM INDEX DATE AND MAP PANEL NUMBER DEPICTING COMMUNITY FEMA Form 81-64 MAR 08. DEPARTMENT OF HOMELAND SECURITY FEDERAL EMERGENCY MANAGEMENT AGENCY O. M. B. NO. 1660-0004 Expires March 31 2011 APPLICATION FOR PARTICIPATION IN THE NATIONAL FLOOD INSURANCE PROGRAM PAPERWORK BURDEN DISCLOSURE NOTICE Public reporting burden for this form is estimated to average 4 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 the form* You are not required to submit 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 the burden to Information Collections Management Department of Homeland Security Federal Emergency Management Agency 500 C Street SW Washington DC 20472 and Paperwork Reduction Project 1660-0004. NOTE Do not send your completed form to this address. DATE 1. APPLICANT COMMUNITY NAME City town etc* COUNTY STATE 2. COMMUNITY OFFICIAL - CHIEF EXECUTIVE OFFICER CEO E-MAIL ADDRESS TELEPHONE NO. Include area code ADDRESS Street or box no. city state zip code 3. PROGRAM COORDINATOR Official if different from above with overall responsibility for implementing program LOCATION OF COMMUNITY REPOSITORY FOR PUBLIC INSPECTION OF NFIP MAPS ADDRESS 5. ESTIMATES FOR THOSE AREAS PRONE TO FLOOD AND/OR MUDSLIDE AS OF THE DATE OF THIS APPLICATION AREA IN ACRES NO. OF 1-4 FAMILYSTRUCTURES POPULATION NO. OF ALL OTHER STRUCTURES 6. ESTIMATES OF TOTALS IN ENTIRE COMMUNITY 7. FOR FEMA REGIONAL USE ONLY 1. FEMA REGIONAL OFFICE 2. NAME OF CONTACT 4. LEVEL OF 44 CFR 60. 3 REGULATION ADOPTED Check one 60. DEPARTMENT OF HOMELAND SECURITY FEDERAL EMERGENCY MANAGEMENT AGENCY O. M. B. NO. 1660-0004 Expires March 31 2011 APPLICATION FOR PARTICIPATION IN THE NATIONAL FLOOD INSURANCE PROGRAM PAPERWORK BURDEN DISCLOSURE NOTICE Public reporting burden for this form is estimated to average 4 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 the form* You are not required to submit to this collection of information unless it displays a valid OMB control number. 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* You are not required to submit 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 the burden to Information Collections Management Department of Homeland Security Federal Emergency Management Agency 500 C Street SW Washington DC 20472 and Paperwork Reduction Project 1660-0004.

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