U.S. Department of Homeland Security 500 C Street, SW Washington, DC 20472 W-10052 May 7, 2010 MEMORANDUM FOR: Write Your Own (WYO) Principal Coordinators and the National Flood Insurance Program (NFIP) Servicing Agent FROM: Jim Sadler Director of Claims National Flood Insurance Program SUBJECT: Substantially Damaged Structures On April 30, 2010 and continuing, the 2010 Late Spring Storms produced torrential rains which caused moderate to extensive flood damage to residential and commercial properties in the state of Tennessee. FICO 257 has been established to track this event. Early reports indicate that substantially damaged property may result. Please ensure that your claims adjusters follow the guidelines below. Their cooperation will help expedite the community officials’ determination of substantially damaged buildings. • It is mandatory for adjusters to continue to report the statistics promptly. • After conducting the inspection of the building and identifying it as possibly meeting the criteria for substantial damage, the adjuster is required to enter the information for that building on the attached “Adjuster Preliminary Damage Assessment” (APDA) form. An interactive version of this form is available on the FEMA web site at http://www.fema.gov/library/viewRecord.do?id=2580. The form will continue to be used to capture critical information during the adjustment phase. • Even though the form allows entries for two separate policies, adjuster should not hold the form while awaiting additional or final claims information. The form must be submitted to the NFIP Bureau and Statistical Agent as soon as the information is completed for a single policy. • Adjusters are required to submit daily reports of possible substantially damaged properties to the NFIP Bureau and Statistical Agent by fax at (301) 577-3421, email to iservice_claims@ostglobal.com, or by mail to P.O. Box 310, Lanham, MD 20706. • There may be buildings that were damaged in previous flood events. Adjusters should be aware of pre-existing damage and ask specific questions regarding repairs of this damage. Receipts and invoices to support prior repairs may be needed if there are questions. In previous flood events there were many substantially damaged buildings. The adjuster should Substantially Damaged Structures May 7, 2010 Page 2 be aware that these buildings should now be Post-FIRM and in compliance with the community’s floodplain management law and ordinance. Any questions should be referred to the Company. We recognize the formidable job that community officials have in handling the substantial damage issue. In many instances, they must survey widespread areas of damage with limited resources. However, by observing the guidelines above, adjusters can help us provide community officials with timely, accurate information that will allow them to make expeditious determinations of substantially damaged buildings. We ask for your full support. If there are any questions, please contact the NFIP Bureau and Statistical Agent Claims Department. Attachment cc: Vendors, IBHS, FIPNC, and Government Technical Representative Required Routing: Claims and Underwriting www.fema.gov DEPARTMENT OF HOMELAND SECURITY FEDERAL EMERGENCY MANAGEMENT AGENCY ADJUSTER PRELIMINARY DAMAGE ASSESSMENT NATIONAL FLOOD INSURANCE PROGRAM O.M.B. No. 1660-0005 Expires September 30, 2010 Privacy Act Statement The information requested is necessary to process the subject loss. The authority to collect the information is Title 42, U.S. Code, Sectin 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 enabel 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 nonduplication of benefits; to the Department of Justice for purposes of litigation or as required by law; and to State and Local 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 this form is estimated to average 15 minutes per response. The burden estimate includes the time, effort or financial resources expended by persons to generate, maintain, retain, disclose, or provide information to the Mitigation Division or its agent. 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. Send completed forms to: NFIP Bureau & Statistical Agent, Certification Coordinator, P.O. box 310 , Lanham, MD 20703-0310. WYO COMPANY DATE OF LOSS ADJUSTER FICO NUMBER This form is to be used for advisory purposes in helping FEMA and communities identify potential substantially damaged buildings. The adjuster will use "replacement cost" when completing this form; however, the community is required under the National Flood Insurance Program to use "market value" in determining substantial damage. PLEASE PRINT LEGIBLY POLICY HOLDER POLICY NUMBER PROPERTY ADDRESS (include zip code) **PROBABLE REPAIR COST BUILDING REPLACEMENT COST VALUE $ BUILDING ACTUAL CASH VALUE $ POLICY HOLDER POLICY NUMBER PROPERTY ADDRESS (include zip code) **PROBABLE REPAIR COST BUILDING REPLACEMENT COST VALUE $ BUILDING ACTUAL CASH VALUE $ POLICY HOLDER POLICY NUMBER PROPERTY ADDRESS (include zip code) **PROBABLE REPAIR COST BUILDING REPLACEMENT COST VALUE $ BUILDING ACTUAL CASH VALUE $ **This is an estimate of the cost to repair the building to its pre-flood condition. FEMA Form 81-109, OCT 07 REPLACES ALL PREVIOUS EDITIONS. F-674 Privacy 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 81-40 Worksheet-Contents-Personal Property 2.5 Hours 81-41 Worksheet-Building 2.5 Hours 81-41A Worksheet-Building (Cont'd) 1.0 Hours 81-42 Proof of Loss .08 Hours 81-42A Increased Cost of Compliance 2.0 Hours 81-43 Notice of Loss .07 Hours 81-44 Statement as to Full Cost to Repair or Replacement .10 Hours Cost Coverage, Subject to the Terms and Conditions of this Policy 81-57 National Flood Insurance Program Preliminary Report .07 Hours 81-58 National Flood Insurance Program Final Report .07 Hours 81-59 National Flood Insurance Program Narrative Report .08 Hours 81-63 Cause of Loss and Subrogation Report 1 Hour 81-96 Manufactured (Mobile) Home/Travel Trailer Worksheet .50 Hours 81-96A Mobile Home/Travel Trailer Worksheet (Continued) .25 Hours 81-98 Increased Cost of Compliance (ICC) Adjuster Report .42 Hours 81-109 Adjuster Preliminary Damage Assessment .25 Hours 81-110 Adjuster Certification Application .25 Hours