U.S. Department of Homeland Security 500 C Street, SW Washington, DC 20472 Fema_for_Word W-09057 October 6, 2009 MEMORANDUM FOR: Write Your Own (WYO) Principal Coordinators and the NFIP Servicing Agent for Dissemination to all Claims Managers FROM: James A. Sadler, CPCU, AIC Director of Claims National Flood Insurance Program SUBJECT: Substantially Damaged Structures On September 16, 2009, and continuing, torrential rains caused moderate to extensive flood damage to residential and commercial properties in the state of Georgia. 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. 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. Substantially Damaged Structures September 27, 2009 Page 2 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 NATIONAL FLOODINSURANCE PROGRAM DEPARTMENT OF HOMELAND SECURITYFEDERAL EMERGENCY MANAGEMENT AGENCYADJUSTER PRELIMINARY DAMAGE ASSESSMENT O.M.B. No. 1660-0005Expires September 30, 2010 Privacy Act StatementThe 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 isvoluntary on your part to furnish the information. However, omission of an item may preclude processing of the form. The information will not be disclosed outsideof the Federal Emergency Management Agency, except to the servicing agent, acting as the government's fiscal agent; to claims adjusters to enabel them to confirmcoverage and the location of insured property; to certain Federal, State, and Local Government agencies for determining eligibility for benefits and for verification ofnonduplication 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 byyou 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 NoticePublic reporting burden for this form is estimated to average 15 minutes per response. The burden estimate includes the time, effort or financial resources expendedby 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 ofinformation unless a currently valid OMB control number and expiration date is displayed in the upper right corner of the these forms. Send comments regarding theaccuracy of the burden estimate and suggestions for reducing the burden to: Information Collections Management, Department of Homeland Security, FederalEmergency Management Agency, 500 C Street, S.W., Washington, DC 20472, Paperwork Reduction Project (1660-0005). NOTE: Do not send your completedform to this address. Send completed forms to: NFIP Bureau & Statistical Agent, Certification Coordinator, P.O. box 310 , Lanham, MD 20703-0310. WYO COMPANY ADJUSTER DATE OF LOSS 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" indetermining 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 07REPLACES ALL PREVIOUS EDITIONS.F-674 Privacy Act StatementThe information requested is necessary to process the subject loss. The authority to collect the information is Title 42, U.S. Code, Section 4001 to4028. It is voluntary on your part to furnish the information. However, omission of an item may preclude processing of the form. The informationwill 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 Governmentagencies for determining eligibility for benefits and for verification of agencies for acquisition and relocation-related projects, consistent with theNational Flood Insurance Program and consistent with the routine uses described in the program's system of record. Failure by you to provide someor all of the information may result in delay in processing or denial of this claim and/or application. PAPERWORK BURDEN DISCLOSURE NOTICEPublic reporting burden for the collection of information titled Claims for National Flood Insurance Program (NFIP) is estimated to average 6 hoursper response. The burden estimate includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the dataneeded, and completing and submitting these forms. You are not required to respond to this collection of information unless a currently valid OMBcontrol number and expiration date is displayed in the upper right corner of the these forms. Send comments regarding the accuracy of the burdenestimate and suggestions for reducing the burden to: Information Collections Management, Department of Homeland Security, Federal EmergencyManagement Agency, 500 C Street, S.W., Washington, DC 20472, Paperwork Reduction Project (1660-0005). NOTE: Do not send yourcompleted form to this address. FEMA Form No. TitleBurden Hours81-40 Worksheet-Contents-Personal Property 2.5 Hours81-41 Worksheet-Building 2.5 Hours81-41A Worksheet-Building (Cont'd) 1.0 Hours81-42 Proof of Loss .08 Hours81-42A Increased Cost of Compliance 2.0 Hours81-43 Notice of Loss .07 Hours81-44 Statement as to Full Cost to Repair or Replacement .10 HoursCost Coverage, Subject to the Terms and Conditionsof this Policy81-57 National Flood Insurance Program Preliminary Report .07 Hours81-58 National Flood Insurance Program Final Report .07 Hours81-59 National Flood Insurance Program Narrative Report .08 Hours81-63 Cause of Loss and Subrogation Report 1 Hour81-96 Manufactured (Mobile) Home/Travel Trailer Worksheet .50 Hours81-96AMobile Home/Travel Trailer Worksheet (Continued).25 Hours81-98 Increased Cost of Compliance (ICC) Adjuster Report .42 Hours81-109Adjuster Preliminary Damage Assessment.25 Hours81-110Adjuster Certification Application.25 Hours