**CHAPTER 27**

**FLOOD INSURANCE PROTECTION**

1.  [PURPOSE]{.underline}*.* The purpose of this Chapter is to provide
    guidance on monitoring to verify the program participant's
    compliance with the legal requirements of Sections 102(a) and 202(a)
    of the Flood Disaster Protection Act of 1973 as amended, and Sec.
    582(a) of the National Flood Insurance Reform Act of 1994.
    Monitoring ensures that Federal investments are properly safeguarded
    and that property owners are obtaining the benefit and protection of
    flood insurance as mandated by the law for buildings located in
    Special Flood Hazard Areas (SFHAs). *Program participant* means a
    unit of general local government, State, or entity that provides
    Federal financial assistance to a property owner for acquisition or
    construction (including rehabilitation) purposes for a building
    located within the SFHA.

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A.  [Section 102(a)]{.underline} mandates the purchase of flood
    insurance protection for a prescribed period of time and dollar
    amount for any assisted SFHA building. The only exception is for
    State-owned property that is covered by an adequate State policy of
    self-insurance satisfactory to the Director of the Federal Emergency
    Management Agency (FEMA), who must publish a list of any such
    covered States. **Flood insurance must be purchased when any form of
    Federal financial assistance is intended in whole or in part for the
    acquisition, construction, reconstruction, repair, or improvement of
    any publicly or privately owned building or mobile home located
    within a SFHA, and for any machinery, equipment, fixtures, and
    furnishings contained or to be contained therein.**

    B. [Section 202(a)]{.underline} prohibits Federal financial
    assistance to any SFHA building located within a community suspended
    from, withdrawn from, or otherwise not participating in the National
    Flood Insurance Program (NFIP).

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C.  [Section 582(a)]{.underline} mandates that HUD flood disaster
    assistance that is made available in a SFHA may not be used to make
    a payment (including any loan assistance payment) to a person for
    repair, replacement or restoration for flood damage to any personal,
    residential or commercial property if: (1) the person had previously
    received Federal flood disaster assistance conditioned on obtaining
    and maintaining flood insurance; and (2) that person failed to
    obtain and maintain flood insurance as required under applicable
    Federal law on such property.

    27-2 [APPLICABILITY]{.underline}*.* The monitoring procedures
    outlined in this section apply to

    any form of financial assistance made under CPD Programs except
    State-

    administered formula grant programs. Attachment 27-1 provides a list
    of HUD programs covered for flood insurance protection under 24 CFR
    58.6(a) and (b) and the corresponding program regulatory or other
    reference. These procedures apply [only]{.underline} to program
    participants that have provided financial assistance for acquisition
    or construction purposes for buildings located within Special Flood
    Hazard Areas (hereafter "assisted SFHA buildings"). Sec. 3(a)(3) of
    the Act defines the term "financial assistance" to mean "...any form
    of loan, grant, guaranty, insurance, payment, rebate, subsidy,
    disaster assistance loan or grant, or any other form of direct or
    indirect Federal assistance, other than general or special revenue
    sharing or formula grants made to States." Sec. 3(a)(4) of the Act
    defines the term "financial assistance for acquisition or
    construction purposes" to mean "...any form of financial assistance
    which is intended in whole or in part for the acquisition,
    construction, reconstruction, repair, or improvement of any publicly
    or privately owned building or mobile home, and for any machinery,
    equipment, fixtures, and furnishings contained or to be contained
    therein, and shall include the purchase or subsidization of
    mortgages or mortgage loans but shall exclude assistance pursuant to
    the Disaster Relief Act of l974 (other than assistance under such
    Act in connection with a flood);..."

    Program participants should **[not]{.underline}** be selected for
    monitoring for flood insurance compliance under any of these
    circumstances:

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A.  There is no Special Flood Hazard Area within the program
    participant's jurisdiction;

    B. By its own stated public policy, the program participant does not
    provide HUD financial assistance to SFHA buildings;

    C. Based on pre-monitoring preparation by the CPD Representative
    (see Section 27-6), the program participant's evidence of compliance
    included acceptable documentation (see Section 27-5) and the program
    participant identified no assisted SFHA building for which a current
    [Policy Declarations]{.underline} form (or a paid receipt for the
    annual flood insurance premium and a copy of the application for
    flood insurance) was lacking; or

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D.  If the program participant is a State administering funds under any
    of the following HUD grant programs: (1) Community Development Block
    Grant Program (CDBG) pursuant to an allocation under Section 106(d)
    of the Housing and Community Development Act of 1974; (2) HOME
    Investment Partnerships Program (HOME); (3) Emergency Shelter Grant
    Program (ESG); (4) Housing Opportunities for Persons with AIDS
    (HOPWA); and (5) Project-based Section 8 Rental Assistance Program.
    These HUD formula grants made to States are not subject to the
    requirements of Sections 102(a) and 202(a) of the Act.

    Flood insurance protection is required [only]{.underline} in SFHAs
    as designated officially on Flood Insurance Rate Maps (FIRMs) issued
    by FEMA for purposes of NFIP. Although citations to the Federal laws
    authorizing flood insurance protection appear in HUD environmental
    regulations at 24 CFR 50.4(b)(1), 58.6(a) and (b), this Chapter for
    monitoring compliance with flood insurance protection is not to be
    confused with guidance provided in Chapter 21 of this Handbook for
    monitoring compliance with environmental procedures under 24 CFR
    Parts 50 and 58.

    27-3 [RESPONSIBILITY]{.underline}*.* CPD Representatives for CPD
    Programs have the responsibility for monitoring flood insurance
    protection. Attachment 27-1 lists the covered programs. As part of a
    monitoring strategy, it may be most practicable to combine a review
    for compliance with flood insurance protection when monitoring any
    form of financial assistance for the acquisition, construction,
    reconstruction, repair, or improvement of SFHA buildings. Reviewers
    are to follow selection criteria and risk analysis procedures for
    selecting program participants to monitor (see Section 27-4). Field
    and Regional Environmental Officers are responsible for providing
    flood insurance oversight for their assigned service area and are to
    provide training to HUD program staff and program participants. For
    efficient use of HUD staff and travel resources, HUD reviewers that
    visit Program Participants to perform on-site environmental
    monitoring under Chapter 21 are also to perform the monitoring for
    flood insurance protection, if the selection criteria and risk
    analysis warrant such monitoring.

    27-4 [SELECTION CRITERIA AND RISK ANALYSIS]{.underline}*.* In
    selecting program participants to be monitored for flood insurance
    compliance, CPD Field Offices should focus their attention on
    assisted SFHA buildings lacking, or possibly lacking, flood
    insurance protection based on news reports and other available
    information. Section 27-2 lists the program participants that should
    **not** be selected for monitoring. Priority should be given to
    program participants whose assisted SFHA buildings are affected by
    any of these circumstances that occurred since the previous HUD
    onsite monitoring.

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A.  FEMA has provided public notice that the program participant is no
    longer in good standing in the NFIP (i.e., suspended from program
    eligibility or placed on probation under 44 CFR 59.24) or otherwise
    is not participating in the NFIP. Reviewers are to verify that no
    Federal assistance was provided to SFHA buildings during the
    sanction or non-participation period. Information on a community's
    status is available from the FEMA Regional Office or from the NFIP
    "Community Status Book" on-line at:
    <http://www.fema.gov/fema/csb.shtm>.

    B. Flooding damage to the program participant's assisted SFHA
    buildings was experienced; or HUD disaster assistance was provided
    to the program participant to assist recovery from flooding damage
    under a Presidential declaration of emergency;

    C. The program participant's form HUD 7015.15 approved by HUD
    contained copies of floodplain management notices reporting that the
    program participant assisted buildings located within the
    floodplain. Reviewers are to verify whether the program participant
    complied with flood insurance protection for these buildings. For
    further information, see Exhibit 21-4, "Guide for Review of
    Floodplains and Wetlands," Question 6(e), regarding compliance with
    NFIP standards;

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D.  HUD has been advised, or is aware, of an unresolved complaint or
    litigation in connection with the program participant's flood
    insurance compliance; or

    E. The program participant took no corrective action on the flood
    insurance finding(s) made during a previous monitoring; or the
    corrective action taken is either in dispute or not yet completely
    implemented.

    27-5 [DOCUMENTATION]{.underline}*.* Monitoring should focus on the
    evidence documenting the **"proof of purchase"** of flood insurance
    protection and the program participant's compliance with Sections
    102(a), 202(a), and 582(a). The program participant should have
    easily accessible information on the status of flood insurance
    protection for assisted SFHA buildings as prescribed for the
    statutorily-mandated amount and duration of coverage. The standard
    documentation for compliance with Section 102(a) is
    **[either]{.underline}** a paid receipt for the current annual flood
    insurance premium and a copy of the application for flood insurance
    **[or]{.underline}** a copy of the current [Policy
    Declarations]{.underline} form (see Attachment 27-2) issued by the
    NFIP or issued by any property insurance company offering coverage
    under the NFIP. The insured has its insurer automatically forward to
    the program participant, in the same manner as to the insured,
    information copies of the [Policy Declarations]{.underline} form for
    verification of compliance with the Act.[^1] Any financially
    assisted SFHA building lacking **[either]{.underline}** a paid
    receipt for the current annual flood insurance premium and a copy of
    the application for flood insurance **[or]{.underline}** a copy of a
    current [Policy Declarations]{.underline} form is in noncompliance.

    Any obligations for compliance with Sections 102(a), 202(a), and
    582, and for monitoring such compliance remaining as of the date of
    the closeout of a grant shall be covered and enforced by HUD and the
    program participant after the grant closeout by the terms of a
    closeout agreement. The agreement shall be prepared by the CPD field
    office in consultation with the program participant. The agreement
    shall identify the grant being closed out, and include provisions
    with respect to ensuring that flood insurance coverage for the
    affected property owners is maintained for the mandatory period and
    amount. This responsibility applies to **all** HUD grant programs
    that provide financial assistance to SFHA buildings. (See Exhibit
    27-1, Question 12.) To enforce this responsibility, some HUD grant
    programs have highlighted this responsibility in their own program
    regulations, e.g., 24 CFR 570.509(c)(4)(iv) and 24 CFR
    92.508(a)(7)(iii). The grant agreement and recipient records are to
    be monitored for compliance with the flood purchase insurance
    requirements after the effective date of a grant closeout agreement.
    For duration of flood insurance coverage, see Section 27-8,
    "Verifying the Duration and Dollar Amount of Coverage."

    27-6 [PRE-MONITORING PREPARATION]{.underline}*.* Prior to conducting
    monitoring, the CPD Representative is to:

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A.  Advise the program participant to have available a copy of the
    current [Policy]{.underline} [Declarations]{.underline} form (or a
    paid receipt for the current annual flood insurance premium and a
    copy of the application for flood insurance) for every assisted SFHA
    building and to identify any assisted buildings for which a current
    [Policy Declarations]{.underline} form (or a paid receipt for the
    current annual flood insurance premium and a copy of the application
    for flood insurance) is lacking;

B.  Request the Field Environmental Officer (FEO) to provide: (1) copies
    of the current Flood Insurance Rate Maps (FIRMs) covering the
    program participant's jurisdiction; (2) the current status of the
    community's participation in the NFIP (if FEMA has sanctioned the
    community, obtain information on the period of time covering the
    community's suspension from or non-participation in the NFIP); (3)
    information on assisted SFHA buildings available from public notices
    (or other sources) such as floodplain notices attached to field
    office processed form HUD-7015.15 \[see Exhibit 21-4, Guide for
    Review of Floodplains and Wetlands, Question 6(e)\]; and (4)
    guidance on the use of these data for preparing and performing
    monitoring. When FEO assistance is unavailable, check the following
    FEMA resources: for FIRMs, see
    [www.fema.gov/hazard/map/firm.shtm](http://www.fema.gov/hazard/map/firm.shtm);
    and for community status, see <http://www.fema.gov/fema/csb.shtm>;

    C. Review the program participant's evidence of compliance with
    flood insurance protection (see Section 27-5);

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D.  Review the Flood Insurance Rate Maps (FIRMs) covering the area of
    the program participant's HUD-assisted activities for the location
    of any SFHA boundaries to determine which, if any, of the program
    participant's HUD assisted activities and projects are located
    within the SFHA for the purpose of monitoring for compliance with
    Sections 102(a) and 202(a); and

    E. Review the program participant's receipt and use of HUD disaster
    assistance for recovery from flooding damage under a Presidential
    declaration of emergency for the purpose of monitoring for
    compliance with Section 582 (see 24 CFR 58.6(b)). Program
    participants' Consolidated Plan Action Plan and the form HUD 7015.15
    are both approved by HUD and provide information on the program
    participants' use of HUD *flood disaster* assistance.

    7.  [CONDUCTING MONITORING]{.underline}*.* To monitor for
        compliance, the CPD Representative is to use Exhibit 27-1, Guide
        for Review of Flood Insurance Protection. This Exhibit can also
        be used for remote monitoring particularly where the program
        participant's past performance demonstrated compliance and, for
        current performance, the program participant provided HUD with
        evidence of compliance that included the current Policy
        Declarations form (or the paid receipt for the current annual
        flood insurance premium and the copy of the application for
        flood insurance) for all financially assisted SFHA buildings in
        accordance with Sections 27-5 and 27-6.

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A.  [Section 102(a).]{.underline} Reviewers should verify that there is
    **either** a paid receipt for the current annual flood insurance
    premium and a copy of the application for flood insurance, **or** a
    copy of the current [Policy Declarations]{.underline} form (see
    Attachment 27-2) for every assisted SFHA building in accord with the
    coverage prescribed by Section 102(a) of the Act. For determining
    the prescribed coverage, see Section 27-8, "Verifying the Duration
    and Dollar Amount of Coverage."

    B. [Section 202(a).]{.underline} Reviewers should verify whether the
    program participant provided HUD financial assistance to any
    buildings or mobile homes located within an SFHA, and for any
    machinery, equipment, fixtures, and furnishings contained or to be
    contained therein during any period when FEMA had provided public
    notice that the program participant's community is no longer in good
    standing in the NFIP (i.e., suspended from program eligibility or
    placed on probation under 44 CFR 59.24), or otherwise is not
    participating in the NFIP.

    C. [Section 582.]{.underline} Reviewers should verify that HUD
    disaster assistance was not made available in an SFHA to make a
    payment (including any loan assistance payment) to a person for
    repair, replacement or restoration for flood damage to any personal,
    residential or commercial property if: (1) the person had previously
    received Federal flood disaster assistance conditioned on obtaining
    and maintaining flood insurance; and (2) the person failed to obtain
    and maintain flood insurance.

    27-8 [VERIFYING THE DURATION AND DOLLAR AMOUNT OF
    COVERAGE]{.underline}*.* Reviewers are to examine a representative
    sample of **either** paid receipts for the current annual flood
    insurance premium and copies of the application for flood insurance
    **or** [Policy Declarations]{.underline} forms to verify compliance
    with the statutorily prescribed period and dollar amount of flood
    insurance coverage. For program participants who by their own stated
    public policy provide HUD financial assistance to SFHA buildings,
    the representative sample must cover at least the SFHA buildings
    that received HUD assistance since the previous on-site monitoring.
    [On-site verification may be substituted by a well organized and
    completed set of data prepared in accordance with Sections 27-5 and
    27-6 and supplied to HUD by the program participant upon request of
    the field office. For example, reviewers can make such a request
    when they are doing pre-monitoring preparations discussed at 27-6.
    If a program participant provides a well-organized and completed set
    of data that demonstrates compliance with flood insurance
    protection, the monitor may decide to make its finding on that
    submission alone.]{.underline}

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A.  [Duration of Flood Insurance Coverage.]{.underline} The statutory
    period for flood insurance coverage may extend beyond project
    completion. For loans, loan insurance or a guaranty of a loan, flood
    insurance coverage must be continued for the term of the loan. For
    grants and other forms of financial assistance, the requirement for
    maintaining flood insurance shall apply during the life of the SFHA
    building, regardless of transfer of ownership of such property.

    B. [Dollar Amount of Flood Insurance Coverage.]{.underline} For
    loans, loan insurance or a guaranty of a loan, the amount of flood
    insurance coverage need not exceed the outstanding principal balance
    of the loan and may not exceed the maximum limit of coverage made
    available by the National Flood Insurance Act (NFIA) with respect to
    the particular type of building involved (SF-Single Family; OR-Other
    Residential; NR-Non-Residential; or SB-Small Business). For grants
    and other forms of financial assistance, the amount of flood
    insurance coverage must be at least equal to the development or
    project cost (less estimated land cost) or to the maximum limit of
    coverage made available by the NFIP with respect to the particular
    type of building involved, whichever is less. The total cost
    (Federal and nonfederal) of the Federally assisted project for
    acquiring, constructing, reconstructing, repairing, or improving the
    building is used to determine the dollar amount of flood insurance
    coverage. If the Federal assistance is used for any portion of the
    cost of any machinery, equipment, fixtures or furnishings, the
    [total]{.underline} cost of such items must also be covered by flood
    insurance as a condition of approval of HUD assistance.

    27-9 [RESOLVING FINDINGS OF NONCOMPLIANCE]{.underline}*.*
    Non-compliance with Section 102(a), Section 202(a), or Section
    582(a) is a finding for which specific corrective action is
    authorized. Corrective or remedial actions to resolve the finding
    may include an offer to provide technical assistance to the program
    participant's staff.

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A.  [Section 102(a).]{.underline} If the program participant has failed
    either to require flood insurance protection for an assisted SFHA
    building or to comply with the statutorily-prescribed period or
    dollar amount, a finding must be made and the program participant
    advised to correct the deficiency by a certain date. Such findings
    may be resolved by submitting **either** a current [Policy
    Declarations]{.underline} form **or** a paid receipt for the current
    annual flood insurance premium and a copy of the application for
    flood insurance for any assisted SFHA building that is not in
    compliance. Where applicable, apprise the program participant that
    certain insurance costs may be eligible expenses under the HUD
    assistance program and the program participant may wish to use such
    funds to help meet those costs.

    B. [Section 202(a).]{.underline} If the program participant was
    suspended from or not participating in the NFIP, during which period
    the program participant provided financial assistance to an SFHA
    building, make a finding, advise the program participant of the
    statutory prohibition, offer technical assistance, and take
    appropriate action in accordance with the applicable program policy
    for non-compliance.

    C. [Section 582(a).]{.underline} If the program participant failed
    to deny HUD disaster

    assistance in a Special Flood Hazard Area to make a payment
    (including any

    loan assistance payment) to a person for repair, replacement or
    restoration for

    flood damage to any personal, residential or commercial property
    where

    \(1\) the person had previously received Federal flood disaster
    assistance conditioned on obtaining and maintaining flood insurance;
    and

    \(2\) the person failed to maintain flood insurance:

    make a finding, advise the program participant of the statutory
    prohibition, offer technical assistance, and take appropriate action
    in accordance with the applicable program policy for non-compliance.

27-10 [POST-MONITORING ACTIONS.]{.underline} Copies of monitoring
letters for flood insurance protection and completed Exhibits are to be
provided to the Field Environmental Officer for oversight evaluation,
for providing follow-up training for HUD program participants, and for
resolution of any outstanding issues.

27-11 [CHAPTER ATTACHMENTS AND EXHIBIT.]{.underline} This Chapter
contains a single Exhibit and three attachments to assist HUD reviewers
in monitoring for flood insurance protection. Evidence of noncompliance
with Sections 102(a) or 202(a) of the Flood Disaster Protection Act or
Section 582(a) of the National Flood Insurance Reform Act of 1994
requires the monitor to make a Finding.

A. Attachment 27-1, "List of Covered Programs". This Attachment lists
the programs subject to this Handbook that are covered by the statutory
requirements as referenced in HUD's regulatory provisions at 24 CFR
50.4(b)(1), 58.6(a) and (b). The list identifies the name of the program
and the regulation citation. The term "covered programs" applies to the
CPD programs listed in Section 1-3 of this Handbook and for which field
offices are responsible for program monitoring.

B.  Attachment 27-2, "Sample Form of the National Flood Insurance
    Program -- Policy Declarations." This Attachment provides an example
    of a proof of purchase for national flood insurance. The [Policy
    Declarations]{.underline} form is also referred to as "policy dec"
    page or renewal declarations, or renewal certificate. The insurer
    issues the [Policy Declarations]{.underline} form when the insured
    "renews" an existing flood insurance policy. NFIP follows the
    insurance industry practice: the supporting documents for proof of
    insurance or evidence of compliance are ***either*** a paid receipt
    for the annual flood insurance premium and a copy of the flood
    insurance application ***or*** a copy of the [Policy
    Declarations]{.underline} form. This statutory requirement is
    explained in the Flood Insurance Manual "General Rules" Section page
    GR8 available at <http://www.fema.gov/business/nfip/manual.shtm>.

C.  Attachment 27-3, "Sample Application for National Flood Insurance."
    This attachment provides HUD reviewers with a sample flood insurance
    application. In lieu of the [Policy Declarations]{.underline} form,
    the insured may submit to the program participant a paid receipt for
    the flood insurance premium and a copy of the flood insurance
    application. The attachment also highlights a box (see Attachment
    27-3A) that appears on the Sample Application that pertains to
    program participants' receipt of flood insurance renewal and
    expiration notices from the insurer.

D.  Exhibit 27-1, "Guide for Review of Flood Insurance Protection:" This
    Exhibit is to be used for monitoring the program participant's
    compliance with the legal requirements of Sections 102(a) and 202(a)
    of the Flood Disaster Protection Act of l973 as amended, and Section
    582(a) of the National Flood Insurance Reform Act of l994.
    Monitoring ensures that Federal investments are properly safeguarded
    and that property owners are obtaining the benefit and protection of
    flood insurance as mandated by the law for buildings located in
    Special Flood Hazard Areas.

+-----------------------+----------------------------------------------+
| **List of Covered     |                                              |
| Programs**            |                                              |
+-----------------------+----------------------------------------------+
| **CPD Program**       | **Flood Insurance Reference**[^2]            |
+-----------------------+----------------------------------------------+
| Community Development | 24 CFR 570.605, National Flood Insurance     |
| Block Grant (CDBG)    | Program                                      |
| Entitlement, Small    |                                              |
| Cities, Insular Areas | 24 CFR 570.604, Environmental Standards      |
|                       |                                              |
|                       | 24 CFR 570.202(b)(7)(iii), Types of          |
|                       | Assistance (Flood Insurance Premiums)        |
|                       |                                              |
|                       | 24 CFR 570.509(c)(4)(iv), Grant Closeout     |
|                       | Procedures                                   |
+-----------------------+----------------------------------------------+
| Section 108 Loan      | 24 CFR 570.707                               |
| Guarantees            |                                              |
+-----------------------+----------------------------------------------+
| Economic Development  | 24 CFR 570.605                               |
| Initiative (EDI-SP)   |                                              |
| Grants                |                                              |
+-----------------------+----------------------------------------------+
| Brownfield Economic   | 24 CFR 570.605                               |
| Development           |                                              |
| Initiative Grants     |                                              |
+-----------------------+----------------------------------------------+
| Emergency Shelter     | 24 CFR 576.57(e), Environmental Review       |
| Grants (ESG)          | Responsibilities                             |
+-----------------------+----------------------------------------------+
| Empowerment Zones     | 24 CFR 598.405, Environmental Review         |
| (EZ) Round Two        |                                              |
+-----------------------+----------------------------------------------+
| HOME Investment       | 24 CFR 92.352, Environmental Review          |
| Partnerships Program  |                                              |
| (HOME)                | 24 CFR 92.508(a)(7)(iii), Record Keeping     |
+-----------------------+----------------------------------------------+
| Housing Opportunities | 24 CFR 574.640, Flood Insurance Protection   |
| for People with AIDS  |                                              |
| (HOPWA)               |                                              |
+-----------------------+----------------------------------------------+
| Section 8 Moderate    | 24 CFR 882.804(c)                            |
| Rehabilitation Single |                                              |
| Room Occupancy (SRO)  |                                              |
+-----------------------+----------------------------------------------+
| Shelter Plus Care     | 24 CFR 582.230, Environmental Review         |
+-----------------------+----------------------------------------------+
| Supportive Housing    | 24 CFR 583.230, Environmental Review         |
+-----------------------+----------------------------------------------+
| Environmental Review  | 24 CFR 58.6(a) and (b)                       |
| Procedures for        |                                              |
| Entities Assuming HUD | 24 CFR 50.4(b)(1)                            |
| Environmental         |                                              |
| Responsibilities      |                                              |
+-----------------------+----------------------------------------------+
| ####### Rural         | 24 CFR 50.4(b)(1) & CPD Notice 06-09         |
|  Housing and Economic |                                              |
|                       |                                              |
| Development (RHED)    |                                              |
| Grants                |                                              |
+-----------------------+----------------------------------------------+

Attachment 27-2

Sample Form of the National Flood Insurance Program\*

POLICY DECLARATIONS

POLICY NUMBER FL2-0226-3478-1

**POLICY TERM** IS FROM: 04/20/05-04/20/06

12:01 A.M. TIME AT THE INSURED PROPERTY LOCATION.

PAYOR IS INSURED

[PROGRAM PARTICIPANT'S NAME AND ADDRESS]{.underline} [INSURED'S NAME AND
ADDRESS]{.underline}

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
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**[AMOUNT OF COVERAGE:]{.underline}** BUILDING: \$60,000 CONTENTS:
\$20,000

# [DESCRIPTION OF BUILDING AND CONTENTS]{.underline}

BUILDING: THREE OR MORE FLOORS WITH UNFINISHED BASEMENT

A SINGLE FAMILY RESIDENCE

CONTENTS: CONTENTS ON FIRST FLOOR AND ABOVE

# RATING DATA

COMMUNITY NAME: WATERTOWN, BOROUGH OF: COMMUNITY NUMBER: 420052

REGULAR PROGRAM--- ZONE A

BUILDING WAS CONSTRUCTED OR SUBSTANTIALLY IMPROVED PRIOR TO 5/16/77

[RATING]{.underline} -- COVERAGE IN HUNDREDS OF DOLLARS

BUILDING AND CONTENTS COVERAGE IN FORCE

\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*BASIC\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*ADDITIONAL\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*

[TOTAL]{.underline}

[COVERAGE]{.underline} [RATE]{.underline} [PREMIUM]{.underline}
[COVERAGE]{.underline} [RATE]{.underline} [PREMIUM]{.underline}
[PREMIUM]{.underline}

BLDG: 350 0.30 \-- \$105.00 250 0.20\-- \$50.00 \$155.00

CONT: 100 0.40 \-- \$40.00 100 0.15\-- \$15.00 \$55.00

[PROPERTY ADDRESS]{.underline} ANNUAL SUBTOTAL: \$210.00

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ EXPENSE
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ TOTAL PREMIUM PAID: \$255.00

## [INSURANCE AGENT'S NAME AND ADDRESS]{.underline}

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

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PROGRAM PARTICIPANT PROJECT NUMBER: 013 04884 THESE **DECLARATIONS ARE
AS** **OF** MARCH 2006.

\*Similar proof of purchase forms are issued by private-sector insurance
companies that are authorized to sell national flood insurance under the
FEMA "Write Your Own" Program. **[Note:]{.underline}** For the
convenience of monitors, bold lettering was added to the text for
certain key information data that reviewers are to review such as
"**policy term**," "**amount of coverage**," and "**declarations are as
of...**".

Sample Application for National Flood Insurance

![](media/image1.png){width="5.615354330708661in"
height="4.318110236220472in"}![](media/image2.png){width="2.58740157480315in"
height="1.2562992125984251in"}![](media/image3.wmf){width="5.625196850393701in"
height="3.6755905511811022in"}

See Attachment 27-3A for instructions

![](media/image4.wmf){width="5.875in"
height="2.2083333333333335in"}![](media/image5.wmf){width="5.875in"
height="2.2083333333333335in"}![](media/image6.wmf){width="5.875in"
height="2.1979166666666665in"}![](media/image6.wmf){width="5.875in"
height="2.1979166666666665in"}

Box from the Sample Application for National Flood Insurance

IF SECOND MORTGAGEE, LOSS PAYEE OR OTHER IS TO BE BILLED, THE

FOLLOWING MUST BE COMPLETE, INCLUDING NAME AND ADDRESS:

2^ND^ MORTGAGEE DISASTER AGENCY

LOSS PAYEE **1.** IF OTHER, PLEASE

SPECIFY

**2.** ATTN:

CONTACT NAME:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
E-MAIL:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**3.** LOAN NO:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

PHONE NO:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ FAX
NO:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

As discussed in Section 27-5, Documentation, the insured (i.e., the
property owner of the HUD assisted SFHA property) has its insurer (i.e.,
the National Flood Insurance Program (NFIP) or any property insurance
company offering coverage under the NFIP) automatically forward to the
program participant, in the same manner as to the insured, information
copies of the [Policy Declarations]{.underline} form issued for
verification of compliance with the Act.

If the SFHA property owner is purchasing flood insurance for the first
time, then a paid receipt for the annual flood insurance premium and a
copy of the application for flood insurance is documentation of
compliance, **only** if the above noted box is completed so that the
program participant is registered to automatically receive the same
notices of expiration and notices of renewal mailed to the SFHA property
owner.

Program participants and HUD staff monitoring program participants
should review the information contained in this box for completeness and
to determine whether the program participant is on record to receive, in
the same manner as the insured, notices of expiration and renewal of
flood insurance protection. This box is normally completed by the flood
insurance agent at the request of the applicant for flood insurance. In
the absence of a current [Policy Declarations]{.underline} form, the
program participant is to receive a copy of the paid receipt for the
annual flood insurance premium and a copy of the application for flood
insurance. Subsequent annual notices of any expiration and renewal of
flood insurance policy of the insured are mailed to the address shown in
this box. The numbers in Attachment 27-3A have been added to the box
copied from the sample application for flood insurance. These numbers
refer to corresponding paragraphs below, which discuss the type of
information that should appear next to each numbered item or as an
attachment to the application.

1.  A checkmark and the words "HUD Assistance" should appear as
    information for the box showing the sentence: "If other, please
    specify."

2.  The following information should appear in the address box.. Add the
    abbreviation "ATTN:" and provide the program participant's name,
    street address, and zip code; contact name and contact's e-mailing
    address.

3.  If the SFHA property owner received a loan, then the loan number
    would appear on the "loan no:" If the SFHA property owner received a
    grant, then the grant number would appear and the word "loan" would
    be replaced with the word "grant." Provide the phone and FAX numbers
    for the contact name.

[^1]: See Attachment 27-3A**.**

[^2]: The term "covered programs" applies to CPD programs listed in
    Section 1-3 of this Handbook and for which field offices are
    responsible for program monitoring.