APPLICATION FORMS FOR CONDITIONAL AND FINAL
LETTERS OF MAP AMENDMENT AND LETTERS OF MAP REVISION BASED ON FILL


General Background Information

In 1968, the U.S. Congress passed the National Flood Insurance Act, which created the National Flood Insurance 
Program (NFIP).  The NFIP was designed to reduce future flood losses through local floodplain management and to 
provide protection for property owners against potential losses through an insurance mechanism that allows a 
premium to be paid for the protection of those most in need.  The creation of the NFIP represented a major shift in 
Federal strategy from previous structural flood-control and disaster relief programs. 

As part of the agreement for making flood insurance available to a community, the NFIP requires the community to 
adopt floodplain management ordinances that meet certain minimum requirements intended to reduce future flood 
losses.  The community official or agency responsible for floodplain management in a community may be able to 
provide information that would be useful to a requester.  This official or agency usually is responsible for 
engineering, public works, flood control, or planning in the community as well.

Use of Application Forms

The Department of Homeland Security's Federal Emergency Management Agency (FEMA) implemented the use of 
application forms for requesting revisions or amendments to NFIP maps for two reasons.  First, because the forms 
provide a step-by-step process for requesters to follow and are comprehensive, requesters are assured of providing 
all of the necessary information to support their requests without having to go through an iterative process of 
providing additional information in a piecemeal fashion, which can result in a time-consuming and cost-intensive 
process.  Second, use of the forms ensures that the requesters' submissions are complete and more logically 
structured, and generally allows DHS-FEMA to complete its review in a shorter timeframe.

The application forms included in this package were designed to assist requesters (community officials, individual 
property owners, and others) in gathering the information DHS-FEMA needs to determine whether property (parcels 
of land or structures) is likely to be flooded during the flood event that has a 1-percent-annual-chance of being 
equaled or exceeded in any given year (base flood).  Lands that are at risk of being inundated by the base flood are 
called Special Flood Hazard Areas (SFHAs).

The forms in this package shall be used to request Letters of Map Amendment (LOMAs), Conditional Letters of 
Map Amendment (CLOMAs), Letters of Map Revision Based on Fill (LOMR-Fs), and Conditional Letters of Map 
Revision Based on Fill (CLOMR-Fs), as defined below.  Please note that not all of the forms apply to every request. 
Only those forms that apply to the request should be submitted.

LOMA	A letter from DHS-FEMA stating that an existing structure or parcel of land that has not 
been elevated by fill (natural grade) would not be inundated by the base flood.

CLOMA	A letter from DHS-FEMA stating that a proposed structure that is not to be elevated by fill 
(natural grade) would not be inundated by the base flood if built as proposed.

LOMR-F	A letter from DHS-FEMA stating that an existing structure or parcel of land that has been 
elevated by fill would not be inundated by the base flood.

CLOMR-F	A letter from DHS-FEMA stating that a parcel of land or proposed structure that will be 
elevated by fill would not be inundated by the base flood if fill is placed on the parcel as 
proposed or the structure is built as proposed.

If the request is being made for a LOMA to be issued on a single residential property, the MT-EZ form, entitled 
"Application Form for Single Lot or Structure, Amendments to National Flood Insurance Program Maps," may be 
used instead of the forms in this package.  This form is available in both an English and Spanish version.  Forms for 
this purpose may be downloaded from our website at http://www.fema.gov/plan/prevent/fhm/dl_mt-ez.shtm. 

The forms in this package and the form entitled "Application Form for Single Lot or Structure, Amendments to 
National Flood Insurance Program Maps," shall not be used in the following instances:

*	Requests involving changes in Base Flood Elevations (BFEs);

*	Requests involving changes in regulatory floodway boundary delineations;

*	Requests for properties in alluvial fan areas;

*	Requests involving property and/or structures that have been elevated by fill placed within the regulatory 
floodway, channelization projects, bridge/culvert replacement projects, or other flood control 
improvements; or

*	Requests involving changes in coastal high hazard areas (V zones).  

For such requests, the community must submit the request to DHS-FEMA in accordance with Title 44, Chapter I, 
Code of Federal Regulations (CFR), Part 65 of the NFIP regulations, which is available online at 
http://www.access.gpo.gov/nara/cfr/waisidx_02/44cfrv1_02.html, using the separately published MT-2 application 
forms package entitled "Application Forms and Instructions for Conditional Letters of Map Revision and Letters of 
Map Revision."  Forms for this purpose may be downloaded from our website at 
http://www.fema.gov/plan/prevent/fhm/dl_mt-2.shtm.  

Please note that the forms in this package may be used for property that has been inadvertently included in a V zone 
or the regulatory floodway.  However, if the property is to be removed from a V zone, it must not be located 
seaward of the landward toe of the primary frontal dune.

For additional assistance in completing these forms, you may consult the LOMA Tutorial, available on DHS-
FEMA's Internet site at: http://www.fema.gov/plan/prevent/fhm/ot_lmreq.shtm.  

Data Submission Requirements

In accordance with the NFIP regulations, DHS-FEMA will use the information provided by these application forms 
to make a determination on whether to remove property (parcel(s) of land or a structure(s)) from a designated 
SFHA.  In certain instances, additional data that are not referenced on these forms may be required.  A DHS-FEMA 
representative will notify the requester of any additional requirements.

Applicable Regulations

The regulations pertaining to LOMAs, CLOMAs, LOMR-Fs, and CLOMR-Fs are presented in Title 44, Chapter I, 
CFR, Parts 65 and 70, which is available online at http://www.access.gpo.gov/nara/cfr/waisidx_02/44cfrv1_02.html. 
The purpose of Part 70 is to provide an administrative procedure whereby DHS-FEMA will review information 
submitted by an owner or lessee of property who believes that their property has been inadvertently included in a 
designated SFHA.  Part 70 provides information about the technical difficulty of accurately delineating the SFHA 
boundaries on a NFIP map for a community.  Part 70 procedures shall not apply if the topography has been altered 
to raise the original ground to or above the BFE since the effective date of the first NFIP map [i.e., a Flood 
Insurance Rate Map (FIRM) or Flood Hazard Boundary Map] showing the property to be within the SFHA.  
Requests involving changes in topography (such as the placement of fill) are handled under the procedures described 
in Part 65.

Fee Requirements

Title 44, Chapter I, CFR, Part 72 of the NFIP regulations, which is available online at 
http://www.access.gpo.gov/nara/cfr/waisidx_02/44cfrv1_02.html, presents information regarding the reimbursement 
procedure initiated by DHS-FEMA to allow for the recovery of costs associated with the review of requests for 
CLOMAs, CLOMR-Fs, and LOMR-Fs via a review and processing fee.  There is no review and processing fee for 
requests for single/multiple, lot/structure LOMAs.

Revised fee schedules are published periodically, but no more than once annually, as a notice in the Federal 
Register. For the most up-to-date fee schedule, please contact the DHS-FEMA Map Assistance Center toll free at 1-
877-FEMAMAP (1-877-336-2627) or consult the DHS-FEMA Internet site at 
http://www.fema.gov/plan/prevent/fhm/frm_fees.shtm.

Payment must be submitted in the form of a check or money order, made payable in U.S. funds to the National 
Flood Insurance Program, or by credit card payment.  In addition, the requester must complete the Payment 
Information Form.  The payment should be mailed together with the application and supporting data to the address 
listed in the Address for Submitting Requests section of these instructions.

Basis of Determination

If no fill has been placed, DHS-FEMA's determination as to whether the SFHA designation may be removed from 
the structure(s) on a property will be based on a comparison of the BFE with the elevation of the Lowest Adjacent 
Grade to the structure (lowest ground touching the structure) including any attached decks or garage.  If fill has been 
placed, DHS-FEMA's determination will be based on a comparison of the BFE with the elevation of the lowest 
adjacent grade to the structure (lowest ground touching the structure) including any attached decks or garage and a 
completed Community Acknowledgment Form (see instructions for the Community Acknowledgment Form [Form 
3] for more information).

For DHS-FEMA to remove the SFHA designation from a legally defined property or portion of property that does 
not have a structure on it, the elevation of the lowest ground on the property must be at or above the BFE.

Please note the following special considerations that may affect DHS-FEMA's determination:

*	In areas of shallow/sheet flooding (Zone AO), the elevation of the Lowest Adjacent Grade (including deck 
posts) of the structure(s) must be above the surrounding grade by an amount equal to or greater than the depth 
shown on the NFIP map.  In addition, adequate drainage paths are required to guide floodwaters around and 
away from the structure(s); the structure(s) should be on an elevated pad within the Zone AO area.  With your 
application package, in addition to elevation information regarding the structure(s), provide a map showing 
the topographic data of the property and the immediate surrounding area, and the location of any structure(s) 
existing on the property (certified by a registered professional engineer or licensed land surveyor) to 
demonstrate that the above criteria have been met.

*	If the lowest floor of a building has been elevated on posts, piers, or pilings above the BFE and any portion of 
the structure (i.e., posts, pilings, or piers) is still below the BFE, the building will not be removed from the 
SFHA.

Response Timeframe

In accordance with the procedures of Title 44, Chapter I, CFR, Part 72, which is available online at 
http://www.access.gpo.gov/nara/cfr/waisidx_02/44cfrv1_02.html, DHS-FEMA will notify the requester of the 
determination in writing within 60 days of the date of receipt of all required data.  Information about the status of 
active Letter of Map Change (LOMC) requests is available from DHS-FEMA's Mapping Information Platform 
(MIP) at https://hazards.fema.gov.  The MIP allows requesters to search Open LOMCs by entering their Project 
(Case) Number and Project Type to find out the status of their request.  From the MIP Home Page requesters should 
click on Tools & Links, Public Reports and select Public Reports from the Report Category dropdown.

Effect on Insurance Purchase Requirements

Although DHS-FEMA may issue a LOMA or LOMR-F removing a structure(s) from the SFHA, it is the lending 
institution's prerogative to require flood insurance, as a condition of a loan, if it deems such action appropriate.  If, 
however, the lending institution agrees to waive the flood insurance purchase requirement for a structure, the 
property owner is eligible for a full refund of the premium paid for the current policy year, provided that no claim is 
pending or has been paid on the policy in question during the same policy year.  If the property owner has been 
required to renew his or her policy during a period when a revised NFIP map was being printed, the premium will be 
refunded for an additional year.  To initiate processing of the refund, the property owner should provide the LOMA 
or LOMR-F and evidence of the waiver of the flood insurance requirement from the lending institution to the 
insurance agent or broker who sold the policy.





Conditional Determinations

To qualify for a CLOMA or CLOMR-F, the proposed project must meet the same criteria as those required for a 
LOMA or LOMR-F.  After construction is completed or fill is placed, certified as-built information must be 
submitted to DHS-FEMA for a LOMA or LOMR-F to be issued.  The NFIP regulations do not require that a 
CLOMA or CLOMR-F be requested and issued for a proposed project.  Check with local community officials to see 
if they are required.

Property owners and developers should note that a CLOMA or CLOMR-F merely provides comment on the 
proposed plan and does not revise or amend the NFIP map.  It also does not relieve Federal agencies of the need to 
comply in carrying out their responsibilities for providing federally undertaken, financed, or assisted construction 
and improvements or in their regulating and licensing activities, in accordance with the provisions of Executive 
Order 11988 (http://www.fema.gov/plan/ehp/ehplaws/eo11988.shtm).

Address for Submitting Requests

Please submit all application forms and data to support a request to remove a property from the floodplain, including 
any applicable fees to the address listed below.  

Mail your request to...


FEMA NATIONAL SERVICE PROVIDER
3601 Eisenhower Avenue
Alexandria, VA 22304-6425
Attn.: LOMA Manager




FEMA REGIONS



 


INSTRUCTIONS FOR COMPLETING THE PROPERTY INFORMATION FORM (FORM 1)


General Instructions

The Property Information Form (Form 1) may be completed by the property owner, or on behalf of the property 
owner by authorized persons including but not limited to; the property owner's agent, licensed land surveyor, or 
registered professional engineer to support a request for a Letter of Map Amendment (LOMA), Conditional Letter of 
Map Amendment (CLOMA), Letter of Map Revision Based on Fill (LOMR-F), or Conditional Letter of Map 
Revision Based on Fill (CLOMR-F) for existing or proposed, single or multiple lots/structures.

Before completing this form, the requester must obtain one of the following documents from the County/Parish 
Clerk, Recorder, or Register of Deeds for the community:

*	A copy of the Deed for the property, showing the recordation information (e.g., Book/Volume and Page 
numbers or Document/Instrument number) containing the recorder's seal and recordation date, accompanied 
by a tax assessor's or other suitable map showing the surveyed location of the property.

*	A copy of the Plat Map for the property, showing the recordation information (e.g., Book/Volume and Page 
numbers or Document/Instrument number) and containing the recorder's seal and recordation date.

The requester also must obtain a photocopy of the effective FIRM panel (including the Title Block) that shows the area 
in which the property is located. The FIRM should be available at the community map repository or from the 
community official or agency responsible for floodplain management.  However, the FIRM Index and FIRM panels 
may be ordered from the Map Service Center (MSC), for a nominal fee.  To place orders from the MSC, go to their 
Internet site: http://www.msc.fema.gov.  A FIRMette, which can be printed from the MSC website, may be submitted 
in lieu of a photocopy of the FIRM

This site allows requesters to search the MSC for maps and other technical data historically available from the MSC 
online.  Requesters can search by the three following criteria:  Catalog, Map Search, and Quick Order. Catalog allows 
requesters to search through the DHS-FEMA Flood Map Store for available data.  Map Search allows requesters to 
search for data available for an individually specified map area.  Quick Order allows requesters to search and order 
available data by specific FIRM panel or Community number.  Payment must be in the form of a credit card.  Only 
Visa and MasterCard are accepted.

Requesters without Internet access should contact the MSC by calling 1-800-358-9616.  They may fax their requests to 
the MSC at 1-800-358-9620.

Requesters should note that for multiple property (structure or lot) requests, this form should only be completed once to 
describe the entire project.  One form for each lot is not necessary.

Specific Instructions

Basis of Request

Select the type of MT-1 Letter of Map Change (LOMC) being requested, by checking only one box.  Next to each type 
of LOMC a brief definition has been provided to assist the requester in making an informed selection.

Fill Placement

Fill is defined as material from any source (including the subject property) placed that raises the ground (natural 
grade) to or above the Base (1%-annual-chance) Flood Elevation (BFE).  The common construction practice of 
removing unsuitable existing material (topsoil) and backfilling with select structural material is not considered the 
placement of fill if the practice does not alter the existing (natural grade) elevation, which is at or above the BFE.  
Fill that is placed before the date of the first National Flood Insurance Program (NFIP) map showing the area 
in a Special Flood Hazard Area is considered natural grade. The Special Flood Hazard Area (SFHA) is the 
area that would be inundated by the base flood.  Assistance to ascertain if fill has been placed on your property 
may be available from the community official or agency responsible for floodplain management.  You may consult 
with the community map repository to obtain previous editions of the NFIP map, archived topographic data, or 

permit drawings related to construction on the site.  If the structure footprint is located on ground higher than the 
surrounding area, fill may have been placed.  Additional sources for assistance would include the developer or 
engineer/designer of the subdivision, previous owners of the site, persons who have owned or resided on adjacent 
parcels, and large scale aerial photographs (check the tax assessor's office).  In addition, historic NFIP maps may be 
available on DHS-FEMA's Map Service Center (MSC), for a nominal fee.  To place orders from the MSC, 
interested parties may visit the MSC website at http://www.msc.fema.gov and click on the "FEMA Flood Map 
Store" link.  For additional information regarding historic maps, interested parties may contact the DHS-FEMA Map 
Assistance Center toll free, at 1-877-FEMA MAP (1-877-336-2627).

Regardless of the type of LOMC being requested, DHS-FEMA must require the requester to clearly state, to the best 
of his or her knowledge, whether fill was or was not placed on his or her property.  The requester must select either 
"yes" or "no."  If fill was placed on the property, the requester must provide the month and year fill was placed.
In addition, for proposed projects, DHS-FEMA requires the requester to clearly state whether fill will be placed on 
his or her property.  If fill will be placed, the requester must provide the month and year fill will be placed.

Number 1 - Street Address

Enter the street address (911 type) for the structure or property being reviewed (subject property).  For requests 
involving multiple lots or structures, attach a separate piece of paper when space is insufficient.

Number 2 - Legal Description

Describe the property by referring to the Deed or Plat Map.  The description may consist of a lot number and 
subdivision name, a parcel number, a tract number, or any other information provided in the Deed or Plat to identify 
the property (e.g. Lot 2, Block 1, Floodville Estates).  It is not necessary to reproduce a lengthy description of the 
property as it appears in the Deed. 

Number 3 - Subject of Determination

DHS-FEMA makes determinations on parcels of land or structures.  The requester should select parcel of land, 
portion of a parcel, or a structure.  If the request is for a structure on a property, the date of construction must be 
provided in this section.  Date of construction information may usually be obtained from real estate settlement 
documents, the property developer, or the local government office where real estate and/or land development 
transactions are recorded.  If there is more than one structure on a property, attach a separate piece of paper with the 
dates of construction.  If the request is for a portion of a parcel, a certified metes and bounds description and map of 
the area to be removed, certified by a licensed land surveyor or registered professional engineer, are required.  The 
metes and bounds description must cover the specific area to be removed, and it must be tied to an identifiable 
starting point.  If the description is for a legally recorded lot or parcel, the metes and bounds description should 
commence or begin at the lot or parcel corner.  Please see the example below for the preferred format of metes and 
bounds descriptions.

BEGINNING at the northeast lot corner; thence S1642'22"E, 100.00 feet; thence S3314'40"W, 
145.92 feet; thence S8913'29"W, 156.01 feet; thence N1642'22"W, 223.14 feet; thence 210.49 
feet along a curve to the left having a radius of 542.00 feet to the POINT OF BEGINNING

Number 4 - Number of Structures or Properties

DHS-FEMA makes determinations on single or multiple, lots (parcels of land) or structures.  Select the choice that 
best describes your request.

Required Data

All requests must include the following data:

*	Property description documentation must be enclosed for every request and will consist of either the Plat Map 
or Deed (containing the recorder's stamp and recordation date) accompanied by a tax assessor's map or other 
suitable map showing the surveyed location of the property.  The recordation data (e.g., Book, Volume, Page, 
Reel, Document Number, and Date) must be evident on the copies of these documents so that DHS-FEMA may 
use the legal description of the property.  In addition, DHS-FEMA must be able to identify the property exactly. 
 If the property is not recorded on a Plat Map, a copy of a tax assessor's map or other suitable map must be 
submitted to aid DHS-FEMA in locating the property.

*	A photocopy of the effective FIRM panel, annotated to show where the property is located, must be submitted 
for every request.  If your community has a separate Flood Boundary and Floodway Map (FBFM), please 
include a copy.  The panel number and effective date of the FIRM must appear on the copy submitted.  The 
actual map or a photographic copy must be used.  A reproduction from a photocopy is unacceptable due to 
possible distortion.  

*	The Elevation Form (Form 2) must be included for all requests, except requests for determinations in which the 
FIRM already shows the property to be CLEARLY outside the SFHA.  For cases in which the determination for 
the property or structure is uncertain, elevation data must be submitted to provide a definitive determination.  
This form must be completed by a licensed land surveyor or registered professional engineer.  If an NFIP 
Elevation Certificate has been completed for a structure, it may be submitted in lieu of this form.  The Elevation 
Certificate must be certified by a licensed land surveyor or registered professional engineer. 

*	The Community Acknowledgment Form (Form 3) must be included for all LOMR-F or CLOMR-F, or for 
LOMA requests in which the property has been inadvertently included within the NFIP regulatory floodway.  
For LOMR-F and CLOMR-F requests only Section A needs to be completed.  For LOMA requests in which the 
property has been inadvertently included within the regulatory floodway, only Section B needs to be completed 
(see INSTRUCTIONS FOR COMPLETING OPTIONAL FORMS of these instructions for additional 
information on the certification requirements of this form).

Review and Processing Fee

The appropriate review and processing fee must be submitted for requests involving proposed projects and for 
requests involving the placement of fill (e.g., CLOMA, LOMR-F, or CLOMR-F).  The Payment Information Form 
should be included with the processing fee.  No fee is required to obtain a determination based on existing 
conditions (i.e. LOMA) as long as no fill has been placed.  For the current fee schedule visits DHS-FEMA's Flood 
Map-Related Fees Internet site: http://www.fema.gov/plan/prevent/fhm/frm_fees.shtm.

Signature

The requester must provide his or her name, mailing address, and telephone number.  The requester must also sign 
and date, where indicated, to certify the accuracy of the information provided.  A Licensed Land Surveyor, 
Registered Professional Engineer, or other designated agent may sign this form for the requester if they are 
submitting on their behalf.


INSTRUCTIONS FOR COMPLETING THE ELEVATION FORM (FORM 2)

General Instructions

The Elevation Form (Form 2) must be completed by a licensed land surveyor or registered professional engineer 
(authorized by law to certify the information requested).  If the request is to remove the structure, and an NFIP 
Elevation Certificate has already been completed for this property, it may be submitted in lieu of this form.  If the 
request is to remove the entire legally recorded property, or a portion thereof, the lowest lot elevation must be 
provided on Form 2.  If the request is to have the SFHA designation removed from the entire legally recorded 
property, but the only elevation provided is the Lowest Adjacent Grade to Structure, the determination will be issued 
for the structure.

For a licensed land surveyor or registered professional engineer to complete this form, it will be necessary to obtain 
the effective Flood Insurance Rate Map (FIRM) panel, effective Flood Boundary and Floodway Map (FBFM) panel 
(if printed), and Flood Insurance Study (FIS) report that cover the area in which the property is located.  These can 
be obtained from the community map repository or ordered from the Map Service Center (MSC), for a nominal fee. 
To place orders from the MSC, go to their Internet site:  http://www.msc.fema.gov.

The DHS-FEMA Flood Map Store allows users, including homeowners, surveyors, and engineers, to search the 
MSC for maps and other technical data historically available from the MSC, online. Searches can be conducted 
under the three following criteria: Catalog, Map Search, and Quick Order. Catalog allows surveyors and engineers to 
search through the Flood Map Store for available data. Map Search allows surveyors and engineers to search for 
data available for an individually specified map area. Quick Order allows surveyors and engineers to search 
available data by a specific FIRM panel or Community number.  All search criteria will allow surveyors and 
engineers to search desired data and add that data to a "shopping cart" for later payment options. Payment must be in 
the form of a credit card.  Only Visa and MasterCard are accepted.

Surveyors and engineers that do not have Internet access should contact the MSC by calling 1-800-358-9616. They 
may fax their requests to the MSC at 1-800-358-9620.

Number 1 - Community Number

Provide the six digit NFIP community number as it appears in the Title Block of the FIRM panel.  In addition, 
include the name of the property (i.e. legal description) and/or the property's address.
For additional information on reading FIRM panels you may consult the tutorial "How to Read a FIRM" on DHS-
FEMA's Internet site: http://www.fema.gov/media/fhm/firm/ot_firm.htm.

*Please note that, in some communities, the only NFIP maps available may be Flood Hazard Boundary Maps, 
instead of FIRMs.

Number 2 - Conditionals

Identify whether the elevations being provided are based on existing or proposed conditions. 

Number 3 - Elevation Datum

Provide the elevation datum (e.g., NGVD 29, NAVD 88, or other specified) for which the property elevations shown 
on the form are referenced.  If the datum being referenced is different than the datum used to produce the effective 
FIS, please provide the datum conversion.

Number 4 - Geographic Coordinate Data

The surveyor or engineer must provide the latitude and longitude of the property in decimal degrees to the nearest 
thousandths (00.000), and indicate the appropriate horizontal datum.

Number 5 - Type of Construction

If the request involves or will involve a structure, provide the type of construction.

Crawl Space - The bottom floor is below the first floor, is enclosed by solid and partial perimeter walls, 
and may be above ground level (grade) on one or more sides. Spaces below ground level on all sides must 
meet the requirements of FEMA Technical Bulletin 11-01. Spaces with a bottom floor elevation more than 
2.0 feet below the Lowest Adjacent Exterior Grade (LAG) elevation will be classified as a basement.

       Slab on Grade - The bottom floor is at or above ground level (grade) on at least one side.

Basement/Enclosure - The bottom floor (basement or underground garage) is below ground level (grade) 
on all sides.  See Crawl Space above.

Other - All other structure types not listed above including, but not limited to split levels, structures on 
piers, mobile homes, etc.  Please be as detailed as possible.

Number 6 - Subsidence or Uplift

Land subsidence is the lowering of the ground as a result of water, oil, gas extraction, as well as other phenomena 
such as soil compaction, decomposition of organic material, and tectonic movement.  Periodically, the National 
Geodetic Survey relevels some benchmarks to determine new elevations above the National Geodetic Vertical 
Datum of 1929 (NGVD 29) or above the North American Vertical Datum of 1988 (NAVD 88); however, not all 
benchmarks are releveled each time.

Check "yes" if the area of the property is in an area of subsidence or uplift, and provide the date of the current 
releveling; check "no" if the area of the property is not in an area of subsidence or uplift. In areas experiencing 
ground subsidence (e.g., Harris County, Texas, and Incorporated Areas); the most recently adjusted Elevation 
Reference Mark (ERM) must be used for accurate ground and structure elevations.  Please consult the effective 
Flood Insurance Study (FIS) for your community or local floodplain administrator for the most current ERM data.  

In general, the effects of subsidence can be accounted for by determining grade and structure elevations using 
benchmark elevations with the same relevel date as the benchmarks used to develop the Base (1%-annual-chance) 
Flood Elevations (BFEs) on the FIRM.  Please be aware that benchmark relevel dates can be different for different 
flooding sources.  No adjustment is necessary to the BFEs on the FIRM.

Elevation Table

A row in the elevation table must be completed for each property (parcels of land or structures) involved in this 
request (subject property).

Lot/Block Number - Provide the property's lot and/or block number if available.  In the absence of a lot or 
block number, the registered professional engineer or licensed land surveyor must include an identifier that 
clearly states for what the elevations are being referenced (e.g. residential structure, commercial building, 
unit 1, etc.).

Lowest Lot Elevation - For requests involving property, or a portion thereof, provide the lowest lot 
elevation to the nearest tenth (0.1) of a foot or meter.  If the FIRM shows BFEs in meters, the accuracy of 
the lowest lot elevation must be to the nearest tenth of a meter.

Lowest Adjacent Grade (LAG) to the Structure - For requests involving a structure, provide the LAG 
elevation, to the nearest tenth (0.1) of a foot or meter.  If the FIRM shows BFEs in meters, the accuracy of 
the LAG elevation must be to the nearest tenth of a meter.

Base Flood Elevation - Provide the BFE affecting the property. FEMA will verify the BFE during the 
review process.  BFEs can be obtained by locating the property on the effective FIRM for the community in 
which the property is located.  Upon locating the property on the FIRM, the engineer or surveyor should 
determine the type of flooding and in which flood zone the property is located.  The summary below will 
provide direction for how to determine the BFE as a result of the flooding type and flood zone 
determination.  

Base Flood Elevation Source - Provide the source used in determining the BFE (e.g. FIRM, profile, 
floodway data table, Community Determined, or other source).  When submitting a BFE that is either 
community determined or from an alternate source, please include in the request, sufficient data that 
supports the BFE.

Riverine Flooding Systems (Zones AE or A1-A30) - Consult the FIS report for the community in which 
the property is located.  Next, locate the flood profile for the flooding source by name.  Estimate the 
property's location along the flood profile and interpolate the BFE using the 100-yr. flood profile line.

Lacustrine (Stillwater) Flooding Systems - Consult the FIS report for the community in which the 
property is located. Next, locate the Summary of Stillwater Elevations table.  Locate the flooding source, 
by name, and use the BFE listed in the table.  The flooding source's BFE is normally shown to the nearest 
one-tenth of a foot.  If the flooding source is not listed in the "Summary of Stillwater Elevations" table, use 
the BFE as shown on the FIRM.

Coastal Flooding Systems (Zones AE or A1-A30 and VE or V1-V30) - First, obtain the BFE from the 
FIRM panel. Next, consult the FIS report for the community in which the property is located. Locate the 
Summary of Stillwater Elevations table in the FIS report.  Identify the flooding source, by name, and use 
the BFE listed in the table. Compare the BFE listed in this table to the BFE obtained from the FIRM.  If the 
stillwater elevation listed in this table is less than or equal to the whole-foot BFE shown on the map minus 
0.5 foot, a wave height, wave runup, and/or wave setup component exists.  In this case, the whole-foot BFE 
shown on the map should be used for rating, construction, and floodplain management purposes.  If the 
stillwater elevation listed in the "Summary of Stillwater Elevations" table is greater than the whole-foot 
BFE shown on the map minus 0.4 foot, the stillwater elevation shown in the table shall be used as the BFE. 
 Note that any property/structure located seaward of the landward toe of the primary frontal dune may not 
be removed from a Zone VE or V1-V30.

Zone A Flooding - If the property is located in a Zone A, an area of approximate flooding with no BFEs 
determined, a BFE will need to be determined by the engineer or surveyor.  First, the engineer or surveyor 
should determine if a Federal, State, or local government agency has developed a BFE.  Such agencies 
include the U.S. Army Corps of Engineers, the U.S. Geological Survey, the State's Department of Natural 
Resources, Department of Environmental Quality, or Department of Transportation; or the local Planning 
and Zoning Department.  If a BFE has not previously been developed, the engineer or surveyor should 
consult DHS-FEMA's Managing Floodplain Development in Approximate Zone A Areas:  A Guide for 
Obtaining and Developing Base (100-year) Flood Elevations (http://www.fema.gov/pdf/fhm/frm_zna.pdf), 
1995 publication.  This publication is an excellent resource, which details the appropriate methods for 
determining BFEs in SFHAs designated flood zone A.  To obtain a copy of this publication, or to obtain 
additional information about developing BFEs, contact the FEMA Map Assistance Center (FMAC) toll free 
at 1-877-FEMA MAP (1-877-336-2627).  If the property is greater than 50 lots or 5 acres, whichever is the 
lesser, the engineer or surveyor must determine a BFE as a provision of Part 60.3(b)(3), which is available 
online at http://www.access.gpo.gov/nara/cfr/waisidx_03/44cfr60_03.html.

Shallow Flooding (Zone AH) - If the property is located in flood zone AH, an area of shallow flooding, 
the engineer or surveyor should use the flood elevation listed on the FIRM.  If different elevations appear 
within the same SFHA, the BFE is obtained by linear interpolation between two adjacent BFE lines.  

Shallow/Sheet Flooding (Zone AO) - For a property located in Zone AO, the characteristics of the Zone 
AO area shown on the NFIP map will determine the appropriate methodology to be used to develop the 
BFE for the property.  If the flooding is conveyed by the street, provide the highest top of curb or crown of 
street elevation (whichever is higher) along the property line and add this to the depth of flooding.  The 
lowest adjacent grade elevation must be above the curb or street elevation by an amount equal to or greater 
than the depth of flooding shown on the NFIP map.  If the entire property is inundated by the SFHA and 
the flow is not conveyed by the street, add the depth of flooding to the average surrounding grade.  If the 
property is partially inundated by the SFHA and the street does not convey the flow, add the depth of 
flooding to the lowest lot elevation.  Along with the information required for one of the above-mentioned 
methods, provide sufficient certified topographic information, including flow paths, to show that the 
structure is located on high ground relative to the depth indicated on the NFIP map.

If the request involves multiple properties (parcels of land or structures), elevations must be provided for each 
property.  If the number of properties for which DHS-FEMA is to make a determination exceeds the number of rows 
on the Elevation Table, additional photocopies of the table may be attached to the back of the Elevation Form.

Certification (by a licensed land surveyor, registered professional engineer, or architect)

The certifier must provide his or her name, license number and expiration date, his or her company name, telephone 
number and, if applicable, his or her fax number.  The certifier's seal, if available, may be provided here.  The 
certifier must sign and date the Elevation Form, where indicated, to certify the accuracy of the information provided. 
Not all states authorize architects and engineers to certify elevation information.  Consult the state board of 
registration for more information.


INSTRUCTIONS FOR COMPLETING OPTIONAL FORMS


General

While Forms 1 and 2 must be completed for all requests, Form 3 must only be completed when applicable.  
Instructions for completing this form are provided below.

Community Acknowledgment Form (Form 3)

The Community Acknowledgment Form (Form 3) must be completed for all requests involving the placement of 
fill, existing or proposed, or requests for land or structures that are inadvertently included in the NFIP regulatory 
floodway.  The form must be completed and signed by the community official responsible for floodplain 
management in the community.  The community name and the subject property address shown in Items 1 and 2 of 
the Property Information Form must appear in the spaces provided.  Space has been provided within each section for 
the community official to provide comments on the project (e.g. Section A- The project is reasonably safe from 
flooding and satisfies Parts 60.3 and 65.5 of the NFIP regulations. Section B - Removal of the project from the 
regulatory floodway will not result in an increase in Base Flood Elevations.).  If additional space is required by the 
community official to provide the community's comments on a project, additional sheets may be attached to the back 
of this form.

Section A - Requests Involving the Placement of Fill

Instructions for Communities:

As a participant in the NFIP under 44 CFR 60.3(a)(2), you are required to ensure, prior to issuing a floodplain 
development permit, that an applicant is in compliance with local and NFIP regulations, and has obtained all 
necessary Federal and State permits related to development.  The most commonly required Federal permits are 
wetlands permits under Section 404 of the Clean Water Act of 1972 and incidental take permits under Section 10 of 
the Endangered Species Act of 1972.  Necessary State permits vary depending on the State.  If you are not sure if a 
wetlands permit is required, refer the applicant to your U.S. Army Corps of Engineers District Office.  If the 
proposed development impacts on threatened or endangered species or you are unsure if it does, have the applicant 
consult with the nearest U.S. Fish and Wildlife Service field office.

Instructions for Applicants:

You are responsible for obtaining all necessary Federal, State, and local permits as a condition of obtaining a 
LOMR-F or CLOMR-F.  Your community is required to verify that you have obtained these necessary permits prior 
to issuing a floodplain development permit or signing the Community Acknowledgment Form (MT-1 Form 3). The 
most commonly required Federal permits are wetlands permits under Section 404 of the Clean Water Act of 1972 
and incidental take permits under Section 10 of the Endangered Species Act of 1972.  Necessary State permits vary 
depending on the State.  If you need a wetlands permit or are not sure if one is required, contact your U.S. Army 
Corps of Engineers District Office.  If your proposed development impacts on threatened or endangered species or 
you are unsure if it does, consult with the nearest U.S. Fish and Wildlife Service field office.

To assist communities in determining if a property or structure, existing or proposed, is reasonably safe from 
flooding, DHS-FEMA has published Technical Bulletin 10-01.  This bulletin outlines safe building practices, which 
when followed, may reduce the risk of flood damage to a property or structure.   Community Officials interested in 
obtaining copies of this bulletin should visit our Internet site at http://www.fema.gov/pdf/fima/tb1001.pdf.  
Community Officials that do not have Internet access should contact the DHS-FEMA Map Assistance Center 
(FMAC) toll free at 1-877-FEMA MAP (1-877-336-2627) and request a copy of this Technical Bulletin be mailed.

All inquires regarding these, or other NFIP regulations, should contact the FMAC for assistance.

Section B - Property Located within the Regulatory Floodway

Required for all requests that are inadvertently included in the regulatory floodway.  The regulatory floodway is the 
area of the Special Flood Hazard Area that must remain unobstructed in order to prevent unacceptable increases in 
Base Flood Elevations.  This form must be signed by a community official, responsible for floodplain management, 
to acknowledge the community's acceptance of a revision to the regulatory floodway within the community.


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Instructions MT-1 Forms (81-87) DEC 07