National Flood Insurance Program - Adjuster Claims Manual - Part IV
The NFIP Adjuster Claims Manual Part IV contains claims forms.
PDF (4354 KB)
Forms Flood
Worksheet Contents Personal Property FEMA Form 086-0-6 (4/17)
The adjuster and the policyholder list and assess the inventory of flood-damaged personal property on this form.
PDF (471 KB)
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NFIP Adjuster Certification Application FEMA Form 086-0-21 (4/17)
This form is used to collect information from individuals seeking to become certified flood adjusters.
PDF (453 KB)
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Cause of Loss and Subrogation Report FEMA Form 086-0-16 (04/17)
The adjuster uses this form to identify potentially responsible third parties and their actions that may have caused worsened flood damage. This includes looking at foundation grading and adequacy of sewer lines.
PDF (475 KB)
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Adjuster Preliminary Flood Damage Assessment FEMA Form 086-0-20 (4/17)
This form is used by adjusters to list potentially substantial damaged structures in preparation for possible ICC claims.
PDF (229 KB)
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National Flood Insurance Program - Adjuster Claims Manual - Part II
NFIP Adjuster Claims Manual Part II
PDF (8908 KB)
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Statement as to Full Cost of Repair or Replacement FEMA Form 086-0-12 (4/14)
This form is used to document the full repair or replacement cost of an insured property.
PDF (388 KB)
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Manufactured (Mobile) Home/Travel Trailer Worksheet (Continued) FEMA Form 086-0-18 (4/17)
This form is a continuation of the Manufactured (Mobile) Home/Travel Trailer Worksheet and is used by the adjuster to record information to determine the replacement cost and actual cash value of a manufactured (mobile) home.
PDF (541 KB)
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National Flood Insurance Program - Adjuster Claims Manual - Part I
NFIP Adjuster Claims Manual Part 1
PDF (748 KB)
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NFIP Adjuster's Preliminary Report FEMA Form 086-0-13 (4/17)
The FEMA Preliminary Report form is used by an adjuster to initially document a property loss insured under the National Flood Insurance Plan.
PDF (612 KB)
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Increased Cost of Compliance Proof of Loss FEMA Form 086-0-10 (4/17)
This form is used by the policyholder to make their statement of the amount for an Increased Cost of Compliance claim with sworn details of loss.
PDF (185 KB)
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Increased Cost of Compliance (ICC) Adjusters Report FEMA Form 086-0-19 (4/17)
This form provides FEMA with information regarding substantial damage, mitigation measures, repetitive loss and cost associated with compliance to floodplain management ordinances.
PDF (401 KB)
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NFIP Narrative Report FEMA Form 086-0-15 (4/17)
The adjuster uses this form to report information in narrative format that is necessary to document the claim that's not provided in the Preliminary or Final Report.
PDF (347 KB)
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Notice of Loss FEMA Form 086-0-11 (4/17)
This form allows insurance agents or brokers to document damages caused by flood-related hazards to structures covered by the National Flood Insurance Program.
PDF (416 KB)
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Worksheet-Building (Continued) FEMA Form 086-0-8 (4/17)
This form is a continuation sheet used by the adjuster and policyholder to list and assess the amount of building property damage.
PDF (331 KB)
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