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.

BROWSE RELATED DOCUMENT LISTINGS

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.

Adjusters Report/Certification

The Adjusters Report/Certification documents the insured property's location, date and type of loss, and summarizes replacement cost and A.C.V. for buildings, structural, contents and additional living expense, with line item detail.

Medical Authorization (HIPAA Compliant)

Authorization form for disclosure of medical records, in compliance with HIPAA requirements.

Medical Authorization (HIPAA Compliant) (Spanish)

Authorization form for disclosure of medical records, in compliance with HIPAA requirements.

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.

NFIP Adjuster's Final Report FEMA Form 086-0-14 (4/17)

This form is used by adjusters to document the overall flood damages to the insured's property and provide a detailed summary of the claims information.

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.