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u.s. DEPARTMENT OF HOMELAND SECURITY. FEDERAL EMERGENCY MANAGEMENT AGENCY
COMMUNITY ACKNOWLEDGMENT FORM
OM.B. NO 16611-0015
ExpiresAugustl1,2007
PAPERWORK BURDEN DISCLOSURE NOTICE
Public reporting burden for this form is estimated to average 1.38 hours per response. The burden estimate includes the time for reviewing instructions.
searching existing data sources. gathenng and maintaining the needed data. and compleDng. reviewing. and submitting the loom. You are not required
to respond to this colleen on of infonmation unless a vaiid OMB control number appears in the upper nght comer 01 this foom. Send comments reg..-cJng
the accuracy of the burden estimate and any suggestions for reducing this burdan to: Information ColiecDons Management. U.S. Department 01
Homeland Security. Federai Emergency Management Agency. 500 C SDeet. 'i'm. Washington DC 20472. Paperwork Reduction Project (166ü-0015).
SUbmission of the lonm is required to obtain or retain benefits under the National Rood Insurance Program. Please do not send your completed
survey to the above address.
This fonm must be completed for requests involving the existing or proposed placement 01 fill (complete Seenon A) OR to provide acl<1owiedgment of
this request to remove a property from the SFHA which was previously located within the regulatory floodway (complate Seenon B).
This fonm must be completed and signed by the official responsible for floodplain management in the community. The community number and the
subject property address must appear in the spaces provided beloo.
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A. REOUESTSINVOLV[NGTHEPLACEMENTOFRLL
As the community cIficial responsitje for floodplain management. I heretlý acknONledge that we have received and reviewed this Letter 01 Map Revision
Based on Fill (LOMR-F) or Concitional LOMR-F request. Based upon the oommun[y's review. we find the completed or proposed project meets or is
designed to meet all of the community floodplain management requirements. including the requirement that no fill be placed in the regulatory floodway.
and that all necessary Federal, SDate, and local perm~s have been, or in the case 01 a Conditional LOMR-F, will be obtained. In addiDon, we h",e
detenmined that the land and any exisDng or proposed structures to be removed from the SFHA are or will be reasonably sale from flooding as defined in
44CFR 65.2{c), and thatwe have available upon request by DHS-FEMA, ail analyses end documantation usad to make this detenmination. For LOMR-F
requests. we understand that this request is being forwarded to DHS-FEMA for a possible map revision. For LOMR-F orCond[ional LOMR-Frequests
that have the potenDai to impact an endangered spedes, documentation will be submitted to shoo that we h",e compliedw~h Seenons 9 end 10 cI the
Endangered Species Act (ESA). Seenon g of the ESA prohibits anyone from .taking- or h..-ming an endangered species. [f an action might hanm an
endangered species. a penmit is required from U.S. Fish and Wildlife Service or Nation'; Manne Ashenos Service under Section 10 of the ESA. For
acTIons authorized, funded, or being carried out tIý Federal or State agencies, documentation from the agency shONing its compliance with Seenon
7(a)(2) of the ESA will be submitted.
Community Comments:
Community Offida!'s Name and l1tie: (Plea.. Print or Type)
Telephone No.:
Community Name:
Community Official's Signature: (required)
Date:
As the community clficial responsible for floodplain management. [ heretlý acknooledge thet we have received and reviewed this request for a LOMA.
We understand that this request is being forwarded to DHS-FEMA to determine if this prope~y has been inadve~ently included in the regulatory
floodway. We ackncwledgethat no fill on this property has been orwill be placed within the designated reguiatoryfloodway. We find that the completed
or proposed project meets or is de9gnedto meet all 01 the community floodplain management requirements.
Community Comments:
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Telephone No:
Community N..-ne:
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DHS. FEMAForm81-87B, FEB 06
Community Acknowledgment Form
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