2005 Activity Worksheets For GPO W OMB AW 440 FEMA CRS
User Manual: AW 440
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OMB No. 1660-0022 Expires: June 30, 2007 National Flood Insurance Program Community Rating System ACTIVITY WORKSHEETS OMB No. 1660-0022 Expires: June 30, 2007 Public reporting burden for this information collection is estimated at 35 hours for the application and certification process. Burden means the time, effort, and financial resources expended by persons to generate, maintain, retain, disclose, or to provide information to us. You may send comments regarding the burden estimate or any aspect of the collection, including suggestions for reducing the burden to: Information Collections Management, U.S. Department of Homeland Security, Emergency Preparedness and Response Directorate, Federal Emergency Management Agency, 500 C St., S.W., Washington, D.C. 20472, Paperwork Reduction Project (OMB Control Number 1660-0022). You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form. Note: do not send your completed questionnaire to this address. Activity Worksheet No. Title AW-210 AW-214 AW-230 CRS Application Cover Page Recertification Worksheet Modification/Cycle Cover Page AW-310 AW-320 AW-330 AW-340 AW-350 AW-360 Elevation Certificates Map Information Service Outreach Projects Hazard Disclosure Flood Protection Information Flood Protection Assistance AW-410 AW-420 AW-430 AW-430LD AW-440 AW-450 Additional Flood Data Open Space Preservation Higher Regulatory Standards Land Development Criteria Flood Data Maintenance Stormwater Management AW-501 AW-502 AW-510 AW-520 AW-530 AW-540 Repetitive Loss List Repetitive Loss Requirements Floodplain Management Planning Acquisition and Relocation Flood Protection Drainage System Maintenance AW-610 AW-620 AW-630 Flood Warning Program Levee Safety Dam Safety AW-710 AW-720 AW-720m Community Growth Adjustment Community Credit Calculations Community Credit Calculations (Modification) AW-CB AW-CE AW-DB AW-IJ AW-MF AW-SU AW-TS AW-UF Closed Basin Lake Hazards Coastal Erosion Hazards Dunes and Beaches Ice Jam Hazards Mudflow Hazards Land Subsidence Hazards Tsunami Hazards Uncertain Flow Path Hazards Activity Worksheets ii Edition: 2006 INSTRUCTIONS The following activity worksheets are to facilitate calculations of Community Rating System (CRS) credit points. They are not used for a community’s initial application to the CRS. INITIAL APPLICATIONS FOR THE CRS ARE SUBMITTED USING THE WORKSHEET PAGES IN THE CRS APPLICATION. These activity worksheets are for internal use by the community, for submittal of modifications, and for use by the ISO/CRS Specialist during verification and cycle verification of a community’s program. These worksheets are designed to be used in conjunction with the CRS Coordinator’s Manual. Each section of the worksheets corresponds to a section in the Coordinator’s Manual. If a section is missing from the worksheets, it is because the Coordinator’s Manual shows that no data or calculations are required for that section. It is recommended that these worksheets be photocopied before they are used. When used for submitting a modification, the Credit Points, Credit Calculation, and Credit Documentation parts of the worksheets should be completed for each activity for which credit is requested. Fill in the blanks with the value for each variable. DO NOT COMPLETE THE VERIFICATION SECTIONS . That is done by the ISO/CRS Specialist during the verification or cycle verification visit. Each worksheet has a Credit Documentation section. Check the blanks to denote that all of the required documentation is available. In some cases, the documentation must be provided with the modification. In others, checking the appropriate spaces confirms that you will provide the documentation when needed. Please consult the CRS Coordinator’s Manual if you have questions about which documentation is to be provided with the request for a modification. ATTACH THE REQUIRED DOCUMENTATION FOR AN ACTIVITY TO THE WORKSHEET FOR THAT ACTIVITY . If the documentation is ordinance language, attach only the necessary page(s) from the ordinance. M ARK THE MARGINS OF THE DOCUMENTATION WITH THE ACRONYM for the element so the ISO/CRS Specialist can identify the basis for the credit. If the document is a certification, it must have an original signature (and seal if required). Not included in this document are the activity worksheets needed for obtaining credit for management of special flood-related hazards, such as uncertain flow paths, closed basin lakes, ice jams, land subsidence, coastal dunes and beaches, mudflows, coastal erosion, and tsunamis. Those worksheets can be found in the appropriate publications listed in Appendix E of the CRS Coordinator’s Manual and in Appendix B of the CRS Application. Two other worksheets are not part of this document: AW-214 (Recertification) and AW-501 (Repetitive Loss List). When needed, these two worksheets are generated separately by the Department of Homeland Security’s Federal Emergency Management Agency (FEMA) and provided to the community. Activity Worksheets iii Edition: 2006 [This page intentionally blank.] Activity Worksheets iv Edition: 2006 OMB No.1660-0022 Expires June 30, 2007 Community : ____________________________ 230 MODIFICATION/CYCLE COVER PAGE 1. Community Name: _______________________________State: ____ BCEGS: _____/_____ NFIP Number: ________________ FIRM Effective Date: ____________________, ______ Population: ___________________ Current FIRM Date: ______________________, ______ Modification/Cycle Date: ___________, 200____ 2. County: __________________________ Chief Executive Officer: CRS Coordinator: Name: _______________________________ ___________________________________ Title: _______________________________ ___________________________________ Address: _______________________________ ___________________________________ _______________________________ ___________________________________ Coordinator’s Telephone: ____________________________ Fax: ______________________ Coordinator’s email:___________________________________ 3. I hereby certify that ___________________________[community name] is implementing the following activities (check the ones that apply). We are modifying or adding activities that have an “m” for modifying, “a” for addition, or “d” for dropping in the blank and have attached new activity worksheets and documentation. We will continue to implement these activities and will advise FEMA if any of them are not being conducted in accordance with this certification. We will cooperate with the ISO/CRS Specialist verification visit and will submit the documentation and annual recertification needed to validate our program. ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ 310 Elevation Certificates 320 Map Information Service 330 Outreach Projects 340 Hazard Disclosure 350 Flood Protection Information 360 Flood Protection Assistance 410 Additional Flood Data 420 Open Space Preservation 430 Higher Regulatory Standards 430LD Land Development Criteria ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ 440 Flood Data Maintenance 450 Stormwater Management Repetitive Loss Requirements 510 Floodplain Management Planning 520 Acquisition and Relocation 530 Flood Protection 540 Drainage System Maintenance 610 Flood Warning Program 620 Levee Safety 630 Dam Safety 4. I hereby certify that to the best of my knowledge and belief, we are maintaining in force all flood insurance policies that have been required of us as a condition of federal financial assistance for insurable buildings owned by us and located in the Special Flood Hazard Area shown on our Flood Insurance Rate Map. I further understand that disaster assistance for flooded public buildings in the Special Flood Hazard Area will be reduced by the amount of flood insurance available from the National Flood Insurance Program for the buildings, even if we do not have a policy. 5. Signed: __________________________ (Chief Executive Officer) Activity Worksheets 230-1 Edition: 2006 OMB No. 1660-0022 Expires: June 30, 2007 Public reporting burden for this information collection is estimated at 35 hours for the application and certification process. Burden means the time, effort, and financial resources expended by persons to generate, maintain, retain, disclose, or to provide information to us. You may send comments regarding the burden estimate or any aspect of the collection, including suggestions for reducing the burden to: Information Collections Management, U.S. Department of Homeland Security, Emergency Preparedness and Response Directorate, Federal Emergency Management Agency, 500 C St., S.W., Washington, D.C. 20472, Paperwork Reduction Project (OMB Control Number 1660-0022). You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form. Note: do not send your completed questionnaire to this address. Activity Worksheet No. Title AW-210 AW-214 AW-230 CRS Application Cover Page Recertification Worksheet Modification/Cycle Cover Page AW-310 AW-320 AW-330 AW-340 AW-350 AW-360 Elevation Certificates Map Information Service Outreach Projects Hazard Disclosure Flood Protection Information Flood Protection Assistance AW-410 AW-420 AW-430 AW-430LD AW-440 AW-450 Additional Flood Data Open Space Preservation Higher Regulatory Standards Land Development Criteria Flood Data Maintenance Stormwater Management AW-501 AW-502 AW-510 AW-520 AW-530 AW-540 Repetitive Loss List Repetitive Loss Requirements Floodplain Management Planning Acquisition and Relocation Flood Protection Drainage System Maintenance AW-610 AW-620 AW-630 Flood Warning Program Levee Safety Dam Safety AW-710 AW-720 AW-720m Community Growth Adjustment Community Credit Calculations Community Credit Calculations (Modification) AW-CB AW-CE AW-DB AW-IJ AW-MF AW-SU AW-TS AW-UF Closed Basin Lake Hazards Coastal Erosion Hazards Dunes and Beaches Ice Jam Hazards Mudflow Hazards Land Subsidence Hazards Tsunami Hazards Uncertain Flow Path Hazards OMB No.1660-0022 Expires June 30, 2007 Community : ____________________________ 310 ELEVATION CERTIFICATES 312 Impact Adjustment: a. Option 1: 1. rECPO = 1.0 2. rECPR = 1.0 3. rECCF = 1.0 4. rECWS = 1.0 b. Option 2: 1. rECPO = 0.25 2. rECPR = 0.25 3. rECCF = 0.25 4. rECWS = 0.25 c. Option 3: 1. rECPO = bECPO bPO _____ = ______ 2. rECPR = bECPR = ______ bPR_______ 3. rECCF = bECCF bEC ______ + bECPO ______ + bECPR ______ = ______ 4. rECWS = bECWS bEC ______ + bECPO ______ + bECPR ______ = ______ 313 Credit Calculation: a. cEC cEC = b. cECPO = ECPO ______ x rECPO ______ cECPO = ______ c. cECPR = ECPR ______ x rECPR ______ cECPR = ______ d. cECCF = ECCF ______ x rECCF ______ cECCF = ______ e. cECWS = ECWS ______ x rECWS ______ cECWS = ______ f. Add lines a through e above = ______ ______ c310 = value above rounded to the nearest whole number: c310 = ______ Enter this value on AW-720-1. Activity Worksheet 310-1 Edition: 2006 OMB No. 1660-0022 Expires: June 30, 2007 Public reporting burden for this information collection is estimated at 35 hours for the application and certification process. Burden means the time, effort, and financial resources expended by persons to generate, maintain, retain, disclose, or to provide information to us. You may send comments regarding the burden estimate or any aspect of the collection, including suggestions for reducing the burden to: Information Collections Management, U.S. Department of Homeland Security, Emergency Preparedness and Response Directorate, Federal Emergency Management Agency, 500 C St., S.W., Washington, D.C. 20472, Paperwork Reduction Project (OMB Control Number 1660-0022). You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form. Note: do not send your completed questionnaire to this address. Activity Worksheet No. Title AW-210 AW-214 AW-230 CRS Application Cover Page Recertification Worksheet Modification/Cycle Cover Page AW-310 AW-320 AW-330 AW-340 AW-350 AW-360 Elevation Certificates Map Information Service Outreach Projects Hazard Disclosure Flood Protection Information Flood Protection Assistance AW-410 AW-420 AW-430 AW-430LD AW-440 AW-450 Additional Flood Data Open Space Preservation Higher Regulatory Standards Land Development Criteria Flood Data Maintenance Stormwater Management AW-501 AW-502 AW-510 AW-520 AW-530 AW-540 Repetitive Loss List Repetitive Loss Requirements Floodplain Management Planning Acquisition and Relocation Flood Protection Drainage System Maintenance AW-610 AW-620 AW-630 Flood Warning Program Levee Safety Dam Safety AW-710 AW-720 AW-720m Community Growth Adjustment Community Credit Calculations Community Credit Calculations (Modification) AW-CB AW-CE AW-DB AW-IJ AW-MF AW-SU AW-TS AW-UF Closed Basin Lake Hazards Coastal Erosion Hazards Dunes and Beaches Ice Jam Hazards Mudflow Hazards Land Subsidence Hazards Tsunami Hazards Uncertain Flow Path Hazards OMB No.1660-0022 Expires June 30, 2007 Community : ____________________________ 314 Credit Documentation: ___ a. [If the community applies for credit under ECPO or ECPR and used a form different from FEMA’s] A copy of the local elevation certificate, along with documentation that FEMA has approved it. Note that a local elevation certificate can only be credited if it was used before 1999 or before the community joined the CRS, whichever is later. ___ b. [If the community applies for ECCF credit and is NOT using the CRS “Computerized Format for FEMA elevation certificates”] a copy of the computer format being used. ___ c. EC – Copies of completed elevation certificates OR ___ ___ ___ ___ ___ ___ d. Certification letter if no new construction or substantial improvements. ECPO – Copies of completed post-FIRM elevation certificates. ECPR – Copies of completed pre-FIRM elevation certificates. ECCF – Printout of sample Certificates. ECWS – Printout of sample Certificates. Website address _____________________ Documentation showing how the impact adjustment ratios were determined. The following will be needed at the annual recertification: ___ e. ECCF – A disk with the elevation and floodproofing certificate data in computer format obtained since the last submittal. Starting month/year for which certificates are consistently available: ____________ , ________ Office where requests should be submitted: _________________________________________ Address _____________________________________________________________________ City ________________________________ State ______________ Zip ________________ Phone ______________ Fax __________________ e-mail ____________________________ How should requests for elevation and/or floodproofing certificates be submitted (mail, phone, fax, etc.)? ______________________________ Comments: __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ Activity Worksheet AW-310-2 Edition: 2006 OMB No. 1660-0022 Expires: June 30, 2007 Public reporting burden for this information collection is estimated at 35 hours for the application and certification process. Burden means the time, effort, and financial resources expended by persons to generate, maintain, retain, disclose, or to provide information to us. You may send comments regarding the burden estimate or any aspect of the collection, including suggestions for reducing the burden to: Information Collections Management, U.S. Department of Homeland Security, Emergency Preparedness and Response Directorate, Federal Emergency Management Agency, 500 C St., S.W., Washington, D.C. 20472, Paperwork Reduction Project (OMB Control Number 1660-0022). You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form. Note: do not send your completed questionnaire to this address. Activity Worksheet No. Title AW-210 AW-214 AW-230 CRS Application Cover Page Recertification Worksheet Modification/Cycle Cover Page AW-310 AW-320 AW-330 AW-340 AW-350 AW-360 Elevation Certificates Map Information Service Outreach Projects Hazard Disclosure Flood Protection Information Flood Protection Assistance AW-410 AW-420 AW-430 AW-430LD AW-440 AW-450 Additional Flood Data Open Space Preservation Higher Regulatory Standards Land Development Criteria Flood Data Maintenance Stormwater Management AW-501 AW-502 AW-510 AW-520 AW-530 AW-540 Repetitive Loss List Repetitive Loss Requirements Floodplain Management Planning Acquisition and Relocation Flood Protection Drainage System Maintenance AW-610 AW-620 AW-630 Flood Warning Program Levee Safety Dam Safety AW-710 AW-720 AW-720m Community Growth Adjustment Community Credit Calculations Community Credit Calculations (Modification) AW-CB AW-CE AW-DB AW-IJ AW-MF AW-SU AW-TS AW-UF Closed Basin Lake Hazards Coastal Erosion Hazards Dunes and Beaches Ice Jam Hazards Mudflow Hazards Land Subsidence Hazards Tsunami Hazards Uncertain Flow Path Hazards OMB No.1660-0022 Expires June 30, 2007 Community : ____________________________ 320 MAP INFORMATION SERVICE 322 Credit Calculation: c320 = MI = c320 = Enter this value on AW-720-1. 323 Credit Documentation: a. Documentation that shows how the community publicizes the service each year. 1. If the community publicizes this service through an annual outreach project credited under Activity 330 (OPC or OPS), “320” must be noted in the margin of the outreach project to the community (OPC) where the map information service is addressed. If an OPS is used, the public information strategy document must discuss the best way to publicize the map information service to the target audiences. 2. If the community publicizes this service through an annual outreach project that is not credited under Activity 330, attach a copy of the project. The materials must be distributed each year and must reach at least 90% of the target audience. 3. If the community sends a letter or e-mail directly to lending institutions and real estate and insurance agencies, attach a copy of the letter or e-mail message. 4. If the community notifies organizations of lending institutions and real estate and insurance agencies, attach copies of the notifications in their publications. If any organization has not yet published the notifications, documentation must include written assurance from the organization that it intends to publish the notification within six months of the Community Rating System (CRS) application date. b. If another agency provides map information, documentation that the agency agrees to provide the service to all inquirers and will allow the CRS to verify its work. c. Records of which institutions and agencies were notified of thi sevice. If the community sends letters to institutions and agencies, a mailing list for those institutions and agencies. d. A record or log that shows the level of service provided. e. Documentation or notations on how the community keeps the FIRM updated. Documentation or notations that the community has copies of all FIRMs since 1999 or the date the community applied for this credit, whichever is later. Starting month/year for which certificates are consistently available: ______________ , ____ Office where requests should be submitted _______________________________________ Address _____________________________________________________________________ City ________________________________________________ State ________ Zip ________ Phone ______________________ Fax __________________ e-mail______________________ How should requests for the service be made (mail, phone, fax, etc.)? ____________________ Activity Worksheet AW-320-1 Edition: 2006 OMB No. 1660-0022 Expires: June 30, 2007 Public reporting burden for this information collection is estimated at 35 hours for the application and certification process. Burden means the time, effort, and financial resources expended by persons to generate, maintain, retain, disclose, or to provide information to us. You may send comments regarding the burden estimate or any aspect of the collection, including suggestions for reducing the burden to: Information Collections Management, U.S. Department of Homeland Security, Emergency Preparedness and Response Directorate, Federal Emergency Management Agency, 500 C St., S.W., Washington, D.C. 20472, Paperwork Reduction Project (OMB Control Number 1660-0022). You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form. Note: do not send your completed questionnaire to this address. Activity Worksheet No. Title AW-210 AW-214 AW-230 CRS Application Cover Page Recertification Worksheet Modification/Cycle Cover Page AW-310 AW-320 AW-330 AW-340 AW-350 AW-360 Elevation Certificates Map Information Service Outreach Projects Hazard Disclosure Flood Protection Information Flood Protection Assistance AW-410 AW-420 AW-430 AW-430LD AW-440 AW-450 Additional Flood Data Open Space Preservation Higher Regulatory Standards Land Development Criteria Flood Data Maintenance Stormwater Management AW-501 AW-502 AW-510 AW-520 AW-530 AW-540 Repetitive Loss List Repetitive Loss Requirements Floodplain Management Planning Acquisition and Relocation Flood Protection Drainage System Maintenance AW-610 AW-620 AW-630 Flood Warning Program Levee Safety Dam Safety AW-710 AW-720 AW-720m Community Growth Adjustment Community Credit Calculations Community Credit Calculations (Modification) AW-CB AW-CE AW-DB AW-IJ AW-MF AW-SU AW-TS AW-UF Closed Basin Lake Hazards Coastal Erosion Hazards Dunes and Beaches Ice Jam Hazards Mudflow Hazards Land Subsidence Hazards Tsunami Hazards Uncertain Flow Path Hazards OMB No.1660-0022 Expires June 30, 2007 Community : ____________________________ 330 OUTREACH PROJECTS 331 Credit Points: a.—c. Variable: OPC Points per topic: OPF 6 OPA1 13 OPA2 2 2 OPA3 2 Topics covered 1. Local flood hazard: 2. Flood safety: 3. Flood insurance: 4. Property protection: 5. Natural & beneficial functions: 6. Local flood hazard map: 7. Flood warning system: 8. Permit requirements: 9. Substantial improvement/damage: 10. Drainage maintenance: Total of above: OPC = OPF = OPA1 = OPA2 = OPA3 = d. OPS 1. Outreach Project pursuant to a strategy (100 points): 2. Multi-hazard strategy (25 points): OPS = the total of lines 1 and 2 above: OPS = e. PFI 1. Brochure or letter (10 or 45 points): 2. Inclusion of photo(s) (5 points): 3. Explanation of FIRM zones (15 points): PFI = the total of lines 1, 2 and 3 above: PFI = 332 Credit Calculation: c330 = EITHER OPC OR + OPF OPC + OPA1 + OPF + OPA2 + OPS + OPA3 + PFI + PFI c330 = c330 = Enter this value on AW-720-1. Activity Worksheet AW-330-1 Edition: 2006 OMB No. 1660-0022 Expires: June 30, 2007 Public reporting burden for this information collection is estimated at 35 hours for the application and certification process. Burden means the time, effort, and financial resources expended by persons to generate, maintain, retain, disclose, or to provide information to us. You may send comments regarding the burden estimate or any aspect of the collection, including suggestions for reducing the burden to: Information Collections Management, U.S. Department of Homeland Security, Emergency Preparedness and Response Directorate, Federal Emergency Management Agency, 500 C St., S.W., Washington, D.C. 20472, Paperwork Reduction Project (OMB Control Number 1660-0022). You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form. Note: do not send your completed questionnaire to this address. Activity Worksheet No. Title AW-210 AW-214 AW-230 CRS Application Cover Page Recertification Worksheet Modification/Cycle Cover Page AW-310 AW-320 AW-330 AW-340 AW-350 AW-360 Elevation Certificates Map Information Service Outreach Projects Hazard Disclosure Flood Protection Information Flood Protection Assistance AW-410 AW-420 AW-430 AW-430LD AW-440 AW-450 Additional Flood Data Open Space Preservation Higher Regulatory Standards Land Development Criteria Flood Data Maintenance Stormwater Management AW-501 AW-502 AW-510 AW-520 AW-530 AW-540 Repetitive Loss List Repetitive Loss Requirements Floodplain Management Planning Acquisition and Relocation Flood Protection Drainage System Maintenance AW-610 AW-620 AW-630 Flood Warning Program Levee Safety Dam Safety AW-710 AW-720 AW-720m Community Growth Adjustment Community Credit Calculations Community Credit Calculations (Modification) AW-CB AW-CE AW-DB AW-IJ AW-MF AW-SU AW-TS AW-UF Closed Basin Lake Hazards Coastal Erosion Hazards Dunes and Beaches Ice Jam Hazards Mudflow Hazards Land Subsidence Hazards Tsunami Hazards Uncertain Flow Path Hazards OMB No.1660-0022 Expires June 30, 2007 Community : ____________________________ 333 Credit Documentation: a. OPC: Copies of the materials, marked with the topics covered. Date sent:_________________________________ OPF: Copies of the materials, marked with the topics covered. Date sent:_________________________________ 90% Coverage Documentation OPA1: A description of the project with copies of the public information materials that were distributed, marked with the topics covered. Date undertaken:__________________ Example or description:________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ OPA2: A description of the project with copies of the public information materials that were distributed, marked with the topics covered. Date undertaken:__________________ Example or description:________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ OPA3: A description of the project with copies of the public information materials that were distributed, marked with the topics covered. Date undertaken:__________________ Example or description:________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ PFI: A copy of the letter or brochure mailed to __ entire community or __ SFHA properties b. OPS: A copy of the public information program strategy marked with the criteria that must be met. Include documentation that the strategy is being implemented. c. Documentation that shows when the projects were undertaken. d. PFI 1. 2. 3. 4. 5. - Prerequisites: Number of buildings in the community: Number of apartments and condominium units in the community: Number of buildings in the SFHA: Number of apartments and condominiums in the SFHA: Notes on how these numbers were calculated: The following will be needed at the annual recertification: ___ e. Copies of the outreach projects that were conducted that year. ___ f. OPS − A copy of the annual OPS evaluation. Activity Worksheet AW-330-2 Edition: 2006 OMB No. 1660-0022 Expires: June 30, 2007 Public reporting burden for this information collection is estimated at 35 hours for the application and certification process. Burden means the time, effort, and financial resources expended by persons to generate, maintain, retain, disclose, or to provide information to us. You may send comments regarding the burden estimate or any aspect of the collection, including suggestions for reducing the burden to: Information Collections Management, U.S. Department of Homeland Security, Emergency Preparedness and Response Directorate, Federal Emergency Management Agency, 500 C St., S.W., Washington, D.C. 20472, Paperwork Reduction Project (OMB Control Number 1660-0022). You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form. Note: do not send your completed questionnaire to this address. Activity Worksheet No. Title AW-210 AW-214 AW-230 CRS Application Cover Page Recertification Worksheet Modification/Cycle Cover Page AW-310 AW-320 AW-330 AW-340 AW-350 AW-360 Elevation Certificates Map Information Service Outreach Projects Hazard Disclosure Flood Protection Information Flood Protection Assistance AW-410 AW-420 AW-430 AW-430LD AW-440 AW-450 Additional Flood Data Open Space Preservation Higher Regulatory Standards Land Development Criteria Flood Data Maintenance Stormwater Management AW-501 AW-502 AW-510 AW-520 AW-530 AW-540 Repetitive Loss List Repetitive Loss Requirements Floodplain Management Planning Acquisition and Relocation Flood Protection Drainage System Maintenance AW-610 AW-620 AW-630 Flood Warning Program Levee Safety Dam Safety AW-710 AW-720 AW-720m Community Growth Adjustment Community Credit Calculations Community Credit Calculations (Modification) AW-CB AW-CE AW-DB AW-IJ AW-MF AW-SU AW-TS AW-UF Closed Basin Lake Hazards Coastal Erosion Hazards Dunes and Beaches Ice Jam Hazards Mudflow Hazards Land Subsidence Hazards Tsunami Hazards Uncertain Flow Path Hazards OMB No.1660-0022 Expires June 30, 2007 Community : ____________________________ 333.e Public Information Program Strategy Evaluation [See page 330–25 of the CRS Coordinator's Manual for a completed example. 1. Goals of the community’s Public Information Program Strategy: 2. Projects implemented to meet those goals and their objectives: 3. Were any projects not implemented or objectives not reached? If not, why? 4. What new projects should be implemented and what projects or objectives should be revised? For more information, contact: _________________________ Phone: ______________ Activity Worksheet AW-330-3 Edition: 2006 OMB No. 1660-0022 Expires: June 30, 2007 Public reporting burden for this information collection is estimated at 35 hours for the application and certification process. Burden means the time, effort, and financial resources expended by persons to generate, maintain, retain, disclose, or to provide information to us. You may send comments regarding the burden estimate or any aspect of the collection, including suggestions for reducing the burden to: Information Collections Management, U.S. Department of Homeland Security, Emergency Preparedness and Response Directorate, Federal Emergency Management Agency, 500 C St., S.W., Washington, D.C. 20472, Paperwork Reduction Project (OMB Control Number 1660-0022). You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form. Note: do not send your completed questionnaire to this address. Activity Worksheet No. Title AW-210 AW-214 AW-230 CRS Application Cover Page Recertification Worksheet Modification/Cycle Cover Page AW-310 AW-320 AW-330 AW-340 AW-350 AW-360 Elevation Certificates Map Information Service Outreach Projects Hazard Disclosure Flood Protection Information Flood Protection Assistance AW-410 AW-420 AW-430 AW-430LD AW-440 AW-450 Additional Flood Data Open Space Preservation Higher Regulatory Standards Land Development Criteria Flood Data Maintenance Stormwater Management AW-501 AW-502 AW-510 AW-520 AW-530 AW-540 Repetitive Loss List Repetitive Loss Requirements Floodplain Management Planning Acquisition and Relocation Flood Protection Drainage System Maintenance AW-610 AW-620 AW-630 Flood Warning Program Levee Safety Dam Safety AW-710 AW-720 AW-720m Community Growth Adjustment Community Credit Calculations Community Credit Calculations (Modification) AW-CB AW-CE AW-DB AW-IJ AW-MF AW-SU AW-TS AW-UF Closed Basin Lake Hazards Coastal Erosion Hazards Dunes and Beaches Ice Jam Hazards Mudflow Hazards Land Subsidence Hazards Tsunami Hazards Uncertain Flow Path Hazards OMB No.1660-0022 Expires June 30, 2007 Community : ____________________________ 340 HAZARD DISCLOSURE 342 Credit Calculation: a. DFH: DFH = ______ b. ODR: ODR = ______ c. REB: REB = ______ d. DOH: DOH = ______ e. Add lines a through d above: c340 = ______ Enter this value on AW-720-1. 343 Credit Documentation: a. DFH: Documentation that demonstrates that real estate agents are advising potential property purchasers of the flood hazard and the flood insurance purchase requirement. Disclosure notices from at least five real estate agencies. Blank forms are not acceptable documentation. OR __ State law that requires real estate agents to advise people whether a property is located in a Special Flood Hazard Area. b. ODR: A copy of ordinance or law language requiring one or more additional disclosure methods at the time of sale or rental of a property. The acronym “ODR” must be marked in the margin of the sections that pertain to this element. ODR1: Regulation: _______________________________________ ODR2: Regulation: _______________________________________ ODR3: Regulation: _______________________________________ c. REB: A brochure or other document that is made available to interested parties by real estate agents. The document must advise people looking to purchase property to investigate the flood hazard before they buy. d. DOH: Documentation that the DFH notification includes disclosure of other floodrelated hazards, such as erosion, subsidence, or wetlands. Comments: _________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ Activity Worksheet AW-340-1 Edition: 2006 OMB No. 1660-0022 Expires: June 30, 2007 Public reporting burden for this information collection is estimated at 35 hours for the application and certification process. Burden means the time, effort, and financial resources expended by persons to generate, maintain, retain, disclose, or to provide information to us. You may send comments regarding the burden estimate or any aspect of the collection, including suggestions for reducing the burden to: Information Collections Management, U.S. Department of Homeland Security, Emergency Preparedness and Response Directorate, Federal Emergency Management Agency, 500 C St., S.W., Washington, D.C. 20472, Paperwork Reduction Project (OMB Control Number 1660-0022). You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form. Note: do not send your completed questionnaire to this address. Activity Worksheet No. Title AW-210 AW-214 AW-230 CRS Application Cover Page Recertification Worksheet Modification/Cycle Cover Page AW-310 AW-320 AW-330 AW-340 AW-350 AW-360 Elevation Certificates Map Information Service Outreach Projects Hazard Disclosure Flood Protection Information Flood Protection Assistance AW-410 AW-420 AW-430 AW-430LD AW-440 AW-450 Additional Flood Data Open Space Preservation Higher Regulatory Standards Land Development Criteria Flood Data Maintenance Stormwater Management AW-501 AW-502 AW-510 AW-520 AW-530 AW-540 Repetitive Loss List Repetitive Loss Requirements Floodplain Management Planning Acquisition and Relocation Flood Protection Drainage System Maintenance AW-610 AW-620 AW-630 Flood Warning Program Levee Safety Dam Safety AW-710 AW-720 AW-720m Community Growth Adjustment Community Credit Calculations Community Credit Calculations (Modification) AW-CB AW-CE AW-DB AW-IJ AW-MF AW-SU AW-TS AW-UF Closed Basin Lake Hazards Coastal Erosion Hazards Dunes and Beaches Ice Jam Hazards Mudflow Hazards Land Subsidence Hazards Tsunami Hazards Uncertain Flow Path Hazards OMB No.1660-0022 Expires June 30, 2007 Community : ____________________________ 350 FLOOD PROTECTION INFORMATION 351 Credit Points: a. LIB: 1. FIRM, Floodway Map, and explanation (4 points): ______ 2. Flood insurance (2 points): ______ 3. Building protection measures (8 points): ______ 4. Floodplain management or hazard mitigation (3 points): ______ 5. Natural and beneficial floodplain functions (3 points): ______ 6. Directory of local sources of more information (3 points): ______ 7. Special Hazards (2 points) ______ LIB = the total of lines 1 through 7 above LIB = ______ b. LPD: LPD = ______ c. WEB: 1. Prerequisites: __ (a) Site is easy to locate using the community’s name. __ (b) Easy to get to the flood information from the home page. __ (c) Links are pertinent to the community’s flood conditions. __ (d) At least one link to FEMA’s website. __ (e) Site is reviewed and updated at least once each year. 2.(a) Outreach Project Topics: 1. Local flood hazard (4 points): ______ 2. Flood safety (4 points): ______ 3. Flood insurance (4 points): ______ 4. Property protection (4 points): ______ 5. Natural & beneficial functions (4 points): ______ 6. Local flood hazard map (4 points): ______ 7. Flood warning system (4 points): ______ 8. Permit requirements (4 points): ______ 9. Substantial improvement/damage (4 points): ______ 10. Drainage maintenance (4 points): ______ (b) Publicizing elevation certificates (2 points): ______ (c) Real time river gauge data (10 points): ______ (d) Other flood warning information (20 points): ______ WEB = the total of lines 2(a)—2(d) above: WEB = ______ 352 Credit Calculation: Add LIB, LPD, and WEB: c350 = ______ Enter this value on AW-720-1. Activity Worksheet AW-350-1 Edition: 2006 OMB No. 1660-0022 Expires: June 30, 2007 Public reporting burden for this information collection is estimated at 35 hours for the application and certification process. Burden means the time, effort, and financial resources expended by persons to generate, maintain, retain, disclose, or to provide information to us. You may send comments regarding the burden estimate or any aspect of the collection, including suggestions for reducing the burden to: Information Collections Management, U.S. Department of Homeland Security, Emergency Preparedness and Response Directorate, Federal Emergency Management Agency, 500 C St., S.W., Washington, D.C. 20472, Paperwork Reduction Project (OMB Control Number 1660-0022). You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form. Note: do not send your completed questionnaire to this address. Activity Worksheet No. Title AW-210 AW-214 AW-230 CRS Application Cover Page Recertification Worksheet Modification/Cycle Cover Page AW-310 AW-320 AW-330 AW-340 AW-350 AW-360 Elevation Certificates Map Information Service Outreach Projects Hazard Disclosure Flood Protection Information Flood Protection Assistance AW-410 AW-420 AW-430 AW-430LD AW-440 AW-450 Additional Flood Data Open Space Preservation Higher Regulatory Standards Land Development Criteria Flood Data Maintenance Stormwater Management AW-501 AW-502 AW-510 AW-520 AW-530 AW-540 Repetitive Loss List Repetitive Loss Requirements Floodplain Management Planning Acquisition and Relocation Flood Protection Drainage System Maintenance AW-610 AW-620 AW-630 Flood Warning Program Levee Safety Dam Safety AW-710 AW-720 AW-720m Community Growth Adjustment Community Credit Calculations Community Credit Calculations (Modification) AW-CB AW-CE AW-DB AW-IJ AW-MF AW-SU AW-TS AW-UF Closed Basin Lake Hazards Coastal Erosion Hazards Dunes and Beaches Ice Jam Hazards Mudflow Hazards Land Subsidence Hazards Tsunami Hazards Uncertain Flow Path Hazards OMB No.1660-0022 Expires June 30, 2007 Community : ____________________________ 353 Credit Documentation: a. LIB: A statement from the head of the library that includes: 1. A list of the documents available in the library with their publication dates. Note which ones also qualify as locally pertinent documents for LPD credit. AND 2. E ITHER: (a) Certification that the documents have been entered into the library’s card catalog or similar system. OR (b) A copy of the card catalog cards or printout of the automated system’s inventory of flood documents. AND 3. A statement that adequate numbers of documents will be maintained and that the FIRMs and other materials will be kept up to date. b. WEB: The URL of the community’s website: ______________________________ If appropriate, documentation that the website is publicized through an outreach project reaching 90% of community. The following will be needed at the annual recertification: c. WEB: Certification that the community has conducted its annual review and update of the information and links in its flood protection website. Comments: __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________________ Activity Worksheet AW-350-2 Edition: 2006 OMB No. 1660-0022 Expires: June 30, 2007 Public reporting burden for this information collection is estimated at 35 hours for the application and certification process. Burden means the time, effort, and financial resources expended by persons to generate, maintain, retain, disclose, or to provide information to us. You may send comments regarding the burden estimate or any aspect of the collection, including suggestions for reducing the burden to: Information Collections Management, U.S. Department of Homeland Security, Emergency Preparedness and Response Directorate, Federal Emergency Management Agency, 500 C St., S.W., Washington, D.C. 20472, Paperwork Reduction Project (OMB Control Number 1660-0022). You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form. Note: do not send your completed questionnaire to this address. Activity Worksheet No. Title AW-210 AW-214 AW-230 CRS Application Cover Page Recertification Worksheet Modification/Cycle Cover Page AW-310 AW-320 AW-330 AW-340 AW-350 AW-360 Elevation Certificates Map Information Service Outreach Projects Hazard Disclosure Flood Protection Information Flood Protection Assistance AW-410 AW-420 AW-430 AW-430LD AW-440 AW-450 Additional Flood Data Open Space Preservation Higher Regulatory Standards Land Development Criteria Flood Data Maintenance Stormwater Management AW-501 AW-502 AW-510 AW-520 AW-530 AW-540 Repetitive Loss List Repetitive Loss Requirements Floodplain Management Planning Acquisition and Relocation Flood Protection Drainage System Maintenance AW-610 AW-620 AW-630 Flood Warning Program Levee Safety Dam Safety AW-710 AW-720 AW-720m Community Growth Adjustment Community Credit Calculations Community Credit Calculations (Modification) AW-CB AW-CE AW-DB AW-IJ AW-MF AW-SU AW-TS AW-UF Closed Basin Lake Hazards Coastal Erosion Hazards Dunes and Beaches Ice Jam Hazards Mudflow Hazards Land Subsidence Hazards Tsunami Hazards Uncertain Flow Path Hazards OMB No.1660-0022 Expires June 30, 2007 Community : ____________________________ 360 FLOOD PROTECTION ASSISTANCE 361 Credit Points: FPA: a. Providing site-specific flood and flood-related data (10 points): ______ b. Providing names of contractors and consultants (4 points): ______ c. Providing material on how to select a contractor (3 points): ______ d. Making site visits to review flood, drainage, and sewer problems (35 points): ______ e. Advising and assisting on retrofitting techniques (14 points): ______ f. Retrofitting Floodprone Residential Buildings course at EMI (5 points) OR FEMA’s Retrofitting home study course (2 points): ______ FPA = the total of lines a through f above: FPA = ______ 362 Credit Calculation: c360 = FPA c360 = ______ Enter this value on AW-720-1. 363 Credit Documentation: a. A copy of the document used to publicize the service. An outreach project to the community (OPC or OPF) credited under Activity 330. An outreach project pursuant to the public information strategy (OPS) credited in Activity 330, provided the public information strategy document discusses the best way to advise the target audiences. OR An annual outreach project that advises all residents and businesses in the community or in the floodplain about the service, but is not credited under Activity 330 (e.g., a short notice with all tax or utility bills). The materials must be distributed each year and must reach at least 90% of the target audience. b. A description of the technical qualifications of all persons who are providing the site visit and retrofitting assistance credited under Sections 361.d and e. If credit is being sought under Section 361.f for graduation from the EMI retrofitting course, a copy of the certificate of graduation. c. If the person is not a community employee, a letter stating that the person and/or agency have agreed to do the work. d. If the community is applying for credit under Section 361.b or c, a list of the names of contractors or consultants and/or a copy of the material the community provides on how to select a contractor. e. If the community is applying for credit under Section 361.d or e, records noting the date and type of assistance given. The records must include the details of the findings and recommendations provided to the inquirer. Activity Worksheet AW-360-1 Edition: 2006 OMB No. 1660-0022 Expires: June 30, 2007 Public reporting burden for this information collection is estimated at 35 hours for the application and certification process. Burden means the time, effort, and financial resources expended by persons to generate, maintain, retain, disclose, or to provide information to us. You may send comments regarding the burden estimate or any aspect of the collection, including suggestions for reducing the burden to: Information Collections Management, U.S. Department of Homeland Security, Emergency Preparedness and Response Directorate, Federal Emergency Management Agency, 500 C St., S.W., Washington, D.C. 20472, Paperwork Reduction Project (OMB Control Number 1660-0022). You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form. Note: do not send your completed questionnaire to this address. Activity Worksheet No. Title AW-210 AW-214 AW-230 CRS Application Cover Page Recertification Worksheet Modification/Cycle Cover Page AW-310 AW-320 AW-330 AW-340 AW-350 AW-360 Elevation Certificates Map Information Service Outreach Projects Hazard Disclosure Flood Protection Information Flood Protection Assistance AW-410 AW-420 AW-430 AW-430LD AW-440 AW-450 Additional Flood Data Open Space Preservation Higher Regulatory Standards Land Development Criteria Flood Data Maintenance Stormwater Management AW-501 AW-502 AW-510 AW-520 AW-530 AW-540 Repetitive Loss List Repetitive Loss Requirements Floodplain Management Planning Acquisition and Relocation Flood Protection Drainage System Maintenance AW-610 AW-620 AW-630 Flood Warning Program Levee Safety Dam Safety AW-710 AW-720 AW-720m Community Growth Adjustment Community Credit Calculations Community Credit Calculations (Modification) AW-CB AW-CE AW-DB AW-IJ AW-MF AW-SU AW-TS AW-UF Closed Basin Lake Hazards Coastal Erosion Hazards Dunes and Beaches Ice Jam Hazards Mudflow Hazards Land Subsidence Hazards Tsunami Hazards Uncertain Flow Path Hazards OMB No.1660-0022 Expires June 30, 2007 Community : ____________________________ 410 ADDITIONAL FLOOD DATA NOTE: Make a copy of this worksheet for each AFD. This worksheet is for AFD ____ 411 Credit Points: a. NS _____ 1. Delineation of an approximate A Zone: ______ 2. Flood elevations for a site at time of development: ______ 3. New profile or length of shoreline: ______ 4. New profile with floodway or length of shoreline with coastal velocity zone delineation: ______ 5. Repetitive loss area(s): ______ Add lines 1 through 5: NS__= ______ b. LEV__ EITHER 1. Non-FEMA share of study Total cost of study = ______ OR 2. A total of the following: (a) 0.25 if better topographic map was contributed: (b) 0.15 if other contributions were made to the study: = ______ LEV__= ______ c. HSS__ 1. Delineation of an approximate A Zone: ______ 2. Flood elevations for a site at time of development: ______ 3. New profile or length of shoreline: ______ HSS__ = ______ d. FWS__ FWS__ = ______ e. CTP2__ CTP2__ = ______ 412 AFDi ___ Impact Adjustment: a. Option 1: rAFD__ = 1.0 b. Option 2: rAFD__ = 0.25 = ______ c. Option 3: rAFD__ = aAFD aSFHA ______ Activity Worksheet AW-410-1 Edition: 2006 OMB No. 1660-0022 Expires: June 30, 2007 Public reporting burden for this information collection is estimated at 35 hours for the application and certification process. Burden means the time, effort, and financial resources expended by persons to generate, maintain, retain, disclose, or to provide information to us. You may send comments regarding the burden estimate or any aspect of the collection, including suggestions for reducing the burden to: Information Collections Management, U.S. Department of Homeland Security, Emergency Preparedness and Response Directorate, Federal Emergency Management Agency, 500 C St., S.W., Washington, D.C. 20472, Paperwork Reduction Project (OMB Control Number 1660-0022). You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form. Note: do not send your completed questionnaire to this address. Activity Worksheet No. Title AW-210 AW-214 AW-230 CRS Application Cover Page Recertification Worksheet Modification/Cycle Cover Page AW-310 AW-320 AW-330 AW-340 AW-350 AW-360 Elevation Certificates Map Information Service Outreach Projects Hazard Disclosure Flood Protection Information Flood Protection Assistance AW-410 AW-420 AW-430 AW-430LD AW-440 AW-450 Additional Flood Data Open Space Preservation Higher Regulatory Standards Land Development Criteria Flood Data Maintenance Stormwater Management AW-501 AW-502 AW-510 AW-520 AW-530 AW-540 Repetitive Loss List Repetitive Loss Requirements Floodplain Management Planning Acquisition and Relocation Flood Protection Drainage System Maintenance AW-610 AW-620 AW-630 Flood Warning Program Levee Safety Dam Safety AW-710 AW-720 AW-720m Community Growth Adjustment Community Credit Calculations Community Credit Calculations (Modification) AW-CB AW-CE AW-DB AW-IJ AW-MF AW-SU AW-TS AW-UF Closed Basin Lake Hazards Coastal Erosion Hazards Dunes and Beaches Ice Jam Hazards Mudflow Hazards Land Subsidence Hazards Tsunami Hazards Uncertain Flow Path Hazards OMB No.1660-0022 Expires June 30, 2007 Community : ____________________________ 413 Credit Calculation: a. cAFDi = ((NSi x LEVi) + HSSi + FWS) x rAFDi x CTP2i cAFD1 = ((____ x ____) + ____ + ____) x ____ x ____ cAFD1 = ______ cAFD2 = ((____ x ____) + ____ + ____) x ____ x ____ cAFD2 = ______ cAFD3 = ((____ x ____) + ____ + ____) x ____ x ____ cAFD3 = ______ cAFD4 = ((____ x ____) + ____ + ____) x ____ x ____ cAFD4 = ______ cAFD5 = ((____ x ____) + ____ + ____) x ____ x ____ cAFD5 = ______ cAFD6 = ((____ x ____) + ____ + ____) x ____ x ____ cAFD6 = ______ b. ΣAFDi = the total of cAFD1 through cAFD6: ΣAFDi = ______ AFDSH______ (enter total 410 credit from all Special Hazards Worksheets) cAFDSH = AFDSH ______ x CTP2 ______ CTP1 cAFDSH = ______ CTP1 = ______ Add the lines under b above = ______ c410 = value above rounded to the nearest whole number: c410 = ______ Enter this value on AW-720-1. Comments: __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ Activity Worksheet AW-410-2 Edition: 2006 OMB No. 1660-0022 Expires: June 30, 2007 Public reporting burden for this information collection is estimated at 35 hours for the application and certification process. Burden means the time, effort, and financial resources expended by persons to generate, maintain, retain, disclose, or to provide information to us. You may send comments regarding the burden estimate or any aspect of the collection, including suggestions for reducing the burden to: Information Collections Management, U.S. Department of Homeland Security, Emergency Preparedness and Response Directorate, Federal Emergency Management Agency, 500 C St., S.W., Washington, D.C. 20472, Paperwork Reduction Project (OMB Control Number 1660-0022). You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form. Note: do not send your completed questionnaire to this address. Activity Worksheet No. Title AW-210 AW-214 AW-230 CRS Application Cover Page Recertification Worksheet Modification/Cycle Cover Page AW-310 AW-320 AW-330 AW-340 AW-350 AW-360 Elevation Certificates Map Information Service Outreach Projects Hazard Disclosure Flood Protection Information Flood Protection Assistance AW-410 AW-420 AW-430 AW-430LD AW-440 AW-450 Additional Flood Data Open Space Preservation Higher Regulatory Standards Land Development Criteria Flood Data Maintenance Stormwater Management AW-501 AW-502 AW-510 AW-520 AW-530 AW-540 Repetitive Loss List Repetitive Loss Requirements Floodplain Management Planning Acquisition and Relocation Flood Protection Drainage System Maintenance AW-610 AW-620 AW-630 Flood Warning Program Levee Safety Dam Safety AW-710 AW-720 AW-720m Community Growth Adjustment Community Credit Calculations Community Credit Calculations (Modification) AW-CB AW-CE AW-DB AW-IJ AW-MF AW-SU AW-TS AW-UF Closed Basin Lake Hazards Coastal Erosion Hazards Dunes and Beaches Ice Jam Hazards Mudflow Hazards Land Subsidence Hazards Tsunami Hazards Uncertain Flow Path Hazards OMB No.1660-0022 Expires June 30, 2007 Community : ____________________________ 414 Credit Documentation: a. The ordinance or law that adopts the flood study for regulatory purposes. AND / OR ___ The ordinance that requires site-specific flood elevation or floodway studies to be conducted at the time of permit application. b. E ITHER: ___ A copy of each study or an explanation of the technique used and a licensed professional engineer’s statement that the study technique is approved by FEMA. OR ___ A copy of the Flood Insurance Study pages or Letter of Map Revision (LOMR) that show that the study has been accepted by FEMA to revise the FIRM. ___ c. If the community requested credit for the independent review, documentation that the state or other agency reviewed and accepted the study or analysis techniques for which credit is being requested. ___ NS: Documentation that new base flood elevations are higher than those shown in the FIRM. ___ NS: If credit for mapping a repetitive loss area is requested, the area must be identified on a map. ___ HSS: Documentation of the higher study standard used in the flood study. ___ FWS: The state or local law that sets the maximum allowable surcharge used in the study and a copy of the Floodway Data Table or similar documentation that shows the surcharge used in the study. ___ CTP1: Documentation that the community or other entity has signed the CTP agreement. ___ CTP2: Documentation showing the relationship between the study and the CTP agreement. ___ d. LEV: Documentation of the non-FEMA share of the study and who paid for it. ___ e. The Impact Adjustment Map if Option 3 is used. ___ f. CTP2: Documentation that shows the relation between the study or standard and the CTP agreement. The following will be needed at the cycle verification visit: ___ g. [If the community has received credit for a new study (NS) under Section 411.a] A certification by the community’s engineer that its regulatory floodplain maps and related data reflect current conditions. Comments: ________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ Activity Worksheet AW-410-3 Edition: 2006 OMB No. 1660-0022 Expires: June 30, 2007 Public reporting burden for this information collection is estimated at 35 hours for the application and certification process. Burden means the time, effort, and financial resources expended by persons to generate, maintain, retain, disclose, or to provide information to us. You may send comments regarding the burden estimate or any aspect of the collection, including suggestions for reducing the burden to: Information Collections Management, U.S. Department of Homeland Security, Emergency Preparedness and Response Directorate, Federal Emergency Management Agency, 500 C St., S.W., Washington, D.C. 20472, Paperwork Reduction Project (OMB Control Number 1660-0022). You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form. Note: do not send your completed questionnaire to this address. Activity Worksheet No. Title AW-210 AW-214 AW-230 CRS Application Cover Page Recertification Worksheet Modification/Cycle Cover Page AW-310 AW-320 AW-330 AW-340 AW-350 AW-360 Elevation Certificates Map Information Service Outreach Projects Hazard Disclosure Flood Protection Information Flood Protection Assistance AW-410 AW-420 AW-430 AW-430LD AW-440 AW-450 Additional Flood Data Open Space Preservation Higher Regulatory Standards Land Development Criteria Flood Data Maintenance Stormwater Management AW-501 AW-502 AW-510 AW-520 AW-530 AW-540 Repetitive Loss List Repetitive Loss Requirements Floodplain Management Planning Acquisition and Relocation Flood Protection Drainage System Maintenance AW-610 AW-620 AW-630 Flood Warning Program Levee Safety Dam Safety AW-710 AW-720 AW-720m Community Growth Adjustment Community Credit Calculations Community Credit Calculations (Modification) AW-CB AW-CE AW-DB AW-IJ AW-MF AW-SU AW-TS AW-UF Closed Basin Lake Hazards Coastal Erosion Hazards Dunes and Beaches Ice Jam Hazards Mudflow Hazards Land Subsidence Hazards Tsunami Hazards Uncertain Flow Path Hazards OMB No.1660-0022 Expires June 30, 2007 Community : ____________________________ 420 OPEN SPACE PRESERVATION 422 Impact Adjustment: a. Option 1: 1. rOS = 1.0 2. rDR = 1.0 3. rNB = 1.0 b. Option 2: 1. rOS = 0.05 2. rDR = 0.1 3. rNB = 0.1 c. Option 3: 1. rOS = aOS aRF 2. rDR = aDR aRF = 3. rNB = aNB aRF = = 423 Credit Calculation: a. cOS = 725 x rOS ______ cOS = ______ b. cDR = 75 x rDR ______ cDR = ______ c. cNB = 100 x rNB ______ cNB = ______ d. cSHOS (Enter total 420 credit from all Special Hazards Worksheets) e. Add lines a through d above = cSHOS = ______ ______ c420 = value above rounded to the nearest whole number: c420 = ______ Enter this value on AW-720-1. 424 Credit Documentation: ___ a. Provide assurance that eligible properties will remain open with a marked-up copy of the restrictive ordinance language. ___ b. Provide assurance that eligible properties will remain open with a document from the owner(s). ___ c. DR: Attach a copy of the deed restriction(s). ___ d. NB: Attach a copy of the documentation from a professional in a natural science that the parcel has been preserved in or restored to an undeveloped natural state, or is otherwise deserving of preservation because of the natural and beneficial function(s) that it serves. ___ e. The Impact Adjustment Map. ___ f. E ITHER the open space areas are ___ located within the SFHA, OR ___ outside the SFHA and documentation is attached showing that floodplain regulations are in effect in the area outside the SFHA. Activity Worksheet AW-420-1 Edition: 2006 OMB No. 1660-0022 Expires: June 30, 2007 Public reporting burden for this information collection is estimated at 35 hours for the application and certification process. Burden means the time, effort, and financial resources expended by persons to generate, maintain, retain, disclose, or to provide information to us. You may send comments regarding the burden estimate or any aspect of the collection, including suggestions for reducing the burden to: Information Collections Management, U.S. Department of Homeland Security, Emergency Preparedness and Response Directorate, Federal Emergency Management Agency, 500 C St., S.W., Washington, D.C. 20472, Paperwork Reduction Project (OMB Control Number 1660-0022). You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form. Note: do not send your completed questionnaire to this address. Activity Worksheet No. Title AW-210 AW-214 AW-230 CRS Application Cover Page Recertification Worksheet Modification/Cycle Cover Page AW-310 AW-320 AW-330 AW-340 AW-350 AW-360 Elevation Certificates Map Information Service Outreach Projects Hazard Disclosure Flood Protection Information Flood Protection Assistance AW-410 AW-420 AW-430 AW-430LD AW-440 AW-450 Additional Flood Data Open Space Preservation Higher Regulatory Standards Land Development Criteria Flood Data Maintenance Stormwater Management AW-501 AW-502 AW-510 AW-520 AW-530 AW-540 Repetitive Loss List Repetitive Loss Requirements Floodplain Management Planning Acquisition and Relocation Flood Protection Drainage System Maintenance AW-610 AW-620 AW-630 Flood Warning Program Levee Safety Dam Safety AW-710 AW-720 AW-720m Community Growth Adjustment Community Credit Calculations Community Credit Calculations (Modification) AW-CB AW-CE AW-DB AW-IJ AW-MF AW-SU AW-TS AW-UF Closed Basin Lake Hazards Coastal Erosion Hazards Dunes and Beaches Ice Jam Hazards Mudflow Hazards Land Subsidence Hazards Tsunami Hazards Uncertain Flow Path Hazards OMB No.1660-0022 Expires June 30, 2007 Community : ____________________________ Comments: __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ _________________________________________________________________________________ Activity Worksheet AW-420-2 Edition: 2006 OMB No. 1660-0022 Expires: June 30, 2007 Public reporting burden for this information collection is estimated at 35 hours for the application and certification process. Burden means the time, effort, and financial resources expended by persons to generate, maintain, retain, disclose, or to provide information to us. You may send comments regarding the burden estimate or any aspect of the collection, including suggestions for reducing the burden to: Information Collections Management, U.S. Department of Homeland Security, Emergency Preparedness and Response Directorate, Federal Emergency Management Agency, 500 C St., S.W., Washington, D.C. 20472, Paperwork Reduction Project (OMB Control Number 1660-0022). You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form. Note: do not send your completed questionnaire to this address. Activity Worksheet No. Title AW-210 AW-214 AW-230 CRS Application Cover Page Recertification Worksheet Modification/Cycle Cover Page AW-310 AW-320 AW-330 AW-340 AW-350 AW-360 Elevation Certificates Map Information Service Outreach Projects Hazard Disclosure Flood Protection Information Flood Protection Assistance AW-410 AW-420 AW-430 AW-430LD AW-440 AW-450 Additional Flood Data Open Space Preservation Higher Regulatory Standards Land Development Criteria Flood Data Maintenance Stormwater Management AW-501 AW-502 AW-510 AW-520 AW-530 AW-540 Repetitive Loss List Repetitive Loss Requirements Floodplain Management Planning Acquisition and Relocation Flood Protection Drainage System Maintenance AW-610 AW-620 AW-630 Flood Warning Program Levee Safety Dam Safety AW-710 AW-720 AW-720m Community Growth Adjustment Community Credit Calculations Community Credit Calculations (Modification) AW-CB AW-CE AW-DB AW-IJ AW-MF AW-SU AW-TS AW-UF Closed Basin Lake Hazards Coastal Erosion Hazards Dunes and Beaches Ice Jam Hazards Mudflow Hazards Land Subsidence Hazards Tsunami Hazards Uncertain Flow Path Hazards OMB No.1660-0022 Expires June 30, 2007 Community : ____________________________ 430 HIGHER REGULATORY STANDARDS 432 Impact Adjustment: a. Option 1: Enter rOS from AW-420-1. If the community did not apply for Activity 420, then rOS = 0 1. rFRB = 1.0 - rOS ______ = ______ 6. rPSC = 1.0 - rOS ______ = _______ 2. rFDN = 1.0 - rOS ______ = ______ 7. rNBR = 1.0 - rOS ______ = _______ 3. rCSI = 1.0 - rOS ______ = ______ 8. rENL = 1.0 - rOS ______ = _______ 4. rLSI = 1.0 - rOS ______ = ______ 9. rOHS = 1.0 - rOS ______ = _______ 5. rPCF = 1.0 – rOS ______ = ______ 10. rCAZ = 1.0 - rOS ______ = _______ b. Option 2: 1. rFRB = 0.25 6. rPSC = 0.25 2. rFDN = 0.25 7. rNBR = 0.25 3. rCSI = 0.25 8. rENL = 0.25 4. rLSI = 0.25 9. rOHS = 0.25 5. rPCF = 0.25 10. rCAZ = 0.1 c. Option 3: 1. rFRB = aFRB aRF = ______ 6. rPSC = aPSC aRF _____ = ______ 2. rFDN = aFDN aRF = ______ 7. rNBR = aNBR aRF _____ = ______ 3. rCSI = aCSI aRF = ______ 8. rENL = aENL = ______ aRF _____ 4. rLSI = aLSI aRF = ______ 9. rOHS = aOHS aRF _____ 5. rPCF = aPCF a500 = ______ 10. rCAZ = aCAZ = ______ aRF _____ Activity Worksheet AW-430-1 = ______ Edition: 2006 OMB No. 1660-0022 Expires: June 30, 2007 Public reporting burden for this information collection is estimated at 35 hours for the application and certification process. Burden means the time, effort, and financial resources expended by persons to generate, maintain, retain, disclose, or to provide information to us. You may send comments regarding the burden estimate or any aspect of the collection, including suggestions for reducing the burden to: Information Collections Management, U.S. Department of Homeland Security, Emergency Preparedness and Response Directorate, Federal Emergency Management Agency, 500 C St., S.W., Washington, D.C. 20472, Paperwork Reduction Project (OMB Control Number 1660-0022). You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form. Note: do not send your completed questionnaire to this address. Activity Worksheet No. Title AW-210 AW-214 AW-230 CRS Application Cover Page Recertification Worksheet Modification/Cycle Cover Page AW-310 AW-320 AW-330 AW-340 AW-350 AW-360 Elevation Certificates Map Information Service Outreach Projects Hazard Disclosure Flood Protection Information Flood Protection Assistance AW-410 AW-420 AW-430 AW-430LD AW-440 AW-450 Additional Flood Data Open Space Preservation Higher Regulatory Standards Land Development Criteria Flood Data Maintenance Stormwater Management AW-501 AW-502 AW-510 AW-520 AW-530 AW-540 Repetitive Loss List Repetitive Loss Requirements Floodplain Management Planning Acquisition and Relocation Flood Protection Drainage System Maintenance AW-610 AW-620 AW-630 Flood Warning Program Levee Safety Dam Safety AW-710 AW-720 AW-720m Community Growth Adjustment Community Credit Calculations Community Credit Calculations (Modification) AW-CB AW-CE AW-DB AW-IJ AW-MF AW-SU AW-TS AW-UF Closed Basin Lake Hazards Coastal Erosion Hazards Dunes and Beaches Ice Jam Hazards Mudflow Hazards Land Subsidence Hazards Tsunami Hazards Uncertain Flow Path Hazards OMB No.1660-0022 Expires June 30, 2007 Community : ____________________________ 433 Credit Calculation: a. cFRB = FRB ______ x rFRB ______ cFRB = ______ b. cFDN = FDN ______ x rFDN ______ cFDN = ______ c. cCSI = CSI ______ x rCSI _______ cCSI = ______ d. cLSI = LSI ______ x rLSI _______ cLSI = ______ e. cPCF = PCF ______ x rPCF ______ cPCF = ______ f. cPSC = PSC ______ x rPSC ______ cPSC = ______ g. cNBR = NBR ______ x rNBR ______ cNBR = ______ h. cENL = ENL ______ x rENL ______ cENL = ______ i. cOHS = OHS ______ x rOHS ______ cOHS = ______ j. c430LD (from AW-430LD-2 and LD values from Special Hazards Worksheets): c430LD = ______ k. cSH (Enter total 430 credit from all Special Hazards Worksheets): l. SMS cSH = ______ ____ FRB ____ FDN ____ CSI ____ LSI ____ PCF ____ PSC ____ NBR ____ ENL ____ OHS ____ LD ____ SH ____ BC ____ STF ____ MHP ____ CAZ ____ NS ____ HSS ____ FWS ____ OS ____ SMR ____ (Other SMS: ________) ____ (Other SMS: ________) 1. 0.1 x (credit for SMS elements ______ ) 2. Insurance agent training cSMS = the total of 1 and 2 above: = ______ = ______ cSMS = ______ m. BC 1. 15 x (7 – BCEGS rating ______ ) = ______ 2. I-Codes credit IBC ____ + IRC ____ + Other codes_____ = ______ cBC = total of 1 and 2 above: cBC = ______ n. STF 1. All regulatory staff are CFMs (50 points) ______ 2. All development projects reviewed and approved by CFM (25 points) ______ 3. 5 points for each CFM or EMI course graduate (max 25 points) ______ cSTF = 1 or 2 or 3 above: cSTF = ______ o. MHP cMHP = ______ p. cCAZ = CAZ ______x rCAZ ______ cCAZ = ______ q. Add lines a through p above = ______ c430 = value above rounded to the nearest whole number: c430 = ______ Enter this value on AW-720-1. Activity Worksheet AW-430-2 Edition: 2006 OMB No. 1660-0022 Expires: June 30, 2007 Public reporting burden for this information collection is estimated at 35 hours for the application and certification process. Burden means the time, effort, and financial resources expended by persons to generate, maintain, retain, disclose, or to provide information to us. You may send comments regarding the burden estimate or any aspect of the collection, including suggestions for reducing the burden to: Information Collections Management, U.S. Department of Homeland Security, Emergency Preparedness and Response Directorate, Federal Emergency Management Agency, 500 C St., S.W., Washington, D.C. 20472, Paperwork Reduction Project (OMB Control Number 1660-0022). You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form. Note: do not send your completed questionnaire to this address. Activity Worksheet No. Title AW-210 AW-214 AW-230 CRS Application Cover Page Recertification Worksheet Modification/Cycle Cover Page AW-310 AW-320 AW-330 AW-340 AW-350 AW-360 Elevation Certificates Map Information Service Outreach Projects Hazard Disclosure Flood Protection Information Flood Protection Assistance AW-410 AW-420 AW-430 AW-430LD AW-440 AW-450 Additional Flood Data Open Space Preservation Higher Regulatory Standards Land Development Criteria Flood Data Maintenance Stormwater Management AW-501 AW-502 AW-510 AW-520 AW-530 AW-540 Repetitive Loss List Repetitive Loss Requirements Floodplain Management Planning Acquisition and Relocation Flood Protection Drainage System Maintenance AW-610 AW-620 AW-630 Flood Warning Program Levee Safety Dam Safety AW-710 AW-720 AW-720m Community Growth Adjustment Community Credit Calculations Community Credit Calculations (Modification) AW-CB AW-CE AW-DB AW-IJ AW-MF AW-SU AW-TS AW-UF Closed Basin Lake Hazards Coastal Erosion Hazards Dunes and Beaches Ice Jam Hazards Mudflow Hazards Land Subsidence Hazards Tsunami Hazards Uncertain Flow Path Hazards OMB No.1660-0022 Expires June 30, 2007 Community : ____________________________ 434 Credit Documentation: a. Law or ordinance c. Explanation/documentation Language of enforcement procedures Copies of relevant permit records FRB _____ _____ _____ FDN _____ _____ _____ CSI _____ _____ _____ LSI _____ _____ _____ PCF _____ _____ _____ PSC _____ _____ _____ ENL _____ _____ _____ OHS _____ _____ _____ NBR _____ _____ _____ MHP _____ _____ _____ CAZ _____ _____ _____ NBR _____ If credit is for regulations adopted pursuant to a Habitat Conservation Plan, attach the appropriate pages of the plan. LD _____ AW-430LD is attached. SH _____ AW and relevant documentation for each special hazard for which credit is requested is attached. SMS _____ State law or regulation mandating a floodplain management standard is attached. _____ State law or regulation has been approved under Uniform Minimum Credit. _____ State law or regulation mandating flood insurance training for property insurance agents is attached. BC _____ Law or ordinance language adopting I-Codes is attached. MHP _____ Map showing one or more existing manufactured home parks or subdivisions in the regulatory floodplain. The base flood elevations are greater than 3 feet deep in these parks/subdivisions. CAZ _____ Map of the community’s designated Coastal AE Zone. _____ b. Impact Adjustment Option 3 – Attached is the Impact Adjustment Map. _____ d. STF: A copy of the certificate(s) of graduation or CFM certificate(s). Comments: __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ Activity Worksheet AW-430-3 Edition: 2006 OMB No. 1660-0022 Expires: June 30, 2007 Public reporting burden for this information collection is estimated at 35 hours for the application and certification process. Burden means the time, effort, and financial resources expended by persons to generate, maintain, retain, disclose, or to provide information to us. You may send comments regarding the burden estimate or any aspect of the collection, including suggestions for reducing the burden to: Information Collections Management, U.S. Department of Homeland Security, Emergency Preparedness and Response Directorate, Federal Emergency Management Agency, 500 C St., S.W., Washington, D.C. 20472, Paperwork Reduction Project (OMB Control Number 1660-0022). You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form. Note: do not send your completed questionnaire to this address. Activity Worksheet No. Title AW-210 AW-214 AW-230 CRS Application Cover Page Recertification Worksheet Modification/Cycle Cover Page AW-310 AW-320 AW-330 AW-340 AW-350 AW-360 Elevation Certificates Map Information Service Outreach Projects Hazard Disclosure Flood Protection Information Flood Protection Assistance AW-410 AW-420 AW-430 AW-430LD AW-440 AW-450 Additional Flood Data Open Space Preservation Higher Regulatory Standards Land Development Criteria Flood Data Maintenance Stormwater Management AW-501 AW-502 AW-510 AW-520 AW-530 AW-540 Repetitive Loss List Repetitive Loss Requirements Floodplain Management Planning Acquisition and Relocation Flood Protection Drainage System Maintenance AW-610 AW-620 AW-630 Flood Warning Program Levee Safety Dam Safety AW-710 AW-720 AW-720m Community Growth Adjustment Community Credit Calculations Community Credit Calculations (Modification) AW-CB AW-CE AW-DB AW-IJ AW-MF AW-SU AW-TS AW-UF Closed Basin Lake Hazards Coastal Erosion Hazards Dunes and Beaches Ice Jam Hazards Mudflow Hazards Land Subsidence Hazards Tsunami Hazards Uncertain Flow Path Hazards OMB No.1660-0022 Expires June 30, 2007 Community : ____________________________ 430LD LAND DEVELOPMENT CRITERIA 432LD Impact Adjustment: a. Option 1: Enter rOS from AW-420-1. If the community did not apply for Activity 420, then rOS = 0 rLZ__ = 1.0 - rOS ______ = ______ b. Option 2: 1. rLZ__ = 0.05 2. rLZ__ = 0.05 c. Option 3: 1. rLZ___ = aLZ aRF = ______ 2. rLZ___ = aLZ aRF = ______ 3. rLZ___ = aLZ aRF = ______ 433LD Credit Calculation: a. cLZ _ = LZ__ ___ x rLZ__ ____ cLZ__ = ______ cLZ _ = LZ__ ___ x rLZ__ ____ cLZ__ = ______ cLZ _ = LZ__ ___ x rLZ__ ____ cLZ__ = ______ cLDC = LDC ______ cLDC = ______ b. Add the lines above = ______ c430LD = value above rounded to the nearest whole number: c430LD = ______ Enter this value on AW-430-3. 434LD Credit Documentation: ____ a. Ordinance language that adopts the land development criteria or low density zoning. ____ b. The Impact Adjustment Map. ____ c. Attached is an explanation of how the regulations are enforced. ____ d. Attached are examples of developments constructed in accordance with the regulations. Activity Worksheet AW-430LD-1 Edition: 2006 OMB No. 1660-0022 Expires: June 30, 2007 Public reporting burden for this information collection is estimated at 35 hours for the application and certification process. Burden means the time, effort, and financial resources expended by persons to generate, maintain, retain, disclose, or to provide information to us. You may send comments regarding the burden estimate or any aspect of the collection, including suggestions for reducing the burden to: Information Collections Management, U.S. Department of Homeland Security, Emergency Preparedness and Response Directorate, Federal Emergency Management Agency, 500 C St., S.W., Washington, D.C. 20472, Paperwork Reduction Project (OMB Control Number 1660-0022). You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form. Note: do not send your completed questionnaire to this address. Activity Worksheet No. Title AW-210 AW-214 AW-230 CRS Application Cover Page Recertification Worksheet Modification/Cycle Cover Page AW-310 AW-320 AW-330 AW-340 AW-350 AW-360 Elevation Certificates Map Information Service Outreach Projects Hazard Disclosure Flood Protection Information Flood Protection Assistance AW-410 AW-420 AW-430 AW-430LD AW-440 AW-450 Additional Flood Data Open Space Preservation Higher Regulatory Standards Land Development Criteria Flood Data Maintenance Stormwater Management AW-501 AW-502 AW-510 AW-520 AW-530 AW-540 Repetitive Loss List Repetitive Loss Requirements Floodplain Management Planning Acquisition and Relocation Flood Protection Drainage System Maintenance AW-610 AW-620 AW-630 Flood Warning Program Levee Safety Dam Safety AW-710 AW-720 AW-720m Community Growth Adjustment Community Credit Calculations Community Credit Calculations (Modification) AW-CB AW-CE AW-DB AW-IJ AW-MF AW-SU AW-TS AW-UF Closed Basin Lake Hazards Coastal Erosion Hazards Dunes and Beaches Ice Jam Hazards Mudflow Hazards Land Subsidence Hazards Tsunami Hazards Uncertain Flow Path Hazards OMB No.1660-0022 Expires June 30, 2007 Community : ____________________________ To facilitate verification of this activity, please provide the names of the CRS Coordinator and planning director if other than the CRS Coordinator: CRS Coordinator Local Planning Director Name: Title: Phone: Fax: Fax: Address: E-mail: Comments: __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ Activity Worksheet AW-430LD-2 Edition: 2006 OMB No. 1660-0022 Expires: June 30, 2007 Public reporting burden for this information collection is estimated at 35 hours for the application and certification process. Burden means the time, effort, and financial resources expended by persons to generate, maintain, retain, disclose, or to provide information to us. You may send comments regarding the burden estimate or any aspect of the collection, including suggestions for reducing the burden to: Information Collections Management, U.S. Department of Homeland Security, Emergency Preparedness and Response Directorate, Federal Emergency Management Agency, 500 C St., S.W., Washington, D.C. 20472, Paperwork Reduction Project (OMB Control Number 1660-0022). You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form. Note: do not send your completed questionnaire to this address. Activity Worksheet No. Title AW-210 AW-214 AW-230 CRS Application Cover Page Recertification Worksheet Modification/Cycle Cover Page AW-310 AW-320 AW-330 AW-340 AW-350 AW-360 Elevation Certificates Map Information Service Outreach Projects Hazard Disclosure Flood Protection Information Flood Protection Assistance AW-410 AW-420 AW-430 AW-430LD AW-440 AW-450 Additional Flood Data Open Space Preservation Higher Regulatory Standards Land Development Criteria Flood Data Maintenance Stormwater Management AW-501 AW-502 AW-510 AW-520 AW-530 AW-540 Repetitive Loss List Repetitive Loss Requirements Floodplain Management Planning Acquisition and Relocation Flood Protection Drainage System Maintenance AW-610 AW-620 AW-630 Flood Warning Program Levee Safety Dam Safety AW-710 AW-720 AW-720m Community Growth Adjustment Community Credit Calculations Community Credit Calculations (Modification) AW-CB AW-CE AW-DB AW-IJ AW-MF AW-SU AW-TS AW-UF Closed Basin Lake Hazards Coastal Erosion Hazards Dunes and Beaches Ice Jam Hazards Mudflow Hazards Land Subsidence Hazards Tsunami Hazards Uncertain Flow Path Hazards OMB No.1660-0022 Expires June 30, 2007 Community : ____________________________ 440 FLOOD DATA MAINTENANCE 441 Credit Points: a. AMD: 1. Prerequisites: ___ (a) The system is used regularly by the community regulatory staff. ___ (b) New data are added at least annually. ___ (c) Digitized data will be made available annually to FEMA. 2. Credit Points: (a) Regulatory floodplain, corporate limits, streets, and parcels/lots (32 points): ______ (b) Location of buildings (15 points): ______ (c) Floodways or coastal high hazard areas (8 points): ______ (d) Base flood elevations (8 points): ______ (e) FIRM zone attributes (6 points): ______ (f) 500-year elevations or boundaries (8 points): ______ (g) Other natural hazard areas (8 points): ______ (h) Topographic contour lines (10 or 20 points): ______ (i) Floodplain data in tax assessment data base (8 points): ______ (j) Overlays for previous FIRMs (8 points): ______ (k) Other regulatory or mitigation overlays (8 points): ______ AMD = the total of lines (a) through (k) above: AMD = ______ b. ERM: (Credit EITHER a OR b) (a) Periodic checks of reference marks: YCM = number of years between checks: ERM = EITHER: (1) 120 YCM: OR (2) 150 (b) Reference marks checked after notification: d. FM: Activity Worksheet OR (3) 180 = ______ = ______ ERM = ______ FM = ______ AW-440-1 Edition: 2006 OMB No. 1660-0022 Expires: June 30, 2007 Public reporting burden for this information collection is estimated at 35 hours for the application and certification process. Burden means the time, effort, and financial resources expended by persons to generate, maintain, retain, disclose, or to provide information to us. You may send comments regarding the burden estimate or any aspect of the collection, including suggestions for reducing the burden to: Information Collections Management, U.S. Department of Homeland Security, Emergency Preparedness and Response Directorate, Federal Emergency Management Agency, 500 C St., S.W., Washington, D.C. 20472, Paperwork Reduction Project (OMB Control Number 1660-0022). You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form. Note: do not send your completed questionnaire to this address. Activity Worksheet No. Title AW-210 AW-214 AW-230 CRS Application Cover Page Recertification Worksheet Modification/Cycle Cover Page AW-310 AW-320 AW-330 AW-340 AW-350 AW-360 Elevation Certificates Map Information Service Outreach Projects Hazard Disclosure Flood Protection Information Flood Protection Assistance AW-410 AW-420 AW-430 AW-430LD AW-440 AW-450 Additional Flood Data Open Space Preservation Higher Regulatory Standards Land Development Criteria Flood Data Maintenance Stormwater Management AW-501 AW-502 AW-510 AW-520 AW-530 AW-540 Repetitive Loss List Repetitive Loss Requirements Floodplain Management Planning Acquisition and Relocation Flood Protection Drainage System Maintenance AW-610 AW-620 AW-630 Flood Warning Program Levee Safety Dam Safety AW-710 AW-720 AW-720m Community Growth Adjustment Community Credit Calculations Community Credit Calculations (Modification) AW-CB AW-CE AW-DB AW-IJ AW-MF AW-SU AW-TS AW-UF Closed Basin Lake Hazards Coastal Erosion Hazards Dunes and Beaches Ice Jam Hazards Mudflow Hazards Land Subsidence Hazards Tsunami Hazards Uncertain Flow Path Hazards OMB No.1660-0022 Expires June 30, 2007 Community : ____________________________ 442 Impact Adjustment: a. Option 1: rAMD = 1.0 b. Option 2: rAMD = 0.25 c. Option 3: rAMD = aAMD aRF = ______ 443 Credit Calculation: a. cAMD = AMD ______ x rAMD ______ = cAMD = ______ b. ERM: ERM = ______ c. EDM (from AW-CE): EDM= ______ d. FM: FM = ______ Add the lines above = ______ c440 = value above rounded to the nearest whole number: c440 = ______ Enter this value on AW-720-1. 444 Credit Documentation: ____ a. A summary or example showing the types of data in the data maintenance program. ____ b. If the data maintenance program does not include the entire community, the Impact Adjustment Map. ____ c. Copies of the digitized mapping, parcel records, or overlay maps, as appropriate. ____ Copies of the shoreline erosion records. ____ Copies of the old FIRMs, Floodway Maps, Flood Insurance Studies, and/or Flood Hazard Boundary Maps. ____ d. A copy of the master list of elevation reference marks and documentation that shows when they are inspected and repaired or replaced. ____ e. Information on reference marks that appear on the FIRM that were found to be missing or inaccurate. Comments: __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ Activity Worksheet AW-440-2 Edition: 2006 OMB No. 1660-0022 Expires: June 30, 2007 Public reporting burden for this information collection is estimated at 35 hours for the application and certification process. Burden means the time, effort, and financial resources expended by persons to generate, maintain, retain, disclose, or to provide information to us. You may send comments regarding the burden estimate or any aspect of the collection, including suggestions for reducing the burden to: Information Collections Management, U.S. Department of Homeland Security, Emergency Preparedness and Response Directorate, Federal Emergency Management Agency, 500 C St., S.W., Washington, D.C. 20472, Paperwork Reduction Project (OMB Control Number 1660-0022). You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form. Note: do not send your completed questionnaire to this address. Activity Worksheet No. Title AW-210 AW-214 AW-230 CRS Application Cover Page Recertification Worksheet Modification/Cycle Cover Page AW-310 AW-320 AW-330 AW-340 AW-350 AW-360 Elevation Certificates Map Information Service Outreach Projects Hazard Disclosure Flood Protection Information Flood Protection Assistance AW-410 AW-420 AW-430 AW-430LD AW-440 AW-450 Additional Flood Data Open Space Preservation Higher Regulatory Standards Land Development Criteria Flood Data Maintenance Stormwater Management AW-501 AW-502 AW-510 AW-520 AW-530 AW-540 Repetitive Loss List Repetitive Loss Requirements Floodplain Management Planning Acquisition and Relocation Flood Protection Drainage System Maintenance AW-610 AW-620 AW-630 Flood Warning Program Levee Safety Dam Safety AW-710 AW-720 AW-720m Community Growth Adjustment Community Credit Calculations Community Credit Calculations (Modification) AW-CB AW-CE AW-DB AW-IJ AW-MF AW-SU AW-TS AW-UF Closed Basin Lake Hazards Coastal Erosion Hazards Dunes and Beaches Ice Jam Hazards Mudflow Hazards Land Subsidence Hazards Tsunami Hazards Uncertain Flow Path Hazards OMB No.1660-0022 Expires June 30, 2007 Community : ____________________________ 450 STORMWATER MANAGEMENT 451 Credit Points: a. SMR 1. SZ SZ = ______ 2. DS DS = ______ 3. PUB PUB = ______ SMR = the total of lines 1 through 3: SMR = ______ b. SMP 1. The four prerequisites are met (80 points): ______ 2. The plan is also based on the 100-year storm (25 points): ______ 3. The community also manages peaks and volumes (40 points): ______ 4. The community uses the 5-day event (25 points): ______ 5. Identification of wetlands, etc. (15 points): ______ 6. Protection of natural channels (10 points): ______ 7. Requiring “soft” techniques for bank stabilization (10 points): ______ 8. Coordination with the floodplain management plan (20 points): ______ SMP = the total of lines 1 through 8: SMP =______ 452 Impact Adjustment: a. Option 1: 1. rSMR = 1.0 2. rSMP = 1.0 b. Option 2: 1. rSMR = 0.25 2. rSMP = 0.25 c. Option 3: 1. rSMR = aSMR aW = ______ 2. rSMP = aSMP = ______ aW ______ 453 Credit Calculation: a. cSMR = SMR x rSMR cSMR = ______ b. cSMP = SMP x rSMP cSMP = ______ c. FRX = ____ x ____height in feet of lowest floor or opening, OR 50, where site plan accounts for drainage, OR 20, where positive drainage required FRX = ______ d. ESC ESC = ______ e. WQ WQ = ______ Add the lines a—e above = ______ c450 = value above rounded to the nearest whole number: c450 = ______ Enter this value on AW-720-1. Activity Worksheet AW-450-1 Edition: 2006 OMB No. 1660-0022 Expires: June 30, 2007 Public reporting burden for this information collection is estimated at 35 hours for the application and certification process. Burden means the time, effort, and financial resources expended by persons to generate, maintain, retain, disclose, or to provide information to us. You may send comments regarding the burden estimate or any aspect of the collection, including suggestions for reducing the burden to: Information Collections Management, U.S. Department of Homeland Security, Emergency Preparedness and Response Directorate, Federal Emergency Management Agency, 500 C St., S.W., Washington, D.C. 20472, Paperwork Reduction Project (OMB Control Number 1660-0022). You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form. Note: do not send your completed questionnaire to this address. Activity Worksheet No. Title AW-210 AW-214 AW-230 CRS Application Cover Page Recertification Worksheet Modification/Cycle Cover Page AW-310 AW-320 AW-330 AW-340 AW-350 AW-360 Elevation Certificates Map Information Service Outreach Projects Hazard Disclosure Flood Protection Information Flood Protection Assistance AW-410 AW-420 AW-430 AW-430LD AW-440 AW-450 Additional Flood Data Open Space Preservation Higher Regulatory Standards Land Development Criteria Flood Data Maintenance Stormwater Management AW-501 AW-502 AW-510 AW-520 AW-530 AW-540 Repetitive Loss List Repetitive Loss Requirements Floodplain Management Planning Acquisition and Relocation Flood Protection Drainage System Maintenance AW-610 AW-620 AW-630 Flood Warning Program Levee Safety Dam Safety AW-710 AW-720 AW-720m Community Growth Adjustment Community Credit Calculations Community Credit Calculations (Modification) AW-CB AW-CE AW-DB AW-IJ AW-MF AW-SU AW-TS AW-UF Closed Basin Lake Hazards Coastal Erosion Hazards Dunes and Beaches Ice Jam Hazards Mudflow Hazards Land Subsidence Hazards Tsunami Hazards Uncertain Flow Path Hazards OMB No.1660-0022 Expires June 30, 2007 Community : ____________________________ 454 Credit Documentation: a. Stormwater Management Regulation (SMR): 1. A copy of the ordinance or law language regulating surface water runoff from new developments in the watershed. For SMR credit, the language must require that peak runoff from new developments be no greater than the runoff from the site in its pre-development condition. As an alternative to such a performance standard, the language may be based on criteria designed to produce the same result on a regional basis (e.g., a standard allowable discharge per acre based on a regional study). The margin next to where this appears in the ordinance must be marked “SMR.” Ordinance language from other communities within the watershed with the same or similar regulations. The margin next to where this appears in the ordinance must be marked “SMR,” OR Written assurance from a county, regional, or state agency that similar standards are in effect in the upstream communities. Development and permit records that demonstrate enforcement. 2. SZ: The ordinance language that includes the types of development regulated to ensure that peak runoff from new developments be no greater than the runoff from the site in its predevelopment condition. Include the part of the ordinance that specifies exemptions to this requirement. The margin next to where this appears in the ordinance must be marked “SZ.” Ordinance language from other communities within the watershed with the same or similar regulations. The margin next to where this appears in the ordinance must be marked “SZ,” OR . Provide written assurance from a county, regional, or state agency that similar standards are in effect in the upstream communities. 3. DS: The ordinance language that includes the design storm(s) used by the community for stormwater management regulation. This is the recurrence interval for the storm(s) that is/are regulated to prevent increased runoff due to development. If credit is based on language that does not include storm recurrence intervals, the community must provide an estimate of the recurrence intervals. The margin next to where this appears in the ordinance must be marked “DS.” Ordinance language from upstream communities within the watershed with the same or similar regulations. The margin next to where this appears in the ordinance must be marked “DS.” OR Provide written assurance from a county, regional, or state agency that similar standards are in effect in the upstream communities. 4. PUB: The ordinance language that shows that the community has the authority to inspect all private and public stormwater facilities and ensure that they are properly maintained. The margin next to where this appears in the ordinance must be marked “PUB.” Ordinance language that requires that all stormwater facilities be dedicated to the community.” OR Ordinance language that allows community staff to enter private property to inspect stormwater facilities, AND allows community staff to perform necessary maintenance.” OR Ordinance language that requires the owner(s) of private stormwater facilities to have them inspected at least annually by a registered engineer, to perform all maintenance indicated by such inspections, and to submit copies of all inspection reports and maintenance reports to the community. Activity Worksheet AW-450-2 Edition: 2006 OMB No. 1660-0022 Expires: June 30, 2007 Public reporting burden for this information collection is estimated at 35 hours for the application and certification process. Burden means the time, effort, and financial resources expended by persons to generate, maintain, retain, disclose, or to provide information to us. You may send comments regarding the burden estimate or any aspect of the collection, including suggestions for reducing the burden to: Information Collections Management, U.S. Department of Homeland Security, Emergency Preparedness and Response Directorate, Federal Emergency Management Agency, 500 C St., S.W., Washington, D.C. 20472, Paperwork Reduction Project (OMB Control Number 1660-0022). You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form. Note: do not send your completed questionnaire to this address. Activity Worksheet No. Title AW-210 AW-214 AW-230 CRS Application Cover Page Recertification Worksheet Modification/Cycle Cover Page AW-310 AW-320 AW-330 AW-340 AW-350 AW-360 Elevation Certificates Map Information Service Outreach Projects Hazard Disclosure Flood Protection Information Flood Protection Assistance AW-410 AW-420 AW-430 AW-430LD AW-440 AW-450 Additional Flood Data Open Space Preservation Higher Regulatory Standards Land Development Criteria Flood Data Maintenance Stormwater Management AW-501 AW-502 AW-510 AW-520 AW-530 AW-540 Repetitive Loss List Repetitive Loss Requirements Floodplain Management Planning Acquisition and Relocation Flood Protection Drainage System Maintenance AW-610 AW-620 AW-630 Flood Warning Program Levee Safety Dam Safety AW-710 AW-720 AW-720m Community Growth Adjustment Community Credit Calculations Community Credit Calculations (Modification) AW-CB AW-CE AW-DB AW-IJ AW-MF AW-SU AW-TS AW-UF Closed Basin Lake Hazards Coastal Erosion Hazards Dunes and Beaches Ice Jam Hazards Mudflow Hazards Land Subsidence Hazards Tsunami Hazards Uncertain Flow Path Hazards OMB No.1660-0022 Expires June 30, 2007 Community : ____________________________ A list or map that shows the locations of all publicly and privately owned stormwater facilities for which the community is requesting PUB credit. Documentation that shows that all public and private stormwater facilities have been inspected at least annually. This documentation should include a standard operating procedure for inspections and records of actual inspections and maintenance. This documentation is similar to, and may be combined with, documentation for channel debris removal (CDR) in Activity 540. 5. Impact adjustment. E ITHER If the community uses Option 1, it must document that all of the watershed that affects the community is regulated to the same standard. This is true if there is a regional stormwater management standard applied by all upstream communities, or if the community is entirely on an island, and no other communities on the island drain into the community, or if the community’s upstream boundaries exactly match the watershed boundaries. Provide an Impact Adjustment Map that shows the area regulated by the community (usually the community’s boundaries) (marked “aSMR”) and the boundaries of the watershed that affects the community (marked “aW”). aSMR and aW must be equal. OR If the community uses Option 2, rSMR = 0.25 and no documentation is required. OR If the community uses Option 3, it must provide an Impact Adjustment map. Provide an Impact Adjustment map that shows the area regulated by the community (usually the community’s boundaries) (marked “aSMR”) and the boundaries of the watershed that affects the community (marked “aW”). If areas within the upstream watershed are regulated by other communities, their boundaries must also be marked. b. Stormwater Master Plan (SMP): 1. SMP Prerequisites (one prerequisite is credit for SMR): a. Documentation that the community has adopted a stormwater management master plan for one or more of the watersheds that drain into the community. The margin next to where this appears in the documentation must be marked “SMP 1.a.” c. The section of the plan that includes regulatory standards to manage future peak flows so that they do not increase over present values. The margin next to where this appears in the documentation must be marked “SMP 1.c.” d. The section of the plan that includes regulatory standards to manage runoff from all storms up to and including at least the 25-year event. The margin next to where this appears in the documentation must be marked “SMP 1.c.” 2. SMP Credit (Basic credit is provided for meeting the prerequisites): b. Documentation that shows management of peak flows for all storms up to and including the 100-year storm. The margin next to where this appears in the documentation must be marked “SMP 2.b.” c. Documentation that shows management of peak flows AND volumes so that they do not exceed present values. The plan must include either regulations that meet these criteria, or must be based on a rainfall/runoff model that achieves these results. The margin next to where this appears in the documentation must be marked “SMP 2.c.” Activity Worksheet AW-450-3 Edition: 2006 OMB No. 1660-0022 Expires: June 30, 2007 Public reporting burden for this information collection is estimated at 35 hours for the application and certification process. Burden means the time, effort, and financial resources expended by persons to generate, maintain, retain, disclose, or to provide information to us. You may send comments regarding the burden estimate or any aspect of the collection, including suggestions for reducing the burden to: Information Collections Management, U.S. Department of Homeland Security, Emergency Preparedness and Response Directorate, Federal Emergency Management Agency, 500 C St., S.W., Washington, D.C. 20472, Paperwork Reduction Project (OMB Control Number 1660-0022). You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form. Note: do not send your completed questionnaire to this address. Activity Worksheet No. Title AW-210 AW-214 AW-230 CRS Application Cover Page Recertification Worksheet Modification/Cycle Cover Page AW-310 AW-320 AW-330 AW-340 AW-350 AW-360 Elevation Certificates Map Information Service Outreach Projects Hazard Disclosure Flood Protection Information Flood Protection Assistance AW-410 AW-420 AW-430 AW-430LD AW-440 AW-450 Additional Flood Data Open Space Preservation Higher Regulatory Standards Land Development Criteria Flood Data Maintenance Stormwater Management AW-501 AW-502 AW-510 AW-520 AW-530 AW-540 Repetitive Loss List Repetitive Loss Requirements Floodplain Management Planning Acquisition and Relocation Flood Protection Drainage System Maintenance AW-610 AW-620 AW-630 Flood Warning Program Levee Safety Dam Safety AW-710 AW-720 AW-720m Community Growth Adjustment Community Credit Calculations Community Credit Calculations (Modification) AW-CB AW-CE AW-DB AW-IJ AW-MF AW-SU AW-TS AW-UF Closed Basin Lake Hazards Coastal Erosion Hazards Dunes and Beaches Ice Jam Hazards Mudflow Hazards Land Subsidence Hazards Tsunami Hazards Uncertain Flow Path Hazards OMB No.1660-0022 Expires June 30, 2007 Community : ____________________________ d. Documentation that shows management of the runoff from all storms up to and including the 5-day event. If a community can demonstrate that an event shorter than five days is the locally appropriate “worst-case” runoff event for stormwater management, it may receive the credit if it uses that event for its regulatory standard. The margin next to where this appears in the documentation must be marked “SMP 2.d.” e. Documentation that the plan identifies existing wetlands or other natural open space areas to be preserved from development to provide natural attenuation, retention, or detention of runoff. The margin next to where this appears in the documentation must be marked “SMP 2.e.” f. Documentation that the plan prohibits development, alteration, or modification of existing natural channels. The margin next to where this appears in the documentation must be marked “SMP 2.f.” g. Documentation that the plan requires that channel improvement projects use natural or “soft” approaches rather than gabions, riprap, concrete, or other “hard” techniques. The margin next to where this appears in the documentation must be marked “SMP 2.g.” h. Documentation that the plan was prepared in coordination with or as a part of the community's floodplain management plan credited under Activity 510. The margin next to where this appears in the documentation must be marked “SMP 2.h.” EITHER The Floodplain Management Plan is mentioned prominently in the stormwater master plan, and if references in the stormwater master plan demonstrate that it is intended to help implement the Floodplain Management Plan. OR Hydrologic output from the stormwater master plan is used as input for the Floodplain Management Plan. 3. Impact adjustment. Either: If the community uses Option 1, it must document that all of the watershed that affects the community is covered by its stormwater master plan(s). This is true if there is a regional stormwater management plan applied by all upstream communities, or if the community is entirely on an island, and no other communities on the island drain into the community, or if the community’s upstream boundaries exactly match the watershed boundaries. Provide an Impact Adjustment Map that shows the area covered by the watershed master plan(s) (marked “aSMP”) and the boundaries of the watershed that affects the community (marked “aW”). aSMP and aW must be equal. OR If the community uses Option 2, rSMP = 0.25 and no documentation is required. OR If the community uses Option 3, it must provide an Impact Adjustment Map. Provide an Impact Adjustment map that shows the area covered by the watershed master plan(s) (marked “aSMP”) and the boundaries of the watershed that affects the community (marked “aW”). c. Freeboard in B, C, D, and X Zones (FRX): A copy of the ordinance or law language that requires elevation of the lowest floor or lowest opening of new buildings. The margin next to where this appears in the documentation must be marked “FRX.” Development and building permit records that demonstrate enforcement. Activity Worksheet AW-450-4 Edition: 2006 OMB No. 1660-0022 Expires: June 30, 2007 Public reporting burden for this information collection is estimated at 35 hours for the application and certification process. Burden means the time, effort, and financial resources expended by persons to generate, maintain, retain, disclose, or to provide information to us. You may send comments regarding the burden estimate or any aspect of the collection, including suggestions for reducing the burden to: Information Collections Management, U.S. Department of Homeland Security, Emergency Preparedness and Response Directorate, Federal Emergency Management Agency, 500 C St., S.W., Washington, D.C. 20472, Paperwork Reduction Project (OMB Control Number 1660-0022). You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form. Note: do not send your completed questionnaire to this address. Activity Worksheet No. Title AW-210 AW-214 AW-230 CRS Application Cover Page Recertification Worksheet Modification/Cycle Cover Page AW-310 AW-320 AW-330 AW-340 AW-350 AW-360 Elevation Certificates Map Information Service Outreach Projects Hazard Disclosure Flood Protection Information Flood Protection Assistance AW-410 AW-420 AW-430 AW-430LD AW-440 AW-450 Additional Flood Data Open Space Preservation Higher Regulatory Standards Land Development Criteria Flood Data Maintenance Stormwater Management AW-501 AW-502 AW-510 AW-520 AW-530 AW-540 Repetitive Loss List Repetitive Loss Requirements Floodplain Management Planning Acquisition and Relocation Flood Protection Drainage System Maintenance AW-610 AW-620 AW-630 Flood Warning Program Levee Safety Dam Safety AW-710 AW-720 AW-720m Community Growth Adjustment Community Credit Calculations Community Credit Calculations (Modification) AW-CB AW-CE AW-DB AW-IJ AW-MF AW-SU AW-TS AW-UF Closed Basin Lake Hazards Coastal Erosion Hazards Dunes and Beaches Ice Jam Hazards Mudflow Hazards Land Subsidence Hazards Tsunami Hazards Uncertain Flow Path Hazards OMB No.1660-0022 Expires June 30, 2007 Community : ____________________________ d. Erosion and sedimentation control regulations (ESC): A copy of the ordinance or law language that requires developers or property owners to use techniques that prevent erosion and soil loss from exposed land. The ordinance(s) or law must designate an office or official responsible for receiving complaints and monitoring compliance and it must include enforcement and abatement provisions. The margin next to where this appears in the documentation must be marked “ESC.” Development and building permit records that demonstrate enforcement. e. Water quality regulations (WQ): A copy of the ordinance or law language that requires new developments to implement appropriate best management practices to improve water quality. The margin next to where this appears in the documentation must be marked “WQ.” Development and building permit records that demonstrate enforcement. To facilitate verification of this activity, please provide the names of the CRS Coordinator and local stormwater manager if other than the CRS Coordinator: CRS Coordinator Local Stormwater Manager Name: Title: Phone: Fax: Fax: Address: E-mail: Comments: ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ Activity Worksheet AW-450-5 Edition: 2006 OMB No. 1660-0022 Expires: June 30, 2007 Public reporting burden for this information collection is estimated at 35 hours for the application and certification process. Burden means the time, effort, and financial resources expended by persons to generate, maintain, retain, disclose, or to provide information to us. You may send comments regarding the burden estimate or any aspect of the collection, including suggestions for reducing the burden to: Information Collections Management, U.S. Department of Homeland Security, Emergency Preparedness and Response Directorate, Federal Emergency Management Agency, 500 C St., S.W., Washington, D.C. 20472, Paperwork Reduction Project (OMB Control Number 1660-0022). You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form. Note: do not send your completed questionnaire to this address. Activity Worksheet No. Title AW-210 AW-214 AW-230 CRS Application Cover Page Recertification Worksheet Modification/Cycle Cover Page AW-310 AW-320 AW-330 AW-340 AW-350 AW-360 Elevation Certificates Map Information Service Outreach Projects Hazard Disclosure Flood Protection Information Flood Protection Assistance AW-410 AW-420 AW-430 AW-430LD AW-440 AW-450 Additional Flood Data Open Space Preservation Higher Regulatory Standards Land Development Criteria Flood Data Maintenance Stormwater Management AW-501 AW-502 AW-510 AW-520 AW-530 AW-540 Repetitive Loss List Repetitive Loss Requirements Floodplain Management Planning Acquisition and Relocation Flood Protection Drainage System Maintenance AW-610 AW-620 AW-630 Flood Warning Program Levee Safety Dam Safety AW-710 AW-720 AW-720m Community Growth Adjustment Community Credit Calculations Community Credit Calculations (Modification) AW-CB AW-CE AW-DB AW-IJ AW-MF AW-SU AW-TS AW-UF Closed Basin Lake Hazards Coastal Erosion Hazards Dunes and Beaches Ice Jam Hazards Mudflow Hazards Land Subsidence Hazards Tsunami Hazards Uncertain Flow Path Hazards OMB No.1660-0022 Expires June 30, 2007 Community : ____________________________ REPETITIVE LOSS REQUIREMENTS 501 Repetitive Loss List: ___ The community has reviewed the repetitive loss list dated ___________, 200___, and ___ Attached are updated Repetitive Loss Update Worksheets, AW-501. OR ___ There are no changes to FEMA’s repetitive loss list. As the current CRS Coordinator for ______________________[community name], I have examined the repetitive loss data provided for each of our ______[#] assigned repetitive loss properties. For each property in need of update, I have attached an AW-501 that reflects the current and accurate address, the correct NFIP community identification number, and all known mitigation actions with the primary source of funding noted. In addition, to the best of my knowledge and belief, any AW-501 not updated and submitted as part of this application has been checked and is not in need of update at this time. Signature: ___________________________________________ (Community CRS Coordinator) 502 Repetitive Loss Category: After updating, the number of properties counted for CRS purposes is:___ This community is a: ___ Category A community because it has removed all properties from being counted as repetitive loss properties for CRS purposes. ___ Category B community with 1 to 9 properties counted for CRS purposes. OR ___ Category C community with 10 or more properties counted for CRS purposes. N OTE : A LL C ATEGORY B AND C REPETITIVE LOSS COMMUNITIES MUST COMPLETE THE FOLLOWING S ECTION 503 AND SUBMIT THE ACCOMPANYING DOCUMENTATION. CATEGORY C COMMUNITIES MUST ALSO RECEIVE CREDIT FOR A F LOODPLAIN M ANAGEMENT P LAN UNDER A CTIVITY 510 (F LOODPLAIN M ANAGEMENT P LANNING ). A CATEGORY C COMMUNITY WILL REVERT TO C LASS 10 IF IT FAILS TO SUBMIT A PLAN . 503 Repetitive Loss Area Outreach Project: ___ a. A description of the causes of the repetitive flooding. ___ b. A map with the repetitive loss areas identified. ___ c. The addresses for all the properties in the repetitive loss areas. d. The number of buildings in the repetitive loss areas is: ________( = bRLA). ___ e. The outreach project sent to all properties in the repetitive loss areas. The following will be needed at the annual recertification: ___ The outreach project sent to all properties in the repetitive loss areas. Activity Worksheet AW-500-1 Edition: 2006 OMB No. 1660-0022 Expires: June 30, 2007 Public reporting burden for this information collection is estimated at 35 hours for the application and certification process. Burden means the time, effort, and financial resources expended by persons to generate, maintain, retain, disclose, or to provide information to us. You may send comments regarding the burden estimate or any aspect of the collection, including suggestions for reducing the burden to: Information Collections Management, U.S. Department of Homeland Security, Emergency Preparedness and Response Directorate, Federal Emergency Management Agency, 500 C St., S.W., Washington, D.C. 20472, Paperwork Reduction Project (OMB Control Number 1660-0022). You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form. Note: do not send your completed questionnaire to this address. Activity Worksheet No. Title AW-210 AW-214 AW-230 CRS Application Cover Page Recertification Worksheet Modification/Cycle Cover Page AW-310 AW-320 AW-330 AW-340 AW-350 AW-360 Elevation Certificates Map Information Service Outreach Projects Hazard Disclosure Flood Protection Information Flood Protection Assistance AW-410 AW-420 AW-430 AW-430LD AW-440 AW-450 Additional Flood Data Open Space Preservation Higher Regulatory Standards Land Development Criteria Flood Data Maintenance Stormwater Management AW-501 AW-502 AW-510 AW-520 AW-530 AW-540 Repetitive Loss List Repetitive Loss Requirements Floodplain Management Planning Acquisition and Relocation Flood Protection Drainage System Maintenance AW-610 AW-620 AW-630 Flood Warning Program Levee Safety Dam Safety AW-710 AW-720 AW-720m Community Growth Adjustment Community Credit Calculations Community Credit Calculations (Modification) AW-CB AW-CE AW-DB AW-IJ AW-MF AW-SU AW-TS AW-UF Closed Basin Lake Hazards Coastal Erosion Hazards Dunes and Beaches Ice Jam Hazards Mudflow Hazards Land Subsidence Hazards Tsunami Hazards Uncertain Flow Path Hazards OMB No.1660-0022 Expires June 30, 2007 Community : ____________________________ To facilitate verification of this activity, please provide the names of the CRS Coordinator and local repetitive loss contact person, if other than the CRS Coordinator: CRS Coordinator Repetitive Loss Contact Name: Title: Phone: Fax: Fax: Address: E-mail: Comments: __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ Activity Worksheet AW-500-2 Edition: 2006 OMB No. 1660-0022 Expires: June 30, 2007 Public reporting burden for this information collection is estimated at 35 hours for the application and certification process. Burden means the time, effort, and financial resources expended by persons to generate, maintain, retain, disclose, or to provide information to us. You may send comments regarding the burden estimate or any aspect of the collection, including suggestions for reducing the burden to: Information Collections Management, U.S. Department of Homeland Security, Emergency Preparedness and Response Directorate, Federal Emergency Management Agency, 500 C St., S.W., Washington, D.C. 20472, Paperwork Reduction Project (OMB Control Number 1660-0022). You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form. Note: do not send your completed questionnaire to this address. Activity Worksheet No. Title AW-210 AW-214 AW-230 CRS Application Cover Page Recertification Worksheet Modification/Cycle Cover Page AW-310 AW-320 AW-330 AW-340 AW-350 AW-360 Elevation Certificates Map Information Service Outreach Projects Hazard Disclosure Flood Protection Information Flood Protection Assistance AW-410 AW-420 AW-430 AW-430LD AW-440 AW-450 Additional Flood Data Open Space Preservation Higher Regulatory Standards Land Development Criteria Flood Data Maintenance Stormwater Management AW-501 AW-502 AW-510 AW-520 AW-530 AW-540 Repetitive Loss List Repetitive Loss Requirements Floodplain Management Planning Acquisition and Relocation Flood Protection Drainage System Maintenance AW-610 AW-620 AW-630 Flood Warning Program Levee Safety Dam Safety AW-710 AW-720 AW-720m Community Growth Adjustment Community Credit Calculations Community Credit Calculations (Modification) AW-CB AW-CE AW-DB AW-IJ AW-MF AW-SU AW-TS AW-UF Closed Basin Lake Hazards Coastal Erosion Hazards Dunes and Beaches Ice Jam Hazards Mudflow Hazards Land Subsidence Hazards Tsunami Hazards Uncertain Flow Path Hazards Activity Worksheet AW-510-1 4. Assess the hazard. a. Plan includes an assessment of the flood hazard (REQUIRED) with: (1) A map of known flood hazards (5) (2) A description of known flood hazard (5) (3) A discussion of past floods (5) b. The plan describes other natural hazards (REQUIRED FOR DMA) (5) 3. Coordinate with other agencies. a. Review of existing studies and plans (REQUIRED) (3) b. Invited neighboring communities and other agencies (REQUIRED) (1) c. Contacted communities and NFIP and EM agencies (4) d. NWS, ARC and others are asked how they can help community (4) e. Meetings are held with agencies on mitigation strategies (10) f. Draft action plan sent to agencies for comments (3) 2. Involve the public. a. Planning process conducted through a planning committee (40) b. Public meetings held at the beginning of the planning process (15) c. Public meeting held on draft plan (15) d. Questionnaires ask the public for information (5) e. Recommendations are solicited from advisory groups, etc. (5) f . Other public information activities to encourage input (5) 1. Organize to prepare the plan. a. Supervision or direction of a professional planner (2) b. Planning committee of department staff (6) c. Process formally created by the community’s governing board (2) CRS Step Section/Page 511.a Floodplain Management Planning (FMP) Credit Points: Enter the section or page number in the plan where each credited item can be found. 510 FLOODPLAIN MANAGEMENT PLANNING Step Total Edition: 2006 Score Item Community : ____________________________ OMB No.1660-0022 Expires June 30, 2007 CRS Application Cover Page Recertification Worksheet Modification/Cycle Cover Page Elevation Certificates Map Information Service Outreach Projects Hazard Disclosure Flood Protection Information Flood Protection Assistance Additional Flood Data Open Space Preservation Higher Regulatory Standards Land Development Criteria Flood Data Maintenance Stormwater Management Repetitive Loss List Repetitive Loss Requirements Floodplain Management Planning Acquisition and Relocation Flood Protection Drainage System Maintenance Flood Warning Program Levee Safety Dam Safety Community Growth Adjustment Community Credit Calculations Community Credit Calculations (Modification) AW-310 AW-320 AW-330 AW-340 AW-350 AW-360 AW-410 AW-420 AW-430 AW-430LD AW-440 AW-450 AW-501 AW-502 AW-510 AW-520 AW-530 AW-540 AW-610 AW-620 AW-630 AW-710 AW-720 AW-720m AW-CB AW-CE AW-DB AW-IJ AW-MF AW-SU AW-TS AW-UF Activity Worksheet No. Title AW-210 AW-214 AW-230 Activity Worksheet No. Title Closed Basin Lake Hazards Coastal Erosion Hazards Dunes and Beaches Ice Jam Hazards Mudflow Hazards Land Subsidence Hazards Tsunami Hazards Uncertain Flow Path Hazards Public reporting burden for this information collection is estimated at 35 hours for the application and certification process. Burden means the time, effort, and financial resources expended by persons to generate, maintain, retain, disclose, or to provide information to us. You may send comments regarding the burden estimate or any aspect of the collection, including suggestions for reducing the burden to: Information Collections Management, U.S. Department of Homeland Security, Emergency Preparedness and Response Directorate, Federal Emergency Management Agency, 500 C St., S.W., Washington, D.C. 20472, Paperwork Reduction Project (OMB Control Number 1660-0022). You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form. Note: do not send your completed questionnaire to this address. OMB No. 1660-0022 Expires: June 30, 2007 Activity Worksheet AW-510-2 8. Draft an action plan. Actions must be prioritized (REQUIRED) a. Recommendations for activities from two of the six categories (10) b. Recommendations for activities from three of the six categories (20) c. Recommendations for activities from four of the six categories (30) d. Recommendations for activities from five of the six categories (45) e. Post-disaster mitigation policies and procedures (10) f . Recommendations from Habitat Conservation Plan (10) g. Action items for mitigation of other hazards (5) 7. Review possible activities. a. Preventive activities (5) b. Property protection activities (5) c. Natural resource protection activities (5) d. Emergency services activities (5) e. Structural projects (5) f . Public information activities (5) 6. Set goals. (REQUIRED) (2) 5. Assess the problem. a. Summary of each hazard identified in the hazard assessment and their community impact (REQUIRED) (2) b. Description of the impact of the hazards on: (1) Life, safety, health, procedures for warning and evacuation (5) (2) Critical facilities and infrastructure (5) (3) The community’s economy and tax base (5) c. Number and types of buildings subject to the hazards (5) d. Review of all flood insurance claims (4) e. Natural and beneficial functions (4) f. Development, redevelopment, and population trends (5) CRS Step Section/Page Total Edition: 2006 Score Community : ____________________________ OMB No.1660-0022 Expires June 30, 2007 CRS Application Cover Page Recertification Worksheet Modification/Cycle Cover Page Elevation Certificates Map Information Service Outreach Projects Hazard Disclosure Flood Protection Information Flood Protection Assistance Additional Flood Data Open Space Preservation Higher Regulatory Standards Land Development Criteria Flood Data Maintenance Stormwater Management Repetitive Loss List Repetitive Loss Requirements Floodplain Management Planning Acquisition and Relocation Flood Protection Drainage System Maintenance Flood Warning Program Levee Safety Dam Safety Community Growth Adjustment Community Credit Calculations Community Credit Calculations (Modification) AW-310 AW-320 AW-330 AW-340 AW-350 AW-360 AW-410 AW-420 AW-430 AW-430LD AW-440 AW-450 AW-501 AW-502 AW-510 AW-520 AW-530 AW-540 AW-610 AW-620 AW-630 AW-710 AW-720 AW-720m AW-CB AW-CE AW-DB AW-IJ AW-MF AW-SU AW-TS AW-UF Activity Worksheet No. Title AW-210 AW-214 AW-230 Activity Worksheet No. Title Closed Basin Lake Hazards Coastal Erosion Hazards Dunes and Beaches Ice Jam Hazards Mudflow Hazards Land Subsidence Hazards Tsunami Hazards Uncertain Flow Path Hazards Public reporting burden for this information collection is estimated at 35 hours for the application and certification process. Burden means the time, effort, and financial resources expended by persons to generate, maintain, retain, disclose, or to provide information to us. You may send comments regarding the burden estimate or any aspect of the collection, including suggestions for reducing the burden to: Information Collections Management, U.S. Department of Homeland Security, Emergency Preparedness and Response Directorate, Federal Emergency Management Agency, 500 C St., S.W., Washington, D.C. 20472, Paperwork Reduction Project (OMB Control Number 1660-0022). You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form. Note: do not send your completed questionnaire to this address. OMB No. 1660-0022 Expires: June 30, 2007 Section/Page FMP= Score Total Activity Worksheet AW-510-3 ___ g. An update to the floodplain management or hazard mitigation plan. The following will be needed at least every five years: ___ f. An annual report on evaluating progress toward implementing the action plan’s objectives. The following will be needed at the annual recertification: ___ d. Documentation showing that the plan was adopted by the community’s governing board. Edition: 2006 ___ c. Documentation showing how the public was involved in preparing or reviewing the plan, including a copy of the notice(s) advising residents about the public meeting(s) held pursuant to steps 2(b) and (c), and a record of the meeting(s). ___ b. A copy of the floodplain management plan, hazard mitigation plan, and/or Habitat Conservation Plan. ___ a. FMP: The completed CRS activity worksheet (AW-510-1−510-3) or the mitigation plan review crosswalk. 514 Credit Documentation: Add the totals for steps 1 through 10 above: 10. Implement, evaluate and revise. a. Procedures to monitor and recommend revisions (REQUIRED) (2) b. Same planning committee or successor committee that qualifies under Section 511.a.2(a) does the evaluation (13) 9. Adopt the plan. (2) CRS Step Community : ____________________________ OMB No.1660-0022 Expires June 30, 2007 CRS Application Cover Page Recertification Worksheet Modification/Cycle Cover Page Elevation Certificates Map Information Service Outreach Projects Hazard Disclosure Flood Protection Information Flood Protection Assistance Additional Flood Data Open Space Preservation Higher Regulatory Standards Land Development Criteria Flood Data Maintenance Stormwater Management Repetitive Loss List Repetitive Loss Requirements Floodplain Management Planning Acquisition and Relocation Flood Protection Drainage System Maintenance Flood Warning Program Levee Safety Dam Safety Community Growth Adjustment Community Credit Calculations Community Credit Calculations (Modification) AW-310 AW-320 AW-330 AW-340 AW-350 AW-360 AW-410 AW-420 AW-430 AW-430LD AW-440 AW-450 AW-501 AW-502 AW-510 AW-520 AW-530 AW-540 AW-610 AW-620 AW-630 AW-710 AW-720 AW-720m AW-CB AW-CE AW-DB AW-IJ AW-MF AW-SU AW-TS AW-UF Activity Worksheet No. Title AW-210 AW-214 AW-230 Activity Worksheet No. Title Closed Basin Lake Hazards Coastal Erosion Hazards Dunes and Beaches Ice Jam Hazards Mudflow Hazards Land Subsidence Hazards Tsunami Hazards Uncertain Flow Path Hazards Public reporting burden for this information collection is estimated at 35 hours for the application and certification process. Burden means the time, effort, and financial resources expended by persons to generate, maintain, retain, disclose, or to provide information to us. You may send comments regarding the burden estimate or any aspect of the collection, including suggestions for reducing the burden to: Information Collections Management, U.S. Department of Homeland Security, Emergency Preparedness and Response Directorate, Federal Emergency Management Agency, 500 C St., S.W., Washington, D.C. 20472, Paperwork Reduction Project (OMB Control Number 1660-0022). You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form. Note: do not send your completed questionnaire to this address. OMB No. 1660-0022 Expires: June 30, 2007 Step 2. Data were collected on each building and the cause(s) of the repetitive flood damage was determined. Step 3. Alternative mitigation approaches were reviewed to determine whether any property protection measures or drainage improvements are feasible. Step 4. Agencies or organizations that may have plans that could affect the cause or impacts of the flooding were contacted. Step 5. Document the findings, including a map showing all parcels in the area, recommendations, and how the recommendations will be funded. ____ ____ ____ ____ b. The number of buildings in all of the community’s repetitive loss areas (bRLA) _____________. a. The number of buildings in the repetitive loss areas where the analyses have been completed (bAA) ____________. If the community did not conduct analyses of all the repetitive loss areas, provide the following: RLAA: The completed CRS activity worksheet (AW-510-4) for each analysis. Activity Worksheet AW-510-4 Edition: 2006 ___ f. An annual report on evaluating progress toward implementing the action plan’s objectives and/or the recommendations of the area analyses. A single report may be prepared for all analyses. The following will be needed at the annual recertification: ___ e. A copy of each repetitive loss area analysis to be credited and a memo or other documentation showing that the head of the appropriate department has approved it. The National Flood Mitigation Data Collection Tool database file must also be provided, if requested. ___ 514 Credit Documentation: ____ ____4. A memo or other documentation showing that the head of the appropriate department has approved the analysis. Step 1. Property owners were advised that the analysis would be conducted. ____ 3. Enter the section or page number in the analysis where each credited item can be found. ___ 2. Upon request, provide the data collected on each building in the area(s) using the “limited data view” of the National Flood Mitigation Data Collection Tool. ___ 1. Show that all repetitive loss areas are mapped as described in Section 503.b. Complete one copy of this page for each analysis. 511.b Repetitive Loss Area Analysis (RLAA) Credit Points: Community : ____________________________ OMB No.1660-0022 Expires June 30, 2007 CRS Application Cover Page Recertification Worksheet Modification/Cycle Cover Page Elevation Certificates Map Information Service Outreach Projects Hazard Disclosure Flood Protection Information Flood Protection Assistance Additional Flood Data Open Space Preservation Higher Regulatory Standards Land Development Criteria Flood Data Maintenance Stormwater Management Repetitive Loss List Repetitive Loss Requirements Floodplain Management Planning Acquisition and Relocation Flood Protection Drainage System Maintenance Flood Warning Program Levee Safety Dam Safety Community Growth Adjustment Community Credit Calculations Community Credit Calculations (Modification) AW-310 AW-320 AW-330 AW-340 AW-350 AW-360 AW-410 AW-420 AW-430 AW-430LD AW-440 AW-450 AW-501 AW-502 AW-510 AW-520 AW-530 AW-540 AW-610 AW-620 AW-630 AW-710 AW-720 AW-720m AW-CB AW-CE AW-DB AW-IJ AW-MF AW-SU AW-TS AW-UF Activity Worksheet No. Title AW-210 AW-214 AW-230 Activity Worksheet No. Title Closed Basin Lake Hazards Coastal Erosion Hazards Dunes and Beaches Ice Jam Hazards Mudflow Hazards Land Subsidence Hazards Tsunami Hazards Uncertain Flow Path Hazards Public reporting burden for this information collection is estimated at 35 hours for the application and certification process. Burden means the time, effort, and financial resources expended by persons to generate, maintain, retain, disclose, or to provide information to us. You may send comments regarding the burden estimate or any aspect of the collection, including suggestions for reducing the burden to: Information Collections Management, U.S. Department of Homeland Security, Emergency Preparedness and Response Directorate, Federal Emergency Management Agency, 500 C St., S.W., Washington, D.C. 20472, Paperwork Reduction Project (OMB Control Number 1660-0022). You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form. Note: do not send your completed questionnaire to this address. OMB No. 1660-0022 Expires: June 30, 2007 c510 = ______ ______ cHCP = ______ cRLAA = ______ cFMP = ______ Activity Worksheet AW-510-5 Edition: 2006 ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ Comments: Enter this value on AW-720-1. c510 = value above rounded to the nearest whole number: Add the lines above = HCP ______ RLAA ______ x rRLAA ______ b. FMP ______ x rFMP ______ a. FMP = ______. If any of the step totals in subsections 511.a.1–10 is 0, then FMP = 0. 513 Credit Calculation: rRLAA = bAA__________ = ________ bRLA ________ c. Option 3. rRLAA = 0.25 rFMP = 0.25 b. Option 2: rRLAA = 1.0 rFMP = 1.0 a. Option 1: 512 Impact Adjustment: Community : ____________________________ OMB No.1660-0022 Expires June 30, 2007 CRS Application Cover Page Recertification Worksheet Modification/Cycle Cover Page Elevation Certificates Map Information Service Outreach Projects Hazard Disclosure Flood Protection Information Flood Protection Assistance Additional Flood Data Open Space Preservation Higher Regulatory Standards Land Development Criteria Flood Data Maintenance Stormwater Management Repetitive Loss List Repetitive Loss Requirements Floodplain Management Planning Acquisition and Relocation Flood Protection Drainage System Maintenance Flood Warning Program Levee Safety Dam Safety Community Growth Adjustment Community Credit Calculations Community Credit Calculations (Modification) AW-310 AW-320 AW-330 AW-340 AW-350 AW-360 AW-410 AW-420 AW-430 AW-430LD AW-440 AW-450 AW-501 AW-502 AW-510 AW-520 AW-530 AW-540 AW-610 AW-620 AW-630 AW-710 AW-720 AW-720m AW-CB AW-CE AW-DB AW-IJ AW-MF AW-SU AW-TS AW-UF Activity Worksheet No. Title AW-210 AW-214 AW-230 Activity Worksheet No. Title Closed Basin Lake Hazards Coastal Erosion Hazards Dunes and Beaches Ice Jam Hazards Mudflow Hazards Land Subsidence Hazards Tsunami Hazards Uncertain Flow Path Hazards Public reporting burden for this information collection is estimated at 35 hours for the application and certification process. Burden means the time, effort, and financial resources expended by persons to generate, maintain, retain, disclose, or to provide information to us. You may send comments regarding the burden estimate or any aspect of the collection, including suggestions for reducing the burden to: Information Collections Management, U.S. Department of Homeland Security, Emergency Preparedness and Response Directorate, Federal Emergency Management Agency, 500 C St., S.W., Washington, D.C. 20472, Paperwork Reduction Project (OMB Control Number 1660-0022). You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form. Note: do not send your completed questionnaire to this address. OMB No. 1660-0022 Expires: June 30, 2007 OMB No.1660-0022 Expires June 30, 2007 Community : ____________________________ 520 ACQUISITION AND RELOCATION 522 Impact Adjustment: a. Option 1: (bAR _____ x 5) + (bRL _____ x 10) + (bSRL _____ x 15) = ______. Under Option 1, the maximum value for bAR, bRL or bSRL is 20. The maximum credit for c520 under Option 1 is 300. b. Option 2: rAR = 100 x (bAR bSF ) + (3 x bSRL + bSRL _____ )) = ______ a. Option 1: c520 = (bAR ____ x 5) + (bRL)____ x 10) + (bSRL _____ x 15) = ______ + bAR + (2 x bRL + bRL rAR cannot be greater than 100.0. 523 Credit Calculation: b. Option 2: c520 = 32 x rAR ______ = ______ c520 = value above rounded to the nearest whole number: ______ c520 = ______ Enter this value on AW-720-1. 524 Credit Documentation: ___ a. A map showing the location of parcels where buildings have been demolished or relocated since the effective date of the FIRM and the total number of such buildings. ___ b. Documentation showing that each site credited can also qualify for credit as preserved open space. ___ c. Impact Adjustment Option 2 – Calculations showing the number of buildings in the SFHA (bSF). ___ d. Real estate or permit records that document the date of removal of each building. ___ e. Either the non-repetitive loss buildings (bAR) are ___ located within the SFHA OR ___ outside the SFHA and documentation is attached showing that floodplain regulations are in effect in the area outside the SFHA. 504 National Flood Insurance Reform Act of 1994: ___ No projects with CRS credit were funded with Flood Mitigation Assistance Program Funds. ___ Flood Mitigation Assistance Program Funds were used to finance the acquisition and relocation of ____ buildings which are on the list of buildings for CRS credit. Comments: ________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ ________________________________________________________________________________ Activity Worksheet AW-520-1 Edition: 2006 OMB No. 1660-0022 Expires: June 30, 2007 Public reporting burden for this information collection is estimated at 35 hours for the application and certification process. Burden means the time, effort, and financial resources expended by persons to generate, maintain, retain, disclose, or to provide information to us. You may send comments regarding the burden estimate or any aspect of the collection, including suggestions for reducing the burden to: Information Collections Management, U.S. Department of Homeland Security, Emergency Preparedness and Response Directorate, Federal Emergency Management Agency, 500 C St., S.W., Washington, D.C. 20472, Paperwork Reduction Project (OMB Control Number 1660-0022). You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form. Note: do not send your completed questionnaire to this address. Activity Worksheet No. Title AW-210 AW-214 AW-230 CRS Application Cover Page Recertification Worksheet Modification/Cycle Cover Page AW-310 AW-320 AW-330 AW-340 AW-350 AW-360 Elevation Certificates Map Information Service Outreach Projects Hazard Disclosure Flood Protection Information Flood Protection Assistance AW-410 AW-420 AW-430 AW-430LD AW-440 AW-450 Additional Flood Data Open Space Preservation Higher Regulatory Standards Land Development Criteria Flood Data Maintenance Stormwater Management AW-501 AW-502 AW-510 AW-520 AW-530 AW-540 Repetitive Loss List Repetitive Loss Requirements Floodplain Management Planning Acquisition and Relocation Flood Protection Drainage System Maintenance AW-610 AW-620 AW-630 Flood Warning Program Levee Safety Dam Safety AW-710 AW-720 AW-720m Community Growth Adjustment Community Credit Calculations Community Credit Calculations (Modification) AW-CB AW-CE AW-DB AW-IJ AW-MF AW-SU AW-TS AW-UF Closed Basin Lake Hazards Coastal Erosion Hazards Dunes and Beaches Ice Jam Hazards Mudflow Hazards Land Subsidence Hazards Tsunami Hazards Uncertain Flow Path Hazards OMB No.1660-0022 Expires June 30, 2007 Community : ____________________________ 530 FLOOD PROTECTION 532 Impact Adjustment: a. Option 1. Number of protected non-repetitive loss buildings in the regulatory floodplain: _____ Number of protected non-Severe Repetitive Loss buildings ___ x 2 = _____ Number of protected Severe Repetitive Loss buildings ___ x 3 = _____ Add the above lines _____ rPB = 0.15 x the total of the above ____ b. Option 2. rPB = 100 x PB bSF ______ = ______ = ______ 533 Credit Calculation: 28 x rPB ______ = ______ c530 = value above rounded to the nearest whole number: c530 = ______ Enter this value on AW-720-1. 534 Credit Documentation: ___ a. and b. Elevation certificates, completed AW-530-3, or other documentation that shows that each protection project meets this activity’s prerequisites and shows the type of protection measure and protection level for each retrofitted building. ___ c. A map showing the location of all protected buildings for which credit is being applied. ___ d. Impact Adjustment Option 2 – Calculations showing the number of buildings in the SFHA (bSF). ___ e. Either the non-repetitive loss protected buildings are _____ located within the SFHA OR ___ outside the SFHA and documentation is attached showing that floodplain regulations are in effect in the area outside the SFHA. 504 National Flood Insurance Reform Act of 1994: ___ No projects with CRS credit were funded with Flood Mitigation Assistance program funds. ___ Flood Mitigation Assistance program funds were used to finance the protection of ______ buildings which are on the list of buildings for CRS credit. Comments: __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ Activity Worksheet AW-530-1 Edition: 2006 OMB No. 1660-0022 Expires: June 30, 2007 Public reporting burden for this information collection is estimated at 35 hours for the application and certification process. Burden means the time, effort, and financial resources expended by persons to generate, maintain, retain, disclose, or to provide information to us. You may send comments regarding the burden estimate or any aspect of the collection, including suggestions for reducing the burden to: Information Collections Management, U.S. Department of Homeland Security, Emergency Preparedness and Response Directorate, Federal Emergency Management Agency, 500 C St., S.W., Washington, D.C. 20472, Paperwork Reduction Project (OMB Control Number 1660-0022). You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form. Note: do not send your completed questionnaire to this address. Activity Worksheet No. Title AW-210 AW-214 AW-230 CRS Application Cover Page Recertification Worksheet Modification/Cycle Cover Page AW-310 AW-320 AW-330 AW-340 AW-350 AW-360 Elevation Certificates Map Information Service Outreach Projects Hazard Disclosure Flood Protection Information Flood Protection Assistance AW-410 AW-420 AW-430 AW-430LD AW-440 AW-450 Additional Flood Data Open Space Preservation Higher Regulatory Standards Land Development Criteria Flood Data Maintenance Stormwater Management AW-501 AW-502 AW-510 AW-520 AW-530 AW-540 Repetitive Loss List Repetitive Loss Requirements Floodplain Management Planning Acquisition and Relocation Flood Protection Drainage System Maintenance AW-610 AW-620 AW-630 Flood Warning Program Levee Safety Dam Safety AW-710 AW-720 AW-720m Community Growth Adjustment Community Credit Calculations Community Credit Calculations (Modification) AW-CB AW-CE AW-DB AW-IJ AW-MF AW-SU AW-TS AW-UF Closed Basin Lake Hazards Coastal Erosion Hazards Dunes and Beaches Ice Jam Hazards Mudflow Hazards Land Subsidence Hazards Tsunami Hazards Uncertain Flow Path Hazards OMB No.1660-0022 Expires June 30, 2007 Community : ____________________________ 531 RETROFITTED BUILDINGS If the building is a repetitive loss or Severe Repetitive Loss building, use ditto marks and enter the same address two or three times as appropriate. Building # Address FPP - FPB = FPI x TU = FPI x TU ___ ____________________________ ______ - ______ = ______ x ______ = ______ ___ ____________________________ ______ - ______ = ______ x ______ = ______ ___ ____________________________ ______ - ______ = ______ x ______ = ______ ___ ____________________________ ______ - ______ = ______ x ______ = ______ ___ ____________________________ ______ - ______ = ______ x ______ = ______ ___ ____________________________ ______ - ______ = ______ x ______ = ______ ___ ____________________________ ______ - ______ = ______ x ______ = ______ ___ ____________________________ ______ - ______ = ______ x ______ = ______ ___ ____________________________ ______ - ______ = ______ x ______ = ______ ___ ____________________________ ______ - ______ = ______ x ______ = ______ ___ ____________________________ ______ - ______ = ______ x ______ = ______ ___ ____________________________ ______ - ______ = ______ x ______ = ______ ___ ____________________________ ______ - ______ = ______ x ______ = ______ ___ ____________________________ ______ - ______ = ______ x ______ = ______ ___ ____________________________ ______ - ______ = ______ x ______ = ______ ___ ____________________________ ______ - ______ = ______ x ______ = ______ ___ ____________________________ ______ - ______ = ______ x ______ = ______ ___ ____________________________ ______ - ______ = ______ x ______ = ______ ___ ____________________________ ______ - ______ = ______ x ______ = ______ ___ ____________________________ ______ - ______ = ______ x ______ = ______ ___ ____________________________ ______ - ______ = ______ x ______ = ______ ___ ____________________________ ______ - ______ = ______ x ______ = ______ ___ ____________________________ ______ - ______ = ______ x ______ = ______ ___ ____________________________ ______ - ______ = ______ x ______ = ______ ___ ____________________________ ______ - ______ = ______ x ______ = ______ ___ ____________________________ ______ - ______ = ______ x ______ = ______ Add the lines above: PB = (TUi x FPIi) = ______ Add the total of each page to obtain (TUi x FPIi) for the value of PB. Activity Worksheet AW-530-2 Edition: 2006 OMB No. 1660-0022 Expires: June 30, 2007 Public reporting burden for this information collection is estimated at 35 hours for the application and certification process. Burden means the time, effort, and financial resources expended by persons to generate, maintain, retain, disclose, or to provide information to us. You may send comments regarding the burden estimate or any aspect of the collection, including suggestions for reducing the burden to: Information Collections Management, U.S. Department of Homeland Security, Emergency Preparedness and Response Directorate, Federal Emergency Management Agency, 500 C St., S.W., Washington, D.C. 20472, Paperwork Reduction Project (OMB Control Number 1660-0022). You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form. Note: do not send your completed questionnaire to this address. Activity Worksheet No. Title AW-210 AW-214 AW-230 CRS Application Cover Page Recertification Worksheet Modification/Cycle Cover Page AW-310 AW-320 AW-330 AW-340 AW-350 AW-360 Elevation Certificates Map Information Service Outreach Projects Hazard Disclosure Flood Protection Information Flood Protection Assistance AW-410 AW-420 AW-430 AW-430LD AW-440 AW-450 Additional Flood Data Open Space Preservation Higher Regulatory Standards Land Development Criteria Flood Data Maintenance Stormwater Management AW-501 AW-502 AW-510 AW-520 AW-530 AW-540 Repetitive Loss List Repetitive Loss Requirements Floodplain Management Planning Acquisition and Relocation Flood Protection Drainage System Maintenance AW-610 AW-620 AW-630 Flood Warning Program Levee Safety Dam Safety AW-710 AW-720 AW-720m Community Growth Adjustment Community Credit Calculations Community Credit Calculations (Modification) AW-CB AW-CE AW-DB AW-IJ AW-MF AW-SU AW-TS AW-UF Closed Basin Lake Hazards Coastal Erosion Hazards Dunes and Beaches Ice Jam Hazards Mudflow Hazards Land Subsidence Hazards Tsunami Hazards Uncertain Flow Path Hazards OMB No.1660-0022 Expires June 30, 2007 Community : ____________________________ RETROFITTING WORKSHEET This is an optional form that may be used to record CRS credit criteria for retrofitting projects that are not in a high hazard area and that do not need to be designed or approved by an engineer or architect. Elevated buildings should be documented with a FEMA elevation certificate. Property Address: ___________________________________________________ ___________________________________________________ Permit record. EITHER Permit # _________________ Date of Permit: ______________ OR ___ The project meets all requirements of the regulations currently in effect. ___ The project was completed after the effective date of the initial FIRM. Building/project condition. ___ The building or project appears to be maintained. Human intervention. EITHER: ___ The project does not require human intervention. OR ___ The project requires human intervention and there is adequate warning time. Approximate duration of flood events: ________________ hours/days. High hazard area. EITHER: ___ The building is NOT located in a V Zone, floodway with velocity > 5 feet per second, or an area subject to special hazard. OR ___ The building is located in one of the high hazard areas and the design was certified by a licensed professional engineer or architect. Dry floodproofing. ___ The project was designed by an engineer and the design accounts for interior drainage, seepage, and underdrainage. (TU = 0.6) ___ The project does not depend on human intervention to close openings; the project protects to a level less than 3 feet over the first floor; the design accounts for internal drainage, seepage, and underdrainage; and the building does not have a basement. (TU = 0.4) ___ There is no documentation of how openings, internal drainage, seepage, or underdrainage are handled. (TU = 0.2) Activity Worksheet AW-530-3 Edition: 2006 OMB No. 1660-0022 Expires: June 30, 2007 Public reporting burden for this information collection is estimated at 35 hours for the application and certification process. Burden means the time, effort, and financial resources expended by persons to generate, maintain, retain, disclose, or to provide information to us. You may send comments regarding the burden estimate or any aspect of the collection, including suggestions for reducing the burden to: Information Collections Management, U.S. Department of Homeland Security, Emergency Preparedness and Response Directorate, Federal Emergency Management Agency, 500 C St., S.W., Washington, D.C. 20472, Paperwork Reduction Project (OMB Control Number 1660-0022). You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form. Note: do not send your completed questionnaire to this address. Activity Worksheet No. Title AW-210 AW-214 AW-230 CRS Application Cover Page Recertification Worksheet Modification/Cycle Cover Page AW-310 AW-320 AW-330 AW-340 AW-350 AW-360 Elevation Certificates Map Information Service Outreach Projects Hazard Disclosure Flood Protection Information Flood Protection Assistance AW-410 AW-420 AW-430 AW-430LD AW-440 AW-450 Additional Flood Data Open Space Preservation Higher Regulatory Standards Land Development Criteria Flood Data Maintenance Stormwater Management AW-501 AW-502 AW-510 AW-520 AW-530 AW-540 Repetitive Loss List Repetitive Loss Requirements Floodplain Management Planning Acquisition and Relocation Flood Protection Drainage System Maintenance AW-610 AW-620 AW-630 Flood Warning Program Levee Safety Dam Safety AW-710 AW-720 AW-720m Community Growth Adjustment Community Credit Calculations Community Credit Calculations (Modification) AW-CB AW-CE AW-DB AW-IJ AW-MF AW-SU AW-TS AW-UF Closed Basin Lake Hazards Coastal Erosion Hazards Dunes and Beaches Ice Jam Hazards Mudflow Hazards Land Subsidence Hazards Tsunami Hazards Uncertain Flow Path Hazards OMB No.1660-0022 Expires June 30, 2007 Community : ____________________________ Wet floodproofing. ___ The project was designed by a licensed engineer or architect. (TU = 0.5) ___ The project was not designed by a licensed engineer or architect. (TU = 0.3) ___ The furnace, water heater, electrical breaker box, and other utilities are relocated above flood level. (TU = 0.2) Sewer backup protection. ___ The building is located in the SFHA. (TU = 0.2) ___ The building is located outside of the SFHA and the community has a building code or other regulations that require positive drain sewers or other measures that prevent sewer backup into new buildings. (TU = 0.1) Flood protection improvement (FPI). Before the retrofitting project, the building was protected from the ____-year flood FPB = ____ After the retrofitting project, the building was protected from the ____-year flood FPP = ____ The values for FPB and FPP are: 0.0 for protection to less than the 10-year flood 0.3 for protection to the 10-year flood, but less than the 25-year flood 0.5 for protection to the 25-year flood, but less than the 50-year flood 0.8 for protection to the 50-year flood, but less than the 100-year flood 0.9 for protection to the 100-year flood 1.0 for protection to the 100-year plus one foot or more 1.0 for protection to the 500-year flood Source of flood recurrence interval if other than FIS:___________________________________ CRS scores: TU = FPB = FPP = ___ This property is on the FEMA repetitive loss list. ___ This property is on the FEMA Severe Repetitive Loss list. I certify that the items checked above are correct to the best of my knowledge. Name (signed): ___________________________________________________________ Name (printed): _______________________________________ Date: _______________ Activity Worksheet AW-530-4 Edition: 2006 OMB No. 1660-0022 Expires: June 30, 2007 Public reporting burden for this information collection is estimated at 35 hours for the application and certification process. Burden means the time, effort, and financial resources expended by persons to generate, maintain, retain, disclose, or to provide information to us. You may send comments regarding the burden estimate or any aspect of the collection, including suggestions for reducing the burden to: Information Collections Management, U.S. Department of Homeland Security, Emergency Preparedness and Response Directorate, Federal Emergency Management Agency, 500 C St., S.W., Washington, D.C. 20472, Paperwork Reduction Project (OMB Control Number 1660-0022). You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form. Note: do not send your completed questionnaire to this address. Activity Worksheet No. Title AW-210 AW-214 AW-230 CRS Application Cover Page Recertification Worksheet Modification/Cycle Cover Page AW-310 AW-320 AW-330 AW-340 AW-350 AW-360 Elevation Certificates Map Information Service Outreach Projects Hazard Disclosure Flood Protection Information Flood Protection Assistance AW-410 AW-420 AW-430 AW-430LD AW-440 AW-450 Additional Flood Data Open Space Preservation Higher Regulatory Standards Land Development Criteria Flood Data Maintenance Stormwater Management AW-501 AW-502 AW-510 AW-520 AW-530 AW-540 Repetitive Loss List Repetitive Loss Requirements Floodplain Management Planning Acquisition and Relocation Flood Protection Drainage System Maintenance AW-610 AW-620 AW-630 Flood Warning Program Levee Safety Dam Safety AW-710 AW-720 AW-720m Community Growth Adjustment Community Credit Calculations Community Credit Calculations (Modification) AW-CB AW-CE AW-DB AW-IJ AW-MF AW-SU AW-TS AW-UF Closed Basin Lake Hazards Coastal Erosion Hazards Dunes and Beaches Ice Jam Hazards Mudflow Hazards Land Subsidence Hazards Tsunami Hazards Uncertain Flow Path Hazards OMB No.1660-0022 Expires June 30, 2007 Community : ____________________________ 540 DRAINAGE SYSTEM MAINTENANCE 541 Credit Points: a. CDR 1. 200, if the program includes all four requirements: 2. 50, if there are measures for specific problem sites: 3. 50, if there is a capital improvement program: CDR = the total of lines 1 through 3 above: ______ ______ ______ CDR = ______ 542 Impact Adjustment: a. Option 1: rCDR = 1.0 b. Option 2: rCDR = 0.2 = ______ c. Option 3: rCDR = aCDR aDC ______ 543 Credit Calculation: a. cCDR = CDR ______ x rCDR ______ b. SDR cCDR = ______ SDR = ______ c. cEPM (from AW-CE) cEPM = ______ Add the lines above = c540 = above rounded to nearest whole number: Enter this value on AW-720-1. ______ c540 = ______ 544 Credit Documentation: a. CDR: Drainage inspection and maintenance procedures, instructions, or other documents that explain the community’s routine inspection and debris removal program: 1. Identification of the person or position responsible for the various aspects of the maintenance program; 2. Description of the community’s drainage system and areas subject to the maintenance program; 3. Explanation of the procedures for inspection, including when regular inspections are conducted and how soon inspections are conducted after a complaint or a storm; 4. Explanation of the debris removal procedures, i.e., how soon after an inspection an area must be cleared and what can and cannot be removed; and 5. Samples of records that are kept to document both the inspections and the removal projects. If the community is requesting credit for special inspection and maintenance of problem sites (Section 431.a.2), attach a master list of the community’s drainage maintenance problem sites that are inspected and maintained differently or more frequently. The problem sites must be part of the drainage system that the community has mapped for its CDR credit. Activity Worksheet AW-540-1 Edition: 2006 OMB No. 1660-0022 Expires: June 30, 2007 Public reporting burden for this information collection is estimated at 35 hours for the application and certification process. Burden means the time, effort, and financial resources expended by persons to generate, maintain, retain, disclose, or to provide information to us. You may send comments regarding the burden estimate or any aspect of the collection, including suggestions for reducing the burden to: Information Collections Management, U.S. Department of Homeland Security, Emergency Preparedness and Response Directorate, Federal Emergency Management Agency, 500 C St., S.W., Washington, D.C. 20472, Paperwork Reduction Project (OMB Control Number 1660-0022). You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form. Note: do not send your completed questionnaire to this address. Activity Worksheet No. Title AW-210 AW-214 AW-230 CRS Application Cover Page Recertification Worksheet Modification/Cycle Cover Page AW-310 AW-320 AW-330 AW-340 AW-350 AW-360 Elevation Certificates Map Information Service Outreach Projects Hazard Disclosure Flood Protection Information Flood Protection Assistance AW-410 AW-420 AW-430 AW-430LD AW-440 AW-450 Additional Flood Data Open Space Preservation Higher Regulatory Standards Land Development Criteria Flood Data Maintenance Stormwater Management AW-501 AW-502 AW-510 AW-520 AW-530 AW-540 Repetitive Loss List Repetitive Loss Requirements Floodplain Management Planning Acquisition and Relocation Flood Protection Drainage System Maintenance AW-610 AW-620 AW-630 Flood Warning Program Levee Safety Dam Safety AW-710 AW-720 AW-720m Community Growth Adjustment Community Credit Calculations Community Credit Calculations (Modification) AW-CB AW-CE AW-DB AW-IJ AW-MF AW-SU AW-TS AW-UF Closed Basin Lake Hazards Coastal Erosion Hazards Dunes and Beaches Ice Jam Hazards Mudflow Hazards Land Subsidence Hazards Tsunami Hazards Uncertain Flow Path Hazards OMB No.1660-0022 Expires June 30, 2007 Community : ____________________________ b. CDR: Capital improvement program: If the community is requesting credit for an ongoing program, such as a capital improvements plan, to eliminate or correct problem sites or to construct “low maintenance” channels or other facilities (Section 431.a.3): 1. A master list of the community’s drainage maintenance problem sites that are in need of elimination or correction. The problem sites must be part of the drainage system that the community has mapped for its CDR credit. 2. Recommended correction measures for the problem sites. 3. Documentation that funds are spent on improvement projects each year. c. SDR: Stream dumping regulations: A copy of the regulatory language that prohibits dumping in the community’s drainage system. The ordinance or law must designate an office or official responsible for receiving complaints and monitoring compliance and it must include enforcement and abatement provisions. Mark this documentation “SDR.” d. SDR: Stream dumping regulations publicity – EITHER A copy of the outreach project. OR Photographs of “no dumping” signs. e. CDR: Impact Adjustment Map: A map showing all parts of the surface drainage system in the developed areas of the community and showing those parts that are inspected and maintained under CDR. f. CDR: Records: Copies of inspection and maintenance records. Comments: __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ _________________________________________________________________________________ Activity Worksheet AW-540-2 Edition: 2006 OMB No. 1660-0022 Expires: June 30, 2007 Public reporting burden for this information collection is estimated at 35 hours for the application and certification process. Burden means the time, effort, and financial resources expended by persons to generate, maintain, retain, disclose, or to provide information to us. You may send comments regarding the burden estimate or any aspect of the collection, including suggestions for reducing the burden to: Information Collections Management, U.S. Department of Homeland Security, Emergency Preparedness and Response Directorate, Federal Emergency Management Agency, 500 C St., S.W., Washington, D.C. 20472, Paperwork Reduction Project (OMB Control Number 1660-0022). You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form. Note: do not send your completed questionnaire to this address. Activity Worksheet No. Title AW-210 AW-214 AW-230 CRS Application Cover Page Recertification Worksheet Modification/Cycle Cover Page AW-310 AW-320 AW-330 AW-340 AW-350 AW-360 Elevation Certificates Map Information Service Outreach Projects Hazard Disclosure Flood Protection Information Flood Protection Assistance AW-410 AW-420 AW-430 AW-430LD AW-440 AW-450 Additional Flood Data Open Space Preservation Higher Regulatory Standards Land Development Criteria Flood Data Maintenance Stormwater Management AW-501 AW-502 AW-510 AW-520 AW-530 AW-540 Repetitive Loss List Repetitive Loss Requirements Floodplain Management Planning Acquisition and Relocation Flood Protection Drainage System Maintenance AW-610 AW-620 AW-630 Flood Warning Program Levee Safety Dam Safety AW-710 AW-720 AW-720m Community Growth Adjustment Community Credit Calculations Community Credit Calculations (Modification) AW-CB AW-CE AW-DB AW-IJ AW-MF AW-SU AW-TS AW-UF Closed Basin Lake Hazards Coastal Erosion Hazards Dunes and Beaches Ice Jam Hazards Mudflow Hazards Land Subsidence Hazards Tsunami Hazards Uncertain Flow Path Hazards OMB No.1660-0022 Expires June 30, 2007 Community : ____________________________ 610 FLOOD WARNING PROGRAM 611 Credit Points: a. 2. Flood threat recognition system (FTR): (a) (1) Act on NWS warning (20 points): ______ (2) Prediction model (5 or 20 points): ______ (b) (1) Data collection (15 or 20 points): ______ (2) Gage density (10 points): ______ (3) Prediction model (5 or 10 points): ______ FTR = the total of (a)(1) and (2) OR (b)(1) through (b)(3) above: FTR = ______ b. 2. Emergency warning dissemination (EWD): (a) Adopted policy (10 points): ______ (b) Outdoor system (15 points): ______ (c) Door to door (30 points): ______ (d) Emergency Alert System (10 points): ______ (e) Telephone (15 points): ______ (f) Cable TV override (10 points): ______ (g) AM transmitters (10 points): ______ (h) Other system: ______ EWD = the total of (a) through (h) above. If the total is greater than 60, then EWD = 60.: EWD = ______ c. 2. Other response efforts (ORE): (a) Plan keyed to predicted flood levels (20 points): ______ (b) Plan assigns tasks (10 points): ______ (c) Plan identifies resources needed (20 points): ______ ORE = the total of (a) through (c) above: ORE = ______ d. 2. Critical facilities planning (CFP): (a) CFP1 Names and numbers (10 points): CFP1 = ______ (b) CFP2 Warning coordination (20 points): CFP2 = ______ (c) CFP3 Facilities have own plans (20 points): CFP3 = ______ e. SRC Activity Worksheet SRC = ______ AW-610-1 Edition: 2006 OMB No. 1660-0022 Expires: June 30, 2007 Public reporting burden for this information collection is estimated at 35 hours for the application and certification process. Burden means the time, effort, and financial resources expended by persons to generate, maintain, retain, disclose, or to provide information to us. You may send comments regarding the burden estimate or any aspect of the collection, including suggestions for reducing the burden to: Information Collections Management, U.S. Department of Homeland Security, Emergency Preparedness and Response Directorate, Federal Emergency Management Agency, 500 C St., S.W., Washington, D.C. 20472, Paperwork Reduction Project (OMB Control Number 1660-0022). You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form. Note: do not send your completed questionnaire to this address. Activity Worksheet No. Title AW-210 AW-214 AW-230 CRS Application Cover Page Recertification Worksheet Modification/Cycle Cover Page AW-310 AW-320 AW-330 AW-340 AW-350 AW-360 Elevation Certificates Map Information Service Outreach Projects Hazard Disclosure Flood Protection Information Flood Protection Assistance AW-410 AW-420 AW-430 AW-430LD AW-440 AW-450 Additional Flood Data Open Space Preservation Higher Regulatory Standards Land Development Criteria Flood Data Maintenance Stormwater Management AW-501 AW-502 AW-510 AW-520 AW-530 AW-540 Repetitive Loss List Repetitive Loss Requirements Floodplain Management Planning Acquisition and Relocation Flood Protection Drainage System Maintenance AW-610 AW-620 AW-630 Flood Warning Program Levee Safety Dam Safety AW-710 AW-720 AW-720m Community Growth Adjustment Community Credit Calculations Community Credit Calculations (Modification) AW-CB AW-CE AW-DB AW-IJ AW-MF AW-SU AW-TS AW-UF Closed Basin Lake Hazards Coastal Erosion Hazards Dunes and Beaches Ice Jam Hazards Mudflow Hazards Land Subsidence Hazards Tsunami Hazards Uncertain Flow Path Hazards OMB No.1660-0022 Expires June 30, 2007 Community : ____________________________ 612 Impact Adjustment: a. Option 1: 1. rFTR = 1.0 2. rEWD = 1.0 3. rORE = 1.0 4. rCFP3 = 1.0 b. Option 2: 1. rFTR = 0.25 2. rEWD = 0.25 3. rORE = 0.25 4. rCFP3 = 0.25 c. Option 3: 1. rFTR = bFTR bSF = ______ 2. rEWD = bEWD bSF = ______ = ______ 3. rORE = bORE bSF ______ 613 Credit Calculation: a. cFTR = FTR x rFTR cFTR = ______ b. cEWD = EWD x rEWD cEWD = ______ c. cORE = ORE x rORE cORE = ______ d. cCFP = CFP1 _____ + CFP2 _____ + (CFP3 _____ x rCFP3 _____) cCFP = ______ e. SRC SRC = _______ f. Add lines a through e above = ______ c610 = value above rounded to the nearest whole number: c610 = ______ Enter this value on AW-720-1. To facilitate verification of this activity, please provide the names of the CRS Coordinator and local emergency manager if other than the CRS Coordinator: CRS Coordinator Local Emergency Manager Name: Title: Phone: Fax: Fax: Address: E-mail: Comments: __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ Activity Worksheet AW-610-2 Edition: 2006 OMB No. 1660-0022 Expires: June 30, 2007 Public reporting burden for this information collection is estimated at 35 hours for the application and certification process. Burden means the time, effort, and financial resources expended by persons to generate, maintain, retain, disclose, or to provide information to us. You may send comments regarding the burden estimate or any aspect of the collection, including suggestions for reducing the burden to: Information Collections Management, U.S. Department of Homeland Security, Emergency Preparedness and Response Directorate, Federal Emergency Management Agency, 500 C St., S.W., Washington, D.C. 20472, Paperwork Reduction Project (OMB Control Number 1660-0022). You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form. Note: do not send your completed questionnaire to this address. Activity Worksheet No. Title AW-210 AW-214 AW-230 CRS Application Cover Page Recertification Worksheet Modification/Cycle Cover Page AW-310 AW-320 AW-330 AW-340 AW-350 AW-360 Elevation Certificates Map Information Service Outreach Projects Hazard Disclosure Flood Protection Information Flood Protection Assistance AW-410 AW-420 AW-430 AW-430LD AW-440 AW-450 Additional Flood Data Open Space Preservation Higher Regulatory Standards Land Development Criteria Flood Data Maintenance Stormwater Management AW-501 AW-502 AW-510 AW-520 AW-530 AW-540 Repetitive Loss List Repetitive Loss Requirements Floodplain Management Planning Acquisition and Relocation Flood Protection Drainage System Maintenance AW-610 AW-620 AW-630 Flood Warning Program Levee Safety Dam Safety AW-710 AW-720 AW-720m Community Growth Adjustment Community Credit Calculations Community Credit Calculations (Modification) AW-CB AW-CE AW-DB AW-IJ AW-MF AW-SU AW-TS AW-UF Closed Basin Lake Hazards Coastal Erosion Hazards Dunes and Beaches Ice Jam Hazards Mudflow Hazards Land Subsidence Hazards Tsunami Hazards Uncertain Flow Path Hazards OMB No.1660-0022 Expires June 30, 2007 Community : ____________________________ 614 Credit Documentation: Note: If Activity 610 credit has been received before, go to page AW-610-5. Flood Threat Recognition System (FTR): 1. Provide a description of the local flood hazards. [Include sources of flooding, areas affected and impact of flooding on the community.] [See Attachment ____ pages ______________.] If the community does NOT HAVE a description of its flood hazards, FTR=0 and c610=0. 2. Provide a description of the Flood Threat Recognition System. [Include documentation of early notice of a flood at one or more locations within the community. If appropriate, describe show how the community provides flood forecasts for areas other than the above forecast points.] [See Attachment ____ pages _______________.] 3. If the community or another local agency use rainfall and/or runoff data on a real-time basis and makes flood forecasts from these data, provide a description of the system. [Tell whether the collection system is based on precipitation and/or river gage data that are manually or automatically read and reported, the location gage network density, etc.] [See Attachment ____ pages _______________.] 4. Provide documentation showing the method used to predict downstream arrival time and peak flow or elevations. [See Attachment ____ pages _______________.] 5. If flood warnings are received from another agency, • Include a description of how the notice is received. [See Attachment ____ pages ________________.] • Identify local agency procedures for monitoring the system. [Include the written instructions available to the person monitoring the warning system.] [See Attachment ____ pages ________________.] 6. Provide examples of one or more flood forecast notices issued for the community. [See Attachment ____ pages _______________.] 7. Provide documentation of the annual maintenance and testing of the data collection, communications, and data analysis components of the flood threat recognition system. [See Attachment ____ pages _______________.] Emergency Warning Dissemination (EWD): 8. Provide documentation that the local government has adopted an emergency response plan. [See Attachment ____ pages _______________.] 9. Describe the community’s program for testing warning dissemination equipment and procedures. [Include the frequency of the test.] [See Attachment ____ pages ____________.] Activity Worksheet AW-610-3 Edition: 2006 OMB No. 1660-0022 Expires: June 30, 2007 Public reporting burden for this information collection is estimated at 35 hours for the application and certification process. Burden means the time, effort, and financial resources expended by persons to generate, maintain, retain, disclose, or to provide information to us. You may send comments regarding the burden estimate or any aspect of the collection, including suggestions for reducing the burden to: Information Collections Management, U.S. Department of Homeland Security, Emergency Preparedness and Response Directorate, Federal Emergency Management Agency, 500 C St., S.W., Washington, D.C. 20472, Paperwork Reduction Project (OMB Control Number 1660-0022). You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form. Note: do not send your completed questionnaire to this address. Activity Worksheet No. Title AW-210 AW-214 AW-230 CRS Application Cover Page Recertification Worksheet Modification/Cycle Cover Page AW-310 AW-320 AW-330 AW-340 AW-350 AW-360 Elevation Certificates Map Information Service Outreach Projects Hazard Disclosure Flood Protection Information Flood Protection Assistance AW-410 AW-420 AW-430 AW-430LD AW-440 AW-450 Additional Flood Data Open Space Preservation Higher Regulatory Standards Land Development Criteria Flood Data Maintenance Stormwater Management AW-501 AW-502 AW-510 AW-520 AW-530 AW-540 Repetitive Loss List Repetitive Loss Requirements Floodplain Management Planning Acquisition and Relocation Flood Protection Drainage System Maintenance AW-610 AW-620 AW-630 Flood Warning Program Levee Safety Dam Safety AW-710 AW-720 AW-720m Community Growth Adjustment Community Credit Calculations Community Credit Calculations (Modification) AW-CB AW-CE AW-DB AW-IJ AW-MF AW-SU AW-TS AW-UF Closed Basin Lake Hazards Coastal Erosion Hazards Dunes and Beaches Ice Jam Hazards Mudflow Hazards Land Subsidence Hazards Tsunami Hazards Uncertain Flow Path Hazards OMB No.1660-0022 Expires June 30, 2007 Community : ____________________________ 10. Provide a copy of the adopted policy that specifies when and how a warning is issued. [Include the written procedures that tell warning point personnel when, how and what messages to issue.] [See Attachment ____ pages _______________.] 11. If the community uses either a sound or siren system to disseminate flood warnings, provide a map showing the location of the sirens and the coverage area where they can be heard inside a closed building during storm conditions. [See Attachment ____ pages _______________.] 12. If the community uses door-to-door contact or a mobile public address system for flood warning, provided documentation describing how the tasks are organized and conducted. [See Attachment ____ pages _______________.] 13. If the community’s response plan includes flood warning using the Emergency Alert System, provide a copy of the community’s activation policies, procedures, and example messages. [See Attachment ____ pages _______________.] 14. If a telephonic system is used to warn all residents in the SFHA, provide documentation describing how and when the system is updated, and its backup system for warning residents when there is no telephone answer provided. [See Attachment ____ pages ______________.] 15. If the community uses a cable television override system for flood warning, provide documentation of its procedures for activating the system. [See Attachment ____ pages _______________.] 16. If the community has established local AM radio transmitters used for public warning announcements, provide documentation on the procedures for their use. [See Attachment ____ pages _______________.] 17. If the community has other warning methods not described above, these may be submitted for credit evaluation. [See Attachment ____ pages _______________.] Other Response Efforts (ORE): 18. Provide a copy of those sections of the local emergency operations plan, flood response plan, standard operating procedures and other documentation that show how the local government responds to floods. [See Attachment ____ pages _______________.] Critical Facilities Planning (CFP): 19. If the community maintains the names and telephone numbers of the operators of ALL critical facilities affected by flooding, provide documentation that this information is updated at least annually. [See Attachment ____ pages _______________.] 20. If the community provides special flood warnings or early notifications directly to ALL facilities that need them, provide a copy of the section of the adopted plan that describes these arrangements and how they are implemented. [See Attachment ____ pages _____________.] 21. Provide a list of critical facilities that need flood response plans. Identify those critical facilities with flood response plans that have been developed, reviewed, or accepted by the community. [NOTE: The local government may be asked to provide one or more of the plans on the list to the technical reviewer.] [See Attachment ____ pages _______________.] Activity Worksheet AW-610-4 Edition: 2006 OMB No. 1660-0022 Expires: June 30, 2007 Public reporting burden for this information collection is estimated at 35 hours for the application and certification process. Burden means the time, effort, and financial resources expended by persons to generate, maintain, retain, disclose, or to provide information to us. You may send comments regarding the burden estimate or any aspect of the collection, including suggestions for reducing the burden to: Information Collections Management, U.S. Department of Homeland Security, Emergency Preparedness and Response Directorate, Federal Emergency Management Agency, 500 C St., S.W., Washington, D.C. 20472, Paperwork Reduction Project (OMB Control Number 1660-0022). You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form. Note: do not send your completed questionnaire to this address. Activity Worksheet No. Title AW-210 AW-214 AW-230 CRS Application Cover Page Recertification Worksheet Modification/Cycle Cover Page AW-310 AW-320 AW-330 AW-340 AW-350 AW-360 Elevation Certificates Map Information Service Outreach Projects Hazard Disclosure Flood Protection Information Flood Protection Assistance AW-410 AW-420 AW-430 AW-430LD AW-440 AW-450 Additional Flood Data Open Space Preservation Higher Regulatory Standards Land Development Criteria Flood Data Maintenance Stormwater Management AW-501 AW-502 AW-510 AW-520 AW-530 AW-540 Repetitive Loss List Repetitive Loss Requirements Floodplain Management Planning Acquisition and Relocation Flood Protection Drainage System Maintenance AW-610 AW-620 AW-630 Flood Warning Program Levee Safety Dam Safety AW-710 AW-720 AW-720m Community Growth Adjustment Community Credit Calculations Community Credit Calculations (Modification) AW-CB AW-CE AW-DB AW-IJ AW-MF AW-SU AW-TS AW-UF Closed Basin Lake Hazards Coastal Erosion Hazards Dunes and Beaches Ice Jam Hazards Mudflow Hazards Land Subsidence Hazards Tsunami Hazards Uncertain Flow Path Hazards OMB No.1660-0022 Expires June 30, 2007 Community : ____________________________ Cycle verification of previously credited flood warning program 22. What is the date of the current flood warning program (Emergency Operations Plan)? If this date is more recent than the date of the plan used for the previous verification, obtain a copy of those portions related to flood warning and flood operations. Send these materials for technical review. [See Attachment ____.] 23. Has there been a flood insurance restudy since the last verification? Yes No A. If yes, did the new Flood Insurance Study add streams to the SFHA? Yes No If yes, mark these on the FIRM and send for review. [See Attachment ____.] B. Have these new streams been included in the flood warning program? Yes. Provide a description of the flood threat recognition system for these areas. Tell how many SFHA buildings are covered by the expanded warning area. [See Attachment ____.] No. What percentage of the SFHA buildings are located in the area not covered by flood forecast with peak flow or elevation data? ______ 24. Has there been a flood since the last verification that resulted in the loss of life or $50,000 in damage? Yes No A. Was a flood warning evaluation report prepared? Yes copy of the report to this form. [See Attachment ____.] No If yes, attach a B. Were changes made to the flood warning program as a result of the evaluation report? Yes No If yes, attach a copy of the changes to this form. [See Attachment ____.] 25. Has the flood warning program been modified since the last verification for other reasons? Yes No If yes, attach a copy of the changes to this form. [See Attachment ____.] 26. Have emergency warning dissemination methods been added, deleted or modified since the last verification? Yes No If yes, attach a copy of the changes. [See Attachment ____.] 27. Has the local government’s area of jurisdiction changed since the last verification? Yes No A. If yes, do the changes add SFHA to the community’s area of jurisdiction? Yes No If yes, mark these new areas on the FIRM and attach. [See Attachment ____.] B. If yes, have these new streams been included in the flood warning program? Yes. Provide a description of the flood threat recognition system for these areas. [See Attachment ____.] No. What percentage of the SFHA buildings are located in the area not covered by flood forecast with peak flow or elevation data? ______ Activity Worksheet AW-610-5 Edition: 2006 OMB No. 1660-0022 Expires: June 30, 2007 Public reporting burden for this information collection is estimated at 35 hours for the application and certification process. Burden means the time, effort, and financial resources expended by persons to generate, maintain, retain, disclose, or to provide information to us. You may send comments regarding the burden estimate or any aspect of the collection, including suggestions for reducing the burden to: Information Collections Management, U.S. Department of Homeland Security, Emergency Preparedness and Response Directorate, Federal Emergency Management Agency, 500 C St., S.W., Washington, D.C. 20472, Paperwork Reduction Project (OMB Control Number 1660-0022). You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form. Note: do not send your completed questionnaire to this address. Activity Worksheet No. Title AW-210 AW-214 AW-230 CRS Application Cover Page Recertification Worksheet Modification/Cycle Cover Page AW-310 AW-320 AW-330 AW-340 AW-350 AW-360 Elevation Certificates Map Information Service Outreach Projects Hazard Disclosure Flood Protection Information Flood Protection Assistance AW-410 AW-420 AW-430 AW-430LD AW-440 AW-450 Additional Flood Data Open Space Preservation Higher Regulatory Standards Land Development Criteria Flood Data Maintenance Stormwater Management AW-501 AW-502 AW-510 AW-520 AW-530 AW-540 Repetitive Loss List Repetitive Loss Requirements Floodplain Management Planning Acquisition and Relocation Flood Protection Drainage System Maintenance AW-610 AW-620 AW-630 Flood Warning Program Levee Safety Dam Safety AW-710 AW-720 AW-720m Community Growth Adjustment Community Credit Calculations Community Credit Calculations (Modification) AW-CB AW-CE AW-DB AW-IJ AW-MF AW-SU AW-TS AW-UF Closed Basin Lake Hazards Coastal Erosion Hazards Dunes and Beaches Ice Jam Hazards Mudflow Hazards Land Subsidence Hazards Tsunami Hazards Uncertain Flow Path Hazards OMB No.1660-0022 Expires June 30, 2007 Community : ____________________________ 28. If the local government requested credit for critical facilities planning, A. How many critical facilities within the community’s jurisdiction need advanced warning for a flood event? _______ B. How many critical facility managers receive the advanced warning they have identified they need to prepare for a flood? _______ Send a list of critical facilities with their required warning time and contact information for technical review. [See Attachment ____.] 29. How many critical facilities have flood response plans that have been developed, reviewed, or approved by the local government? ______ Send a list of critical facilities with flood response plans that have been developed, reviewed or approved by the local government. [See Attachment ____.] Comments: __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ Activity Worksheet AW-610-6 Edition: 2006 OMB No. 1660-0022 Expires: June 30, 2007 Public reporting burden for this information collection is estimated at 35 hours for the application and certification process. Burden means the time, effort, and financial resources expended by persons to generate, maintain, retain, disclose, or to provide information to us. You may send comments regarding the burden estimate or any aspect of the collection, including suggestions for reducing the burden to: Information Collections Management, U.S. Department of Homeland Security, Emergency Preparedness and Response Directorate, Federal Emergency Management Agency, 500 C St., S.W., Washington, D.C. 20472, Paperwork Reduction Project (OMB Control Number 1660-0022). You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form. Note: do not send your completed questionnaire to this address. Activity Worksheet No. Title AW-210 AW-214 AW-230 CRS Application Cover Page Recertification Worksheet Modification/Cycle Cover Page AW-310 AW-320 AW-330 AW-340 AW-350 AW-360 Elevation Certificates Map Information Service Outreach Projects Hazard Disclosure Flood Protection Information Flood Protection Assistance AW-410 AW-420 AW-430 AW-430LD AW-440 AW-450 Additional Flood Data Open Space Preservation Higher Regulatory Standards Land Development Criteria Flood Data Maintenance Stormwater Management AW-501 AW-502 AW-510 AW-520 AW-530 AW-540 Repetitive Loss List Repetitive Loss Requirements Floodplain Management Planning Acquisition and Relocation Flood Protection Drainage System Maintenance AW-610 AW-620 AW-630 Flood Warning Program Levee Safety Dam Safety AW-710 AW-720 AW-720m Community Growth Adjustment Community Credit Calculations Community Credit Calculations (Modification) AW-CB AW-CE AW-DB AW-IJ AW-MF AW-SU AW-TS AW-UF Closed Basin Lake Hazards Coastal Erosion Hazards Dunes and Beaches Ice Jam Hazards Mudflow Hazards Land Subsidence Hazards Tsunami Hazards Uncertain Flow Path Hazards OMB No.1660-0022 Expires June 30, 2007 Community : ____________________________ 612 Impact Adjustment: Credit points for each element are adjusted to reflect the extent of coverage of the flood warning program. Local governments should describe the impact of their flood warning program using one of the following options. Option 1: The flood threat recognition system, the warning dissemination system, and the flood response tasks COVER THE ENTIRE Special Flood Hazard Area (SFHA). ____ Yes _____No [Remember, the area credited by the flood warning program is the area where the warning program can forecast specific flood conditions in the future. This includes areas where flood elevations and arrival times can be forecast. It does not include areas where the National Weather Service or others can only predict flooding “along streams and low areas.”] Option 2: If the flood threat recognition system, the warning dissemination system, and the flood response tasks COVER LESS THAN THE ENTIRE SFHA, the local government may use a default value of 0.25 for rFTR, rEWD, and rORE. ______ Yes _______ No Option 3: Where local flood warning programs COVER MORE THAN 25% OF THE STRUCTURES, BUT NOT ALL OF in the SFHA, the community may use Option 3. Using this option the impact adjustment ratios for FTR, EWD, and ORE are computed by dividing the number of buildings affected by each element by the total number of buildings in the SFHA (bSF). THE STRUCTURES rFTR=bFTR bSF = rFTR= _________ = __________ Comments: __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ Activity Worksheet AW-610-7 Edition: 2006 OMB No. 1660-0022 Expires: June 30, 2007 Public reporting burden for this information collection is estimated at 35 hours for the application and certification process. Burden means the time, effort, and financial resources expended by persons to generate, maintain, retain, disclose, or to provide information to us. You may send comments regarding the burden estimate or any aspect of the collection, including suggestions for reducing the burden to: Information Collections Management, U.S. Department of Homeland Security, Emergency Preparedness and Response Directorate, Federal Emergency Management Agency, 500 C St., S.W., Washington, D.C. 20472, Paperwork Reduction Project (OMB Control Number 1660-0022). You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form. Note: do not send your completed questionnaire to this address. Activity Worksheet No. Title AW-210 AW-214 AW-230 CRS Application Cover Page Recertification Worksheet Modification/Cycle Cover Page AW-310 AW-320 AW-330 AW-340 AW-350 AW-360 Elevation Certificates Map Information Service Outreach Projects Hazard Disclosure Flood Protection Information Flood Protection Assistance AW-410 AW-420 AW-430 AW-430LD AW-440 AW-450 Additional Flood Data Open Space Preservation Higher Regulatory Standards Land Development Criteria Flood Data Maintenance Stormwater Management AW-501 AW-502 AW-510 AW-520 AW-530 AW-540 Repetitive Loss List Repetitive Loss Requirements Floodplain Management Planning Acquisition and Relocation Flood Protection Drainage System Maintenance AW-610 AW-620 AW-630 Flood Warning Program Levee Safety Dam Safety AW-710 AW-720 AW-720m Community Growth Adjustment Community Credit Calculations Community Credit Calculations (Modification) AW-CB AW-CE AW-DB AW-IJ AW-MF AW-SU AW-TS AW-UF Closed Basin Lake Hazards Coastal Erosion Hazards Dunes and Beaches Ice Jam Hazards Mudflow Hazards Land Subsidence Hazards Tsunami Hazards Uncertain Flow Path Hazards OMB No.1660-0022 Expires June 30, 2007 Community : ____________________________ 620 LEVEE SAFETY 622 Impact Adjustment: a. Option 1: rLP = 1.0 b. Option 2: rLP = 0.01 c. Option 3: rLP = bLP = ______ bSF______ 623 Credit Calculation: 9 x LPL ______ x rLP ______ = ______ c620 = value above rounded to the nearest whole number: c620 = ______ Enter this value on AW-720-1. 624 Credit Documentation: a. Levee protection level documentation. EITHER: ___ A statement signed by the U.S. Army Corps of Engineers that states the levee protection level and the date of construction, OR ___ A certification by a licensed professional engineer that states that the levee meets all the NFIP levee recognition requirements except for height and provides the date of construction and the levee protection level. ___ b. The levee emergency response plan that specifies actions to take at various flood stages. ___ c. The map showing the area protected by the levee, designated as "LP." ___ d. The Impact Adjustment Map (if Option 2 or 3 is used). and ___ Documentation showing how bLP and bSF were determined. The following will be needed at the annual recertification: ___ e. A certification by a licensed professional engineer that the levee has been maintained in such a manner that it meets all the NFIP levee maintenance requirements. Comments: __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ Activity Worksheet AW-620-1 Edition: 2006 OMB No. 1660-0022 Expires: June 30, 2007 Public reporting burden for this information collection is estimated at 35 hours for the application and certification process. Burden means the time, effort, and financial resources expended by persons to generate, maintain, retain, disclose, or to provide information to us. You may send comments regarding the burden estimate or any aspect of the collection, including suggestions for reducing the burden to: Information Collections Management, U.S. Department of Homeland Security, Emergency Preparedness and Response Directorate, Federal Emergency Management Agency, 500 C St., S.W., Washington, D.C. 20472, Paperwork Reduction Project (OMB Control Number 1660-0022). You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form. Note: do not send your completed questionnaire to this address. Activity Worksheet No. Title AW-210 AW-214 AW-230 CRS Application Cover Page Recertification Worksheet Modification/Cycle Cover Page AW-310 AW-320 AW-330 AW-340 AW-350 AW-360 Elevation Certificates Map Information Service Outreach Projects Hazard Disclosure Flood Protection Information Flood Protection Assistance AW-410 AW-420 AW-430 AW-430LD AW-440 AW-450 Additional Flood Data Open Space Preservation Higher Regulatory Standards Land Development Criteria Flood Data Maintenance Stormwater Management AW-501 AW-502 AW-510 AW-520 AW-530 AW-540 Repetitive Loss List Repetitive Loss Requirements Floodplain Management Planning Acquisition and Relocation Flood Protection Drainage System Maintenance AW-610 AW-620 AW-630 Flood Warning Program Levee Safety Dam Safety AW-710 AW-720 AW-720m Community Growth Adjustment Community Credit Calculations Community Credit Calculations (Modification) AW-CB AW-CE AW-DB AW-IJ AW-MF AW-SU AW-TS AW-UF Closed Basin Lake Hazards Coastal Erosion Hazards Dunes and Beaches Ice Jam Hazards Mudflow Hazards Land Subsidence Hazards Tsunami Hazards Uncertain Flow Path Hazards OMB No.1660-0022 Expires June 30, 2007 Community : ____________________________ 630 DAM SAFETY 632 Impact Adjustment: a. Option 1: rDFP = 1.0 b. Option 2: rDFP = 0.25 = ______ c. Option 3: rDFP = bDFP bSF _______ 633 Credit Calculation: a. SDS SDS = ______ b. cDFP = (DFP1 _____ + DFP2 _____ + DFP3 _____) x rDFP _____ = ______ c. Add SDS and DFP = ______ c630 = value above rounded to the nearest whole number: c630 = ______ Enter this value on AW-720-1. 634 Credit Documentation: There is no documentation required for state dam safety program (SDS) credit. a. Dam failure plan (DFP): Pages from the adopted emergency response plan, marked “DFP1,” that (a)(1) Specify that the community will be notified in the event of an impending or actual failure of a dam upstream from the community; (a)(2) Provide projected inundation areas, flood elevations, and estimated arrival times for flood peaks arising from a failure of the dam; and (a)(3) Call for an exercise at least annually. The results of the exercise are evaluated and used to revise the response plan. (b) A procedure to obtain annual reports by the dam operators on the safety and operational status of their dams. Copies of these reports must be sent to the community and the state dam safety office; and (c) Documentation of monthly communication checks between dam operators and emergency services officials. b. DFP warning credit (Mark the documentation for this section “DFP2”): An emergency response plan that details at least three methods of notifying affected residents of an imminent flood resulting from a possible or ongoing dam failure. At least three of the following notification methods must be available: ___ Sound or voice siren system. ___ Telephonic notification, AM transmitters and receivers dedicated to dam failure notification. Activity Worksheet AW-630-1 Edition: 2006 OMB No. 1660-0022 Expires: June 30, 2007 Public reporting burden for this information collection is estimated at 35 hours for the application and certification process. Burden means the time, effort, and financial resources expended by persons to generate, maintain, retain, disclose, or to provide information to us. You may send comments regarding the burden estimate or any aspect of the collection, including suggestions for reducing the burden to: Information Collections Management, U.S. Department of Homeland Security, Emergency Preparedness and Response Directorate, Federal Emergency Management Agency, 500 C St., S.W., Washington, D.C. 20472, Paperwork Reduction Project (OMB Control Number 1660-0022). You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form. Note: do not send your completed questionnaire to this address. Activity Worksheet No. Title AW-210 AW-214 AW-230 CRS Application Cover Page Recertification Worksheet Modification/Cycle Cover Page AW-310 AW-320 AW-330 AW-340 AW-350 AW-360 Elevation Certificates Map Information Service Outreach Projects Hazard Disclosure Flood Protection Information Flood Protection Assistance AW-410 AW-420 AW-430 AW-430LD AW-440 AW-450 Additional Flood Data Open Space Preservation Higher Regulatory Standards Land Development Criteria Flood Data Maintenance Stormwater Management AW-501 AW-502 AW-510 AW-520 AW-530 AW-540 Repetitive Loss List Repetitive Loss Requirements Floodplain Management Planning Acquisition and Relocation Flood Protection Drainage System Maintenance AW-610 AW-620 AW-630 Flood Warning Program Levee Safety Dam Safety AW-710 AW-720 AW-720m Community Growth Adjustment Community Credit Calculations Community Credit Calculations (Modification) AW-CB AW-CE AW-DB AW-IJ AW-MF AW-SU AW-TS AW-UF Closed Basin Lake Hazards Coastal Erosion Hazards Dunes and Beaches Ice Jam Hazards Mudflow Hazards Land Subsidence Hazards Tsunami Hazards Uncertain Flow Path Hazards OMB No.1660-0022 Expires June 30, 2007 Community : ____________________________ ___ NOAA Weather Radio. Receivers with Specific Area Message Encoding (SAME) are preferred. Mobile public address. Emergency Alert System. Cable television override. Door-to-door notification. c. DFP evacuation planning credit (Mark the documentation for this section “DFP3”): 1. Documentation that the adopted emergency plan that includes evacuation routes and detailed procedures for notifying and evacuating critical facilities, specifically including schools, hospitals, nursing homes, jails, and other locations where there are populations that may have difficulty evacuating the dam failure inundation area; and 2. Documentation of at least annual notification of occupants in the dam failure area of the hazard, the area affected, evacuation routes, and flood safety topics appropriate to the hazard. ___ d. The Impact Adjustment Map (if Option 1 or 3 is used), and ___ Documentation showing how bLP and bSF were determined To facilitate verification of DFP, provide the names of the CRS Coordinator and flood warning contact or emergency manager if other than the CRS Coordinator: CRS Coordinator: Flood Warning Contact or Emergency Management Coordinator: Name: Title: Phone: Fax: Fax: Address: Email: Comments: __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ _________________________________________________________________________________ Activity Worksheet AW-630-2 Edition: 2006 OMB No. 1660-0022 Expires: June 30, 2007 Public reporting burden for this information collection is estimated at 35 hours for the application and certification process. Burden means the time, effort, and financial resources expended by persons to generate, maintain, retain, disclose, or to provide information to us. You may send comments regarding the burden estimate or any aspect of the collection, including suggestions for reducing the burden to: Information Collections Management, U.S. Department of Homeland Security, Emergency Preparedness and Response Directorate, Federal Emergency Management Agency, 500 C St., S.W., Washington, D.C. 20472, Paperwork Reduction Project (OMB Control Number 1660-0022). You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form. Note: do not send your completed questionnaire to this address. Activity Worksheet No. Title AW-210 AW-214 AW-230 CRS Application Cover Page Recertification Worksheet Modification/Cycle Cover Page AW-310 AW-320 AW-330 AW-340 AW-350 AW-360 Elevation Certificates Map Information Service Outreach Projects Hazard Disclosure Flood Protection Information Flood Protection Assistance AW-410 AW-420 AW-430 AW-430LD AW-440 AW-450 Additional Flood Data Open Space Preservation Higher Regulatory Standards Land Development Criteria Flood Data Maintenance Stormwater Management AW-501 AW-502 AW-510 AW-520 AW-530 AW-540 Repetitive Loss List Repetitive Loss Requirements Floodplain Management Planning Acquisition and Relocation Flood Protection Drainage System Maintenance AW-610 AW-620 AW-630 Flood Warning Program Levee Safety Dam Safety AW-710 AW-720 AW-720m Community Growth Adjustment Community Credit Calculations Community Credit Calculations (Modification) AW-CB AW-CE AW-DB AW-IJ AW-MF AW-SU AW-TS AW-UF Closed Basin Lake Hazards Coastal Erosion Hazards Dunes and Beaches Ice Jam Hazards Mudflow Hazards Land Subsidence Hazards Tsunami Hazards Uncertain Flow Path Hazards OMB No.1660-0022 Expires June 30, 2007 Community : ____________________________ 710 COMMUNITY GROWTH ADJUSTMENT 712 Growth Adjustment Calculation: a. Average Growth Rate: AGR1 = USGR = ______ AGR2 = USGR + CMGR 2 = ______ AGR = the larger of the two (AGR1 or AGR2) If AGR is less than 0.0, then AGR = 0.0 If AGR is greater than 5.0, then AGR = 5.0 AGR = ______ b. Community Growth Adjustment: CGA = 1 + (0.1 x AGR ______): CGA = ______ Enter this value on AW-720-1. 713 Credit Documentation: ___ If CMGR is used, documentation that the community growth rate (CMGR) data have been accepted by a state or federal agency for reporting requirements. Comments: __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ ________________________________________________________________________________ Activity Worksheet AW-710-1 Edition: 2006 OMB No. 1660-0022 Expires: June 30, 2007 Public reporting burden for this information collection is estimated at 35 hours for the application and certification process. Burden means the time, effort, and financial resources expended by persons to generate, maintain, retain, disclose, or to provide information to us. You may send comments regarding the burden estimate or any aspect of the collection, including suggestions for reducing the burden to: Information Collections Management, U.S. Department of Homeland Security, Emergency Preparedness and Response Directorate, Federal Emergency Management Agency, 500 C St., S.W., Washington, D.C. 20472, Paperwork Reduction Project (OMB Control Number 1660-0022). You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form. Note: do not send your completed questionnaire to this address. Activity Worksheet No. Title AW-210 AW-214 AW-230 CRS Application Cover Page Recertification Worksheet Modification/Cycle Cover Page AW-310 AW-320 AW-330 AW-340 AW-350 AW-360 Elevation Certificates Map Information Service Outreach Projects Hazard Disclosure Flood Protection Information Flood Protection Assistance AW-410 AW-420 AW-430 AW-430LD AW-440 AW-450 Additional Flood Data Open Space Preservation Higher Regulatory Standards Land Development Criteria Flood Data Maintenance Stormwater Management AW-501 AW-502 AW-510 AW-520 AW-530 AW-540 Repetitive Loss List Repetitive Loss Requirements Floodplain Management Planning Acquisition and Relocation Flood Protection Drainage System Maintenance AW-610 AW-620 AW-630 Flood Warning Program Levee Safety Dam Safety AW-710 AW-720 AW-720m Community Growth Adjustment Community Credit Calculations Community Credit Calculations (Modification) AW-CB AW-CE AW-DB AW-IJ AW-MF AW-SU AW-TS AW-UF Closed Basin Lake Hazards Coastal Erosion Hazards Dunes and Beaches Ice Jam Hazards Mudflow Hazards Land Subsidence Hazards Tsunami Hazards Uncertain Flow Path Hazards OMB No.1660-0022 Expires June 30, 2007 Community : ____________________________ 720 COMMUNITY CREDIT CALCULATIONS Calculation Section: Verified Activity Calculations: Credit c310 ______ = c320 ______ = c330 ______ = c340 ______ = c350 ______ = c360 ______ = ______ ______ ______ ______ ______ ______ c410 ______ x CGA ______ = c420 ______ x CGA ______ = c430 ______ x CGA ______ = c440 ______ x CGA ______ = c450 ______ x CGA ______ = ______ ______ ______ ______ ______ c510 ______ = c520 ______ = c530 ______ = c540 ______ = ______ ______ ______ ______ c610 ______ = c620 ______ = c630 ______ = ______ ______ ______ 722 Community Classification Calculation: cT = total of above cT = ______ Community Classification (from Appendix C): CEO Name / Address Class = ______ CRS Coordinator Name / Address Date Report Prepared:___________________ Activity Worksheet AW-720-1 Edition: 2006 OMB No. 1660-0022 Expires: June 30, 2007 Public reporting burden for this information collection is estimated at 35 hours for the application and certification process. Burden means the time, effort, and financial resources expended by persons to generate, maintain, retain, disclose, or to provide information to us. You may send comments regarding the burden estimate or any aspect of the collection, including suggestions for reducing the burden to: Information Collections Management, U.S. Department of Homeland Security, Emergency Preparedness and Response Directorate, Federal Emergency Management Agency, 500 C St., S.W., Washington, D.C. 20472, Paperwork Reduction Project (OMB Control Number 1660-0022). You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form. Note: do not send your completed questionnaire to this address. Activity Worksheet No. Title AW-210 AW-214 AW-230 CRS Application Cover Page Recertification Worksheet Modification/Cycle Cover Page AW-310 AW-320 AW-330 AW-340 AW-350 AW-360 Elevation Certificates Map Information Service Outreach Projects Hazard Disclosure Flood Protection Information Flood Protection Assistance AW-410 AW-420 AW-430 AW-430LD AW-440 AW-450 Additional Flood Data Open Space Preservation Higher Regulatory Standards Land Development Criteria Flood Data Maintenance Stormwater Management AW-501 AW-502 AW-510 AW-520 AW-530 AW-540 Repetitive Loss List Repetitive Loss Requirements Floodplain Management Planning Acquisition and Relocation Flood Protection Drainage System Maintenance AW-610 AW-620 AW-630 Flood Warning Program Levee Safety Dam Safety AW-710 AW-720 AW-720m Community Growth Adjustment Community Credit Calculations Community Credit Calculations (Modification) AW-CB AW-CE AW-DB AW-IJ AW-MF AW-SU AW-TS AW-UF Closed Basin Lake Hazards Coastal Erosion Hazards Dunes and Beaches Ice Jam Hazards Mudflow Hazards Land Subsidence Hazards Tsunami Hazards Uncertain Flow Path Hazards OMB No.1660-0022 Expires June 30, 2007 Community : ____________________________ 720m COMMUNITY CREDIT CALCULATIONS (MODIFICATION): Calculation Section: Previous Score Modified Score Current Credit CGA Credit Activity Total c310 ______ c320 ______ c330 ______ c340 ______ c350 ______ c360 ______ c310 ______ c320 ______ c330 ______ c340 ______ c350 ______ c360 ______ c310 ______ = c320 ______ = c330 ______ = c340 ______ = c350 ______ = c360 ______ = ______ ______ ______ ______ ______ ______ c410 ______ c420 ______ c430 ______ c440 ______ c450 ______ c410 ______ c420 ______ c430 ______ c440 ______ c450 ______ c410 ______ x CGA ______ = c420 ______ x CGA ______ = c430 ______ x CGA ______ = c440 ______ x CGA ______ = c450 ______ x CGA ______ = ______ ______ ______ ______ ______ c510 ______ c520 ______ c530 ______ c540 ______ c510 ______ c520 ______ c530 ______ c540 ______ c510 ______ = c520 ______ = c530 ______ = c540 ______ = ______ ______ ______ ______ c610 ______ c610 ______ c610 ______ = c620 ______ c620 ______ c620 ______ = c630 ______ c630 ______ c630 ______ = ______ ______ ______ 722 Community Classification Calculation: cT = total of above: cT = ______ Community Classification (from Appendix C): Class = ______ CEO Name / Address ____________________________________ CRS Coordinator Name / Address _______________________________________ ____________________________________ _______________________________________ ____________________________________ _______________________________________ ____________________________________ _______________________________________ Date Report Prepared:____________________ Activity Worksheet AW-720-2 Edition: 2006 OMB No. 1660-0022 Expires: June 30, 2007 Public reporting burden for this information collection is estimated at 35 hours for the application and certification process. Burden means the time, effort, and financial resources expended by persons to generate, maintain, retain, disclose, or to provide information to us. You may send comments regarding the burden estimate or any aspect of the collection, including suggestions for reducing the burden to: Information Collections Management, U.S. Department of Homeland Security, Emergency Preparedness and Response Directorate, Federal Emergency Management Agency, 500 C St., S.W., Washington, D.C. 20472, Paperwork Reduction Project (OMB Control Number 1660-0022). You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form. Note: do not send your completed questionnaire to this address. Activity Worksheet No. Title AW-210 AW-214 AW-230 CRS Application Cover Page Recertification Worksheet Modification/Cycle Cover Page AW-310 AW-320 AW-330 AW-340 AW-350 AW-360 Elevation Certificates Map Information Service Outreach Projects Hazard Disclosure Flood Protection Information Flood Protection Assistance AW-410 AW-420 AW-430 AW-430LD AW-440 AW-450 Additional Flood Data Open Space Preservation Higher Regulatory Standards Land Development Criteria Flood Data Maintenance Stormwater Management AW-501 AW-502 AW-510 AW-520 AW-530 AW-540 Repetitive Loss List Repetitive Loss Requirements Floodplain Management Planning Acquisition and Relocation Flood Protection Drainage System Maintenance AW-610 AW-620 AW-630 Flood Warning Program Levee Safety Dam Safety AW-710 AW-720 AW-720m Community Growth Adjustment Community Credit Calculations Community Credit Calculations (Modification) AW-CB AW-CE AW-DB AW-IJ AW-MF AW-SU AW-TS AW-UF Closed Basin Lake Hazards Coastal Erosion Hazards Dunes and Beaches Ice Jam Hazards Mudflow Hazards Land Subsidence Hazards Tsunami Hazards Uncertain Flow Path Hazards
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