What if the FEMA map has changed?

If an updated FEMA map changes the zone, record the new panel and effective date on the form and retain both versions. For disputes, consider a LOMA/LOMR or a formal map appeal if evidence supports a change.

Can the form be electronically signed?

Yes. Electronic signatures meet ESIGN and UETA requirements in the U.S. provided intent, consent, attribution, and retention are satisfied (15 U.S.C. ch. 96; UETA). Ensure the platform records an audit trail.

Who is authorized to sign the form?

Typically a licensed surveyor, certified floodplain professional, insurance agent, or authorized lender representative signs. Confirm lender or insurer signatory rules before execution.

Is notarization required?

Notarization is not universally required for a flood determination, but some lenders or state rules may request notarized certification. Check lender guidelines and state practices.

How do I correct an error after signing?

Void the incorrect form and issue a corrected form with a new date and signature; retain the original and the corrected copies in the record for auditability.

What supporting documents should be attached?

Attach FEMA map excerpts, elevation certificates, survey plats, or LOMA/LOMR documentation as applicable to substantiate the determination and facilitate underwriting or appeals.

Electronic Signature
Templates
Insurance
Insurance Flood Determination Form

Insurance Flood Determination Form

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

INSURANCE FLOOD DETERMINATION FORM

Applicant / Insured Information

Insured Name Date of Birth Primary Contact Phone Mailing Address

Property Subject to Determination

Property Address (location of risk) Parcel Identifier / Tax ID (if known)

Policy Details

Policy Number

Policy Type: Residential Commercial Condominium Mobile Home

Coverage Requested / In Force

Deductible

Annual Premium

Policy Period From

Policy Period To

Agent / Underwriting Contact

Flood Risk Determination

Based upon current Flood Insurance Rate Map (FIRM) data, field observations, and documentation provided, the property at has been classified as:

Special Flood Hazard Area (SFHA) — Zone AE/A/VE Moderate Risk — Zone X (shaded) Low Risk — Zone X (unshaded) Undetermined — Further documentation required

Flood Zone Code:

FIRM Panel Number:

Community Number:

Map Effective Date:

LOMA / LOMR Obtained: Yes No LOMA/LOMR Number (if applicable):

Elevation Certificate Available: Yes No Elevation Certificate ID:

Base Flood Elevation (BFE):

First Floor Elevation:

Lowest Adjacent Grade:

Physical Characteristics of the Insured Structure

Building Type: Detached Single-Family Attached / Townhouse Mobile / Manufactured Home

Occupancy: Number of Floors Above Grade:

Basement / Crawlspace Present: Basement Crawlspace Slab-on-grade

Distance to Nearest Water Body: Water Body Type: River/Stream Lake/Reservoir Coast/Tidal Other

Previous Flood Losses & Claims

Prior Flood Claims: Yes No If yes, number of claims: Date of most recent claim:

Mitigation Measures

Has the structure been mitigated to reduce flood risk? Raised / Elevated Flood Vents Installed Barriers / Seals

Mitigation Details

Exclusions and Notices

This Flood Determination Form is an underwriting and rating determination based on the information available at the time of assessment. It is not a policy of insurance, a binder, or a guarantee of coverage. The insurer expressly excludes coverage for loss or damage caused by earth movement, subsidence, pollution, war, nuclear hazard, and consequential losses unless specifically endorsed. Flood insurance coverage is subject to the terms, conditions, limitations, and exclusions contained in the applicable policy form and endorsements.

Beneficiary Designation

Beneficiary Name

Relationship to Insured

Percentage of Benefit

Documentation Checklist

Please indicate which documents were reviewed and are retained with this determination:

Elevation Certificate Survey / As-built Photographs of Property Prior Flood Loss Records LOMA / LOMR Documents Other

Determination Summary / Analyst Notes

Inspector / Analyst Information (for company use)

Analyst / Inspector Name Company / Department

License / Reg. Number

Contact Phone

Date of Determination

Declaration and Certification by Applicant

I certify that the information provided in this Insurance Flood Determination Form is true, correct, and complete to the best of my knowledge. I understand that this determination is based on currently available mapping, documentation, and representations provided to the insurer. I acknowledge that intentionally providing false or misleading information may result in denial of coverage, rescission of the policy, or other remedies permitted by law. I further acknowledge that this form is used by the insurer for underwriting and rating and does not alter the terms, conditions, or exclusions of any issued policy.

I acknowledge and certify the statements above are true and that I have provided all required documentation to support this determination.

Applicant Name:

Signature:

Date:

What the Insurance Flood Determination Form Is

The Insurance Flood Determination Form documents whether a property is in a federally designated flood zone or subject to flood insurance requirements. Lenders, insurers, and agents use it to record floodplain status, map panel references, effective dates, and the method used to determine flood risk. The form typically includes property identification, flood zone designation, community panel number, and an official signature block for the preparer. It supports underwriting, disclosure and compliance with federal flood insurance rules and lender requirements where applicable.

Why this form matters for insurance and lending

Completing the Insurance Flood Determination Form creates an auditable record of a property's flood status, which affects insurance coverage, premium calculations, and lender-mandated escrow or force-placed insurance decisions.

Who typically completes or relies on the form

The Insurance Flood Determination Form is prepared by insurance agents, flood zone certifiers, mortgage lenders, and municipal floodplain administrators to document flood risk for a specific property.

Insurance agents and underwriters maintain the form with policy files to set premiums and coverage terms.
Mortgage lenders use the form to determine escrow requirements, force-placed insurance, and underwriting eligibility.
Title companies and closing agents review the form during real estate transactions to identify required disclosures and insurance obligations.

Accurate completion helps avoid coverage gaps, ensures compliance with lender requirements, and provides a clear basis for appeals or map change requests.

Essential sections found on a professional form

A complete Insurance Flood Determination Form combines property identifiers, authoritative map references, determination method, effective dates, preparer credentials, and a signature block to create a defensible record.

Property Details

Street address, legal description, and parcel number so the determination links unambiguously to the correct parcel.

Flood Zone

Designated FEMA flood zone code and letter (e.g., AE, VE, X) that drives insurance requirements and rates.

Map Reference

FEMA flood map panel number and effective date to show the source of the boundary used in the determination.

Methodology

How the determination was made (FEMA map lookup, survey, LOMA/LOMR review) and any supporting documentation.

Preparer Information

Name, company, license or certification number, contact information, and date of determination for traceability.

Signature Block

Signed and dated signature line for the preparer and, if required, an attesting official or notary.

Required data elements to collect

Property Address: Full street address

Parcel ID: County parcel or tax ID

FEMA Zone: Designated flood zone

Map Panel: FEMA panel number

Effective Date: Map effective date

Preparer Details: Name and credential

Step-by-step: filling out the form

Follow these steps to complete an accurate Insurance Flood Determination Form and retain evidence for underwriting or appeal.

01

Confirm property: Verify full address and parcel ID against county records.
02

Lookup map: Identify FEMA panel and flood zone from the official map.
03

Record method: Note whether you used FEMA, survey, or LOMA/LOMR.
04

Sign and save: Preparer signs, dates, and stores the completed form.

Typical online workflow settings for the form

Configure the digital workflow to ensure required fields, signer order, and evidence capture are enforced when sending the form.

Field	Configuration
Required fields	Make address, FEMA zone, panel, preparer required
Signer order	Preparer signs before lender or reviewer
Authentication	Enable email or SMS code for signer verification
Audit capture	Record IP, timestamp, and field changes

Where completed forms are sent and stored

Routing ensures the right parties receive a certified copy and the file is retained in the loan or policy record.

To the lender: Stored in loan servicing system for underwriting and escrow decisions
To the insurer: Added to policy file to determine coverage requirements
To the title agent: Included in closing package when required for transactions
Document retention: Archived per records retention policy for audit and appeals

Digital signing and platform considerations

Use a platform that supports required field enforcement, audit trails, and secure storage when processing flood determinations.

Field enforcement: Make fields required and validate formats
Audit trail: Capture IP, timestamps, and actions
Storage formats: Save final PDF with certificate

Timing and common deadline expectations

Deadlines vary by transaction type; the following entries are common timing references to guide processing and reporting.

New loan origination:

Complete before closing or force-place decision

Insurance application:

Include with policy application to set premium

LOMA/LOMR requests:

Processing may take weeks; start early

Responding to appeals:

Provide supporting docs promptly to avoid escalation

Record retention:

Keep determinations through the loan lifecycle

Consequences of incorrect or missing determinations

Coverage gaps: Policy denial risk

Higher premiums: Incorrect zone increases cost

Force-placed insurance: Lender may impose costly coverage

Regulatory exposure: Compliance audit findings

Loan delays: Closings may be postponed

Appeal burden: Time-consuming LOMA requests

Sample scenarios showing practical use

Real-world examples illustrate why precise determinations matter in transactions and insurance.

Property closing

A lender required a flood determination before loan funding and identified zone AE

Lender ordered a quick FEMA map lookup
Accurate panel and effective date prevented unnecessary force-placed insurance and streamlined closing with documented evidence.

LOMA appeal

An owner disputed a VE designation and submitted elevation data

Owner requested LOMA with FEMA
The successful LOMA removed mandatory flood insurance, lowering premiums and clearing the title for sale.

Representative eSignature vendor comparison for form execution

Compare basic pricing and capabilities to support electronic signing and secure storage when processing Insurance Flood Determination Forms.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	7-day free trial	Varies	Varies	Varies	Varies
Bulk Send	Yes	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No

Frequently asked questions about the form

Common questions and answers related to completion, e-signing, notarization, and correcting errors appear below.

Need help? Contact support

What if the FEMA map has changed?
If an updated FEMA map changes the zone, record the new panel and effective date on the form and retain both versions. For disputes, consider a LOMA/LOMR or a formal map appeal if evidence supports a change.
Can the form be electronically signed?
Yes. Electronic signatures meet ESIGN and UETA requirements in the U.S. provided intent, consent, attribution, and retention are satisfied (15 U.S.C. ch. 96; UETA). Ensure the platform records an audit trail.
Who is authorized to sign the form?
Typically a licensed surveyor, certified floodplain professional, insurance agent, or authorized lender representative signs. Confirm lender or insurer signatory rules before execution.
Is notarization required?
Notarization is not universally required for a flood determination, but some lenders or state rules may request notarized certification. Check lender guidelines and state practices.
How do I correct an error after signing?
Void the incorrect form and issue a corrected form with a new date and signature; retain the original and the corrected copies in the record for auditability.
What supporting documents should be attached?
Attach FEMA map excerpts, elevation certificates, survey plats, or LOMA/LOMR documentation as applicable to substantiate the determination and facilitate underwriting or appeals.

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