Required Statements

Required statements for approved insurance provider-issued forms.

• The Collection of Information and Data Statement (Privacy Act) for Agents, Loss Adjusters and Policyholders and the
• The Non-Discrimination Statement must be included on any form the individual signs or provided to the individual on separate form, for each form that is signed by the individual. A copy must be maintained by the approved insurance provider (AIP).
• The Certification Statement must be included on any form that the insured signs that collects information from the insured (for example, application or acreage report). Not applicable to appraisal worksheets.

Please refer to the current Document and Supplemental Standards Handbook (FCIC-24040).

For more information, contact Director of Product Administration and Standards Division.