2021 Immediate Relief Intake - Client Form
This is a pre-application intake form for immediate relief assistance as a result of the 2021 Northern California fires in one of these nine (9) counties: Butte, Glenn, Lassen, Modoc, Plumas, Shasta, Siskiyou, Tehama, and Trinity. Assistance is provided one (1) time per household, if multiple families (i.e. roommates) live within the same home/property, you may need to discuss with your housemates how to divide the relief funds. Financial relief is up to $500 per household that has sustained 50% or more damage. The residence must be your primary residence. Applications may take up to 3 weeks to process. In order to process your application we will need a copy of your ID. If your ID does not have your disaster impacted address (pre-dating the time of the fire), we will need some form of address verification. This may be a utility bill, deed, invoice, lease, W2, paystub or anything else with both your name and address.