RHBA FORM
This is for those affected by the Sep 17, 2025 Fire and will serve 3 purposes, with the goal of using one form to keep the work to a minimum for everyone. The form will remain open so you can update your responses as needed, and you'll receive a copy of your responses. 

1. In order to access certain types of Federal loans, we need to demonstrate the number of affected businesses and size of losses. Information on the starred/required questions is what is needed for this. It will be shared with NYC Emergency Management Department and their State and Federal partners so that Small Business Administration loans for this type of situation can be offered to the group. Only information regarding sole proprietors, LLC's and other formally incorporated businesses will be shared in this way.

Even if you do not plan to take an SBA loan, providing this information quickly will help us meet the threshold that will allow others to apply. Thank you!

2. Information shared will help Carly understand types of needs that the General GoFundMe can be used to support. Once a general picture is established we can look at it together and figure out what makes most sense. This form will remain open - so as you better identify your needs, you can update it!  

3. We will update this form with questions as we get them that can help direct you to the right grant opportunities!
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Email *
Type of entity *
Required
Business Name or Your name if not a business *
Business Address (Include bay/letter/number if you are based at 481. Fill in whether or not you are a "business".) *
Point of contact: name, title, preferred email, phone *
Owner of building, Renter of building, or exhibiting artist/show
Clear selection
Size of space if you are an ongoing renter in the building
Do you have any insurance coverage for this situation? *
Estimated extent of damage to space and contents *
Estimated value of damaged/destroyed property (equipment, materials, supplies, product, etc.)

Unfortunately, do not include value of art. This is for government loan purposes only, not insurance.)
 *
How much of that total value do you expect to be covered by insurance? *
Estimated loss of income, compared to last year: 
Show raw numbers:
1. Your total revenues/income from September 17, 2024-March 17, 2025
2. Your expected revenues/income from September 17, 2025 to March 17, 2025
3. estimated loss
 *
Number of incomes impacted, total (you + Full time staff/contractors, part-time contractors)
Do you have a GoFundMe for yourself/unit? This does NOT prevent you from drawing from general fund.
Clear selection
Please feel free to help us understand what impact(s) you've experienced. But no need to fill this in now if you can't.
Please feel free to help myself and others understand your needs. But no need to fill this in now if you can't.
Questions, Ideas, Concerns
Please list immediate needs that the General GoFundMe could help cover for you (what and the cost)
Please list other costs the General GoFundMe could help cover (what and the cost)
May we share the information you provided with other City agency partners assisting in response and recovery efforts (beyond NYC Emergency Management Department, such as Small Business Services, Department of Cultural Affairs, and others)? *
Do you have photos from your unit, especially before you took things out? If so, please upload them into a subfolder inside of this folder:
1. Create a subfolder with your unit and subunit / name, and then put the images inside that
 *
A copy of your responses will be emailed to the address you provided.
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