Report Flood/Sewer Backup Damage and Estimated Losses
This form serves as a statutory notice only to the City of your losses due to a flooding/sewer backup issue at your location. Registration with FEMA is required to receive assistance from FEMA or the Small Business Administration. Those who experienced losses on June 25-26, 2021 should apply to FEMA for potential financial assistance from the federal government. Visit, call FEMA’s hotline at 800-621-3362, or visit the Disaster Recovery Center at Henry Ford Centennial Library 7 a.m. to 7 p.m. daily. Note: The City of Dearborn’s Department of Public Works is inspecting and monitoring all sewers where flood/sewer backup damage is reported.
Email *
Date of Flood/Backup *
Full Name *
Street Address *
Phone Number *
Description of Issue and Estimated Losses
Please give a brief description of the issue and estimated losses. Keep any photos, videos, and receipts you have that document your losses.
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