Individual Assistance//Damage Survery Report
The questionnaire should take only a few minutes to complete. Most of the questions are specifically related to disasters. Damage Assessment Teams may also visit your home to review and confirm the damages. This Assessment will help determine the counties eligibility for different types of assistance.
Email address *
Street Address (location of the damage) *
Your answer
City *
Your answer
Name of Family *
Your answer
Home *
Type of Home *
Status *
Uninhabitable *
Water Depth *
Income Level
Percent of Loss Insured
Your answer
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms