Hurricane Laura Intake Form
Brief questionnaire to determine eligibility for the SBP Owner-Occupied Rebuild Program
Name *
Street Address *
City *
Phone Number *
Email *
Current occupation
Do you own the damaged property?
Clear selection
If you do not own the damaged property, who does?
Please describe the damages to your home. *
Have you received an estimate for the damages?
Clear selection
It is a mobile home? *
Do you own any other properties?
Clear selection
Do you have homeowner's insurance? *
How much assistance did you get from insurance?
If you do not have homeowner's insurance, would you be willing to get it?
Clear selection
Did you apply for FEMA assistance after Hurricane Laura? *
How much assistance did you get from FEMA?
Did you reapply for FEMA assistance after Hurricane Delta?
Clear selection
How many people live in your home? *
What are the ages of everyone in the house?
What is the estimated monthly income for the household? Include all adults. *
Is anyone in the house a veteran?
Clear selection
Does anyone in the house receive disability payments?
Clear selection
Does anyone in the house receive unemployment benefits?
Clear selection
Any critical health or safety needs? *
Please describe any health or safety needs.
Where did you hear about the SBP Rebuild Program?
Clear selection
Anything else we should know?
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