Form FF-104-FY-21-125 ( FF-104-FY-21-125 ( Internet Application Registration For Disaster Assistanc

Registration Intake Internet

5/25/2018

 

WEB Version of RI

 

 

Disaster Assistance Center

 

Registration Instructions

 

Privacy Act Statement and Declaration of Eligibility

 

Personal Information

 

Personal Information

 

Contact Phone Numbers

 

Damage Dwelling Address

 

County/Parish/Municipio

 

Disaster and Damages

 

Disaster Selection

 

Damage Type

 

Damage Type “Other”

 

Disaster Losses and Needs

 

Disaster Related Losses

 

Damaged Dwelling

 

 

Home Insurance

 

Home Insurance (If did not note insurance for home then must select Under Penalty of perjury prior to moving on)

 

Disaster Related Expenses

 

Other Insurance

 

Disaster Related Vehicle Damage

 

Vehicles

 

Update Vehicle

 

Emergency Needs

 

Special Needs General Categories

 

Special Needs Specific Categories

 

Occupants Information

 

Occupants

 

Update Occupant

 

Update Occupant note drop down when selecting co-applicant

 

Financial Information

 

Business Damages

 

Financial Information when selecting yes to self employed

 

Financial Information when selecting no to self employed

 

Electronic Funds Transfer

 

Income Verification

 

Letter and Documents

 

Correspondence Preferences

 

Correspondence Preferences when selecting E-mail has a way of receiving correspondence

 

SMS Correspondence Summary

 

SMS Correspondence Summary when selecting yes to SMS

 

SMS Correspondence Summary when selecting yes the Phone number auto fills

 

Review Registration

 

Conclusion

 

Next Steps

 

Public Record Questions

 

User ID and Password

 

Account Created

 

What to Expect

 

Assistance Activities

 

Referrals

 

DisasterAssistance.gov Survey Invitation

 

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