Location
|
Current version
|
Proposed Revision
|
Justification
|
Form Name
|
Application/Registration for Disaster Assistance
|
Application for
Disaster Assistance
|
Calibrated Survivor Messaging
|
1
|
Mr. or Mrs.
|
1.
Name
of Applicant (last, first, MI)
|
Change
to numbering
Equity
adjustment
|
2
|
Name of Applicant (last,
first, MI)
|
2.
Preferred
name
|
Equity
adjustment
|
3
|
Language
|
3.
Applicant Social Security No.
|
Change
to numbering
The
language question is removed, incorporated into question 6
options.
Align
with streamline RI
Call
Center Legacy updates
|
4
|
Applicant Social Security
No.
|
4.
Date Of Birth
|
Change to numbering
|
5
|
Date of Birth
|
5.
Email
|
Change to numbering
|
6
|
Email
|
6.
Do you have a disability or language need that requires an
accommodation to interact with FEMA staff and/or access FEMA
programs?
Yes
No
If Yes, what do you
need? (select all that apply)
|
Change to numbering
|
7
|
Do you have a disability or
language need that requires an accommodation to interact with FEMA
staff and/or access FEMA programs?
Yes
No
If
Yes, what do you need? (select all that apply)
|
7. Do
you or anyone in your household have a disability that affects
your ability to perform activities of daily living or requires an
assistive device? (NOTE: An assistive device can include
wheelchair, walker, cane, hearing aid, communication device,
service animal, personal care attendant, oxygen, dialysis, etc.)
Yes
No
If
Yes, select all that apply:
Mobility
Cognitive/Developmental
Disabilities
Mental
Health
Hearing/Speech
Vision
Self-Care
Independent
Living
Other
Prefer Not to Answer
|
Change to numbering
Mental
Health is broken out from Cognitive/Developmental
Disabilities
Align
with streamline RI
Call Center Legacy
updates
|
8
|
Do you or anyone in your household have a disability that affects
your ability to perform activities of daily living or requires an
assistive device? (NOTE: An assistive device can include
wheelchair, walker, cane, hearing aid, communication device,
service animal, personal care attendant, oxygen, dialysis, etc.)
Yes No
If Yes, select all that apply:
Mobility
Cognitive/Developmental
Disabilities/Mental Health Hearing/Speech
Vision Self-Care
Independent Living Other
Prefer Not to Answer
|
8. Did you have any
disability-related assistive devices or medically required
equipment/supplies/support services damaged, destroyed, lost, or
disrupted because of the disaster?
Yes No
If Yes, select all that apply:
|
Change to numbering
|
9
|
Did you have any disability-related assistive devices or medically
required equipment/supplies/support services damaged, destroyed,
lost, or disrupted because of the disaster?
Yes No
If Yes, select all that apply:
|
9. Primary Phone No:
Phone Type:
Note:
|
Change to numbering Align with streamline RI
Call Center Legacy
updates
|
10
|
Damaged Dwelling Phone No. Cell Phone No.
|
10. Alternate Phone No:
Phone Type:
Note:
|
Change to numbering Align with streamline RI
Call Center Legacy
updates
|
11
|
Current Phone No.
Alternate Phone No.
Note:
|
11. Damaged: Dwelling Address
Street with
No. Apt/Lot City State Zip
|
Change to numbering Align with streamline RI
Call Center Legacy
updates
|
12
|
Damaged: Dwelling Address
No. Street Apt/Lot City, State, Zip
County
|
12. Do You: Own Rent
|
Change to numbering
|
13
|
Do You: Own Rent
|
13. Mailing Address
Same as Damaged Address
Street with
No. Apt/Lot City State Zip
In Care of:
|
Change to numbering Align with streamline RI
Call Center Legacy
updates
|
14
|
Mailing Address
Same as Damaged Address
No. Street. Apt/Lot City State Zip County
|
14. Damage address
county/parish/municipality ______
|
New question
Align with streamline RI
Call Center Legacy
updates
|
15
|
Damage Type
|
No Change
|
|
16
|
Home Damage?
Yes No Unknown
|
16.
Home Damage?
Yes No Unknown
Primary
Residency?
Yes No
|
Primary Residency question moved up from 23 and incorporated into
home damage question.
Align with streamline RI
Call Center Legacy
updates
|
18
|
Utilities Out 5 days or more?
Yes No
|
18. Essential Utility Needs?
Yes No
Utilities Out 3
days or more?
Yes No
Utilities out
now?
Yes No
|
New questions added
Change to timeframe for utilities
out.
Align with streamline RI
Call Center Legacy updates
|
19
|
New or additional child care costs?
Yes No
|
19. Access damage?
Yes No
|
New Assessment Question
Align with streamline RI
Call Center Legacy updates
|
20
|
Level of Damage to Home or Personal Property:
|
20.
Vehicle Damage?
Yes No
|
New Assessment Question
Align with streamline RI
Call Center Legacy
updates
|
21
|
Current Location
|
21. Need for food, clothing, shelter, gas,
medication, or medical equipment?
Yes No
|
New Assessment Question
Align with streamline RI
Call Center Legacy updates
|
22
|
Type of Home?
|
22. New or additional childcare
costs?
Yes No
|
Change to numbering
Moved from question 19 to 22
Align with streamline RI
Call Center Legacy updates
|
23
|
Primary Residence?
Yes No
|
23. Lodging Expenses?
Yes No
Received
Assistance with temporary lodging expenses?
Yes No
|
Lodging Expenses are new questions.
Align with streamline RI
Call Center Legacy updates
|
24
|
Currently able to get to your home?
Yes
No, due to mandatory evacuation
No, due to damages to roads or bridges in the area
|
24 Medical expenses?
Yes No
Dental
Expenses? Yes No
Funeral
Expenses? Yes No
|
Medical, Dental, and Funeral (Disaster Related Expenses) moved
from question 26 to 24 and became yes or no questions only. Table
removed.
Align with streamline RI
Call Center Legacy updates
|
25
|
Home/Personal Property Insurance
Table with Insurance Company
|
25. Miscellaneous Expenses?
Yes No
|
New Assessment Question
Align with streamline RI
Call Center Legacy updates
|
26
|
Disaster Related Expenses (uninsured or under-insured)
Table with Insurance Company
|
26. Level of Damage to Home or
Personal Property (Select One):
|
Change to numbering
Level of damage question moved from
20 to 26
Instruction added for ease of use
Align with streamline RI
Call Center Legacy updates
|
27
|
Disaster Related Vehicle Damage
Table with options
|
27. Current Location (Select
One)?
|
Change to numbering
Current location question moved from
21 to 27
Instruction added for ease of use
Align with streamline RI
Call Center Legacy updates
|
28
|
Emergency Needs:
Food, Medication, Durable Medical
Equipment or Gas
Shelter
Clothing
|
28.Type of Home (Select
One)?
|
Change to numbering
Type of Home question moved from 22
to 28.
Instruction added for ease of use.
Align with streamline RI
Call Center Legacy updates
|
29
|
Persons living in your home at time of disaster
Table
|
29. Currently able to get to your
home (Select One)?
Yes, able to
get to and leave home.
No, due to
flooding or damages to roads or bridges in the area
No, due to
damage of a privately owned road, bridge, or dock.
No, due to my
medical or accessibility features are damaged (such as a ramp or
elevator, etc.)
No, due to mandatory evacuation
|
Change to numbering
Currently able to get to your home
question moved from 24 to 29.
Instruction added for ease of use.
Increased options
Align with streamline RI
Call Center Legacy updates
|
30
|
Business Damages
Household’s source of income
is self-employment?
Yes No
Own a business or rental property
affected by the disaster?
Yes No
|
30. Need for Moving and Storage Expenses
after the disaster?
Yes No
|
New Question
Align with streamline RI
Call Center Legacy updates
|
31
|
No. of Dependents
(including yourself)
|
31 Home/Personal Property Insurance
Insurance Type
Insurance Company Name
|
Change to numbering
Insurance moved from question 26 to
31.
Keeps the same table.
Align with streamline RI
Call Center Legacy updates
|
32
|
Family’s pre-disaster income before taxes are deducted
$
Income not available
|
32 How many vehicles in your household?
After the
disaster, how many are drivable?
Did any
damaged vehicles have disability related accessibility features?
Yes No
Are any
damaged vehicles covered by comprehensive (full coverage)
insurance?
Yes No
|
New questions
Align with streamline RI
Call Center Legacy updates
|
33
|
Electronic Funds Transfer
Yes No
Bank/Financial Institution Name
Account Type:
Checking Savings
Routing No. (9 digits):
Account No.:
|
33. Disaster Related Vehicle Damage
Table with Options
Vehicle
Information
Year Make
Model
Damaged?
Drivable?
Yes No
Yes No
Comprehensive
Insurance?
Yes No
Liability
Insurance?
Yes No
Insurance
Company Name
Registered?
Yes No
|
Change to numbering
Vehicle damage with table moved from
question 27 to question 33
Align with streamline RI
Call Center Legacy updates
|
34
|
Correspondence language?
English Spanish
|
34. Emergency Needs:
Food, Medication, Durable Medical
Equipment or Gas
Shelter
Clothing
|
Change to numbering
Emergency Needs question moves from
28 to 34
Align with streamline RI
Call Center Legacy updates
|
35
|
Traditional postal mail or electronic notification?
Postal Mail Email
|
35. Persons living in your home at
time of disaster
Last Name, First Name, MI,
Relationship,
Social Security Number (App and
Co-App)
Age
|
Change to numbering
Occupant Table moved from Question
29 to 35.
Align with streamline RI
Call Center Legacy updates
|
36
|
Receive text messaging updates?
Yes No
Mobile Phone No. Agree to text messaging terms? Yes No
|
36. Financial
Household’s source of income
is self-employment?
Yes No
Own a business or rental property
affected by the disaster?
Yes No
|
Change to numbering
Move Business Damage question from
30 to 36 and rename
Financial
Align with streamline RI
Call Center Legacy updates
|
|
|
37. No. of Dependents
(including yourself)
|
Change to numbering
Dependents moved from question 31 to
37
Align with streamline RI
Call Center Legacy updates
|
|
|
38. Family’s pre-disaster
income before taxes are deducted
$
Income not available
|
Change to numbering
Income moved from question 32 to 38
Align with streamline RI
|
|
|
39. Electronic Funds Transfer
Yes No
Bank/Financial Institution Name:
Account Type:
Checking Savings
Routing No. (9 digits):
Account No.:
|
Change to numbering
EFT question moved from 33 to 39
Align with streamline RI
Call Center Legacy updates
|
|
|
40. Correspondence language?
English Spanish
|
Change to numbering
Correspondence question changed from
34 to 40.
Align with streamline RI
Call Center Legacy updates
|
|
|
41. Traditional postal mail or
electronic notification?
Postal Mail Email
|
Change to numbering
Mail question changed from 35 to 41
Align with streamline RI
Call Center Legacy updates
|
|
|
42. Receive text messaging updates?
Yes No
Mobile Phone No.
Agree to text messaging terms?
Yes No
|
Change to numbering
Text messaging question moved from
36 to 42
Align with streamline RI
Call Center Legacy updates
|
|
|
|
|
Application for Disaster Assistance Instructions
|
Application/Registration for Disaster Assistance
|
Application for Disaster Assistance
|
Calibrated Survivor Messaging
|
Application for Disaster Assistance Instructions
|
No introduction to instruction
|
It’s important you understand that
your application becomes a legal document. FEMA may use external
sources to verify the accuracy of the information you enter.
|
Legal notice - Align with streamline RI
|
Application for Disaster Assistance Instructions
|
No Assessment Section
|
Assessment Section:
What
Help do you Need:
Home
or Property damage
Home
Damage,
Personal
Property Damage
Vehicle
Damage
Other
Expenses
Funeral
or reburial expenses
Lodging
expenses
Medical
or dental expenses
New
or extra childcare expenses
Miscellaneous
Item expenses
Emergency
Needs
Food,
clothing, shelter, gas, medication, or medical equipment
Essential
utilities
Home
access
Business
Unemployment
|
Align with streamline RI
Additional information to assist
with assessment, and need to complete an application
Ease of use.
|
Application for Disaster Assistance Instructions
|
No Referral Section
|
Referrals
Do NOT complete an application for
Business Needs ONLY
You
may be able to get assistance from the U.S. Small Business
Administration (SBA) for business losses.
Provide
referrals to ‘SBA Disaster Assistance’ for Business
ONLY.
Do
NOT complete an application for Unemployment Needs ONLY.
You
may be able to get assistance from your state’s unemployment
office.
Provide
referrals to the ‘Career One Stop’ Unemployment
program for your state.
For
other needs outside of FEMA Individuals and Households Program
(IHP) Assistance contact 211/United Way referral.
|
Align with streamline RI
Instructions added for ease of use.
|
Application for Disaster Assistance Instructions
|
No Primary/Secondary Information
|
Is this your primary home or secondary
home?
Secondary
Home – for some assistance FEMA can only provide assistance
for your primary home.
You
may continue with your application.
|
Align with streamline RI
Informational
Ease of Use
|
Application for Disaster Assistance Instructions
|
No Representative PII warning
|
Representative:
As
a FEMA representative, you must take steps to ensure that you
protect what you collect. Physically secure hard copies of
documents containing PII in a locked file drawer, cabinet, or
safe. Do not leave documents with PII unattended on printers, fax
machines, copiers, or desktops. Crossshred paper containing PII;
do not recycle or place in garbage containers.
|
Align with standard privacy standards. At a DRC or field location
care must be taken to protect PII/SPII
|
Application for Disaster Assistance Instructions
|
No intro to instructions
|
Instructions for completing the
application
Representative:
Complete the Record Information ensuring you have the correct
disaster number and date of loss.
Complete
Personal Information
|
Improved instructions for ease of use
|
Application for Disaster Assistance Instructions
|
Check Mr. or Ms. to properly address correspondence.
|
1.
Enter
the last name, first name, and middle initial of applicant. Enter
JR, SR, III, etc. following the last name if applicable.
If
the application is for Funeral ONLY, enter the name of the person
responsible for the funeral expenses.
|
Change to numbering
Question numbers shift with changes
Remove Mr/Ms
Remove business only wording.
Align with streamline RI, Call Center Legacy updates
|
Application for Disaster Assistance Instructions
|
2.
Enter the last name, first name, and middle initial of applicant.
Enter JR, SR, III, etc. following the last name if applicable. If
the registration is for Business
ONLY,
enter
the
business
owner’s
name
or
representative
(not
the
business
name).
If
the
registration
is
for
Funeral
ONLY,
enter
the
name
of the person responsible for the funeral expenses.
|
2.
Enter the applicant’ preferred name.
|
Change to numbering
Align with streamline RI, Call Center Legacy updates
|
Application for Disaster Assistance Instructions
|
3.
Enter the language applicant speaks. If the applicant speaks
English, leave blank.
4.
Enter applicant's Social Security Number (SSN). If the applicant
does not have an SSN but has a dependent child with an SSN, enter
the child’s SSN and information in fields 1-5. If the
registration is for Business ONLY, enter the responsible party’s
SSN, to be used only as an identifier. If the registration is for
Funeral ONLY, enter the SSN of the person responsible for the
funeral expenses.
|
3.
Enter
applicant's Social Security Number (SSN). If the applicant does
not have an SSN but has a dependent child with an SSN, enter the
child’s SSN and information in fields 1-5.
If
the application
is for Funeral ONLY, enter the SSN of the person responsible for
the funeral expenses.
|
Change to numbering
Question numbers shift with changes
Remove language.
Remove Business only wording
Align with streamline RI, Call Center Legacy updates
|
Application for Disaster Assistance Instructions
|
5.
Enter applicant’s date of birth
|
4.
Enter applicant’s date of birth.
|
Change to numbering
Question numbers shift with changes
Align with streamline RI, Call Center Legacy updates
|
Application for Disaster Assistance Instructions
|
6.
Enter
applicant’s e-mail address, if available.
|
5. Enter
applicant’s e-mail address, if available.
|
Change to numbering
Question numbers shift with changes
Align with streamline RI, Call Center Legacy updates
|
Application for Disaster Assistance Instructions
|
No
Section division
7. Accommodation
or assistance may include, but is not limited to, sign language
interpreter, Braille, large print, accessible electronic format,
or materials in a language other than English. FEMA programs may
include, but are not limited to, home inspection, town hall
meetings, access to a Disaster Recovery Centers, or accessible
temporary housing (if eligible). Check Yes or No accordingly.. If
Yes, check all needs that apply.
|
Language Information
6.
Accommodation
or assistance may include, but is not limited to, sign language
interpreter, Braille, large print, accessible electronic format,
or materials in a language other than English. FEMA programs may
include, but are not limited to, home inspection, town hall
meetings, access to a Disaster Recovery Centers, or accessible
temporary housing (if eligible). Check Yes or No accordingly.. If
Yes, check all needs that apply.
|
Ease of use
Change to numbering
Question numbers shift with changes
Align with streamline RI, Call Center Legacy updates
|
Application for Disaster Assistance Instructions
|
No
Section division
8.
The Americans with Disabilities Act (ADA) defines disability as "a
physical or mental impairment that substantially limits one or
more of the major life activities of such individual." 42 USC
12102(2) (A). If the applicant or household member has such a
disability, check Yes. If Yes, check all that apply or Prefer Not
to Answer.
9.
If the applicant or household member had any disability-related
assistive devices or medically required equipment/supplies/support
services damaged, destroyed, lost or disrupted because of the
disaster, check Yes and check all that apply.
|
Other Needs Information
7. The
Americans with Disabilities Act (ADA) defines disability as "a
physical or mental impairment that substantially limits one or
more of the major life activities of such individual." 42 USC
12102(2) (A). If the applicant or household member has such a
disability, check Yes. If Yes, check all that apply or Prefer Not
to Answer.
8. If the applicant or household
member had any disability-related assistive devices or medically
required equipment/supplies/support services damaged, destroyed,
lost, or disrupted because of the disaster, check Yes and check
all that apply.
|
Ease of use
Change to numbering
Question numbers shift with changes
Align with streamline RI, Call Center Legacy updates
|
Application for Disaster Assistance Instructions
|
No
Section division
|
Phone Numbers
Representative:
If the applicant uses a video relay service (VRS), captioned
telephone (CTS), or other service, give FEMA the number for that
service.
|
Ease of use
Improved instructions
|
Application for Disaster Assistance Instructions
|
10.
Damaged Dwelling Phone: Beginning with the area code, enter the
phone number used at the damaged dwelling at the time of the
disaster, even if the number is not currently working. If there
was no home phone at the time of the disaster, enter a cell phone
or current phone number. Cell Phone: Enter applicant’s cell
phone number if applicable
|
9. Primary
Phone: Beginning
with the area code, enter the phone number used at the damaged
dwelling at the time of the disaster and
enter the type of phone. Use the Note field if specific contact
information is needed.
|
Change to numbering
Question numbers shift with changes
Align with streamline RI, Call Center Legacy updates
|
Application for Disaster Assistance Instructions
|
11.
Current Phone: Enter the current phone number where the applicant
can be reached. Alternate Phone: Enter an alternate phone number
where FEMA can reach the applicant or leave a message, if
applicable. Use the Note field if specific contact information is
needed (i.e. family member’s phone number, neighbor,
minister, etc.).
|
10,
Alternate Phone:
Enter an alternate phone number and
type of phone where
FEMA can reach the applicant or leave a message, if applicable.
Use the Note field if specific contact information is needed (i.e.
family member’s phone number, neighbor, minister, etc.).
|
Change to numbering
Question numbers shift with changes
Align with streamline RI, Call Center Legacy updates
|
Application for Disaster Assistance Instructions
|
Section
Division
|
Address
|
Ease of use
|
Application for Disaster Assistance Instructions
|
12. Enter
the full physical street address exactly as it appears on a
utility bill. Do not use any abbreviations, do not enter a “#”
symbol and do not enter a PO Box or general delivery address.
|
11.
Enter the full physical street address where
the damage occurred, including the house, or building number,
street name and any apartment or lot number (exactly
as it appears on a utility bill).
Do not use any abbreviations, do not enter a “#”
symbol, and do not enter a PO Box or general delivery address.
|
Change to numbering
Question numbers shift with changes
Instructions for ease of use.
Align with streamline RI, Call Center Legacy updates
|
Application for Disaster Assistance Instructions
|
13.
If
the
applicant
is
named
on
the
deed,
or
applicant
maintains
the
home,
pays
no
rent
and
pays
taxes
(if
applicable)
or
has
lifetime
occupancy
rights
while not holding the legal title to the home, check Own. Check
Rent if the applicant does not meet any of the ownership criteria,
even if the applicant pays no rent.
|
12.
If the applicant is named on the deed, or applicant maintains the
home, pays no rent and pays taxes, or has lifetime occupancy
rights while not holding the legal title to the home, check Own.
If
the applicant does not meet any of the ownership criteria, even if
the applicant pays no rent,
check
Rent.
|
Change to numbering
Question numbers shift with changes
Spacing in sentence for ease of use
Readability
Align with streamline RI, Call Center Legacy updates
|
Application for Disaster Assistance Instructions
|
14.
Check Same as Damaged Address, if applicable. If different, enter
the address where the applicant is currently receiving mail. A PO
Box or general delivery address may be used.
|
13. Check
Same as Damaged Address, if applicable. If different, enter the
address where the applicant is currently receiving mail. A PO Box
or general delivery address may be used. If
mail is received in care of another person, add that person’s
name.
|
Change to numbering
Question numbers shift with changes
Instructions ease of use
Align with streamline RI, Call Center Legacy updates
|
Application for Disaster Assistance Instructions
|
No
separate county/parish/municipality question before
|
14. Enter
the county/Parish/Municipality where the damage occurred.
|
Align with streamline RI, Call Center Legacy updates
|
Application for Disaster Assistance Instructions
|
No
Section Division or instruction to representative
|
Losses
Representative:
Only
record losses or needs of the applicant in the following section
|
Ease of use
Instructions
Align with streamline RI, Call Center Legacy updates
|
Application for Disaster Assistance Instructions
|
15.
Check all damage types that apply. Other may include explosion,
drought, riot, etc
|
|
|
Application for Disaster Assistance Instructions
|
16.
Check Yes if the applicant’s home was damaged by the
disaster. Check No if no damage to the applicant’s home or
if the applicant is applying for Business, Transportation, or
Funeral ONLY. Check Unknown if the applicant is unsure of the
damage to the home
23. Check
Yes if the affected home is the applicant’s primary
residence (where the applicant lives more than 6 months of the
year, listed the address on their Federal Tax Return, or files a
homestead exemption at the address). Check No if the affected home
is a secondary residence or vacation home, or if the registration
is Business, Transportation, or Funeral ONLY.
|
16. Check Yes if the applicant’s
home was damaged by the disaster. Check No if no damage to the
applicant’s home or if the applicant is applying for
Transportation
or Funeral ONLY. Check
Unknown if the applicant is unsure of the damage to the home.
If
Home damage selection is Yes, or Unknown, check
Yes if the affected home is the applicant’s primary
residence (where the applicant lives more than 6 months of the
year, listed the address on their Federal Tax Return, or files a
homestead exemption at the address).
Check
No if the affected home is a secondary residence or vacation home,
or if the application Transportation or Funeral ONLY
|
Align with streamline RI, Call Center Legacy updates
Question 23 Primary Residence moved
up to be incorporated with question 16.
Remove Business only information
|
Application for Disaster Assistance Instructions
|
17. Check
Yes if the applicant had personal property damage (i.e.
appliances, clothing, and/or furniture). Check No if no damage to
the applicant’s personal property, or if the applicant is
applying for Business, Transportation, or Funeral ONLY. Check
Unknown if the applicant is unsure of personal property damage.
|
17. Check Yes if the applicant
had personal property damage (i.e. appliances, clothing, and/or
furniture).
Check
No if no damage to the applicant’s personal property, or if
the applicant is applying for Transportation or Funeral ONLY
Check Unknown if the applicant
is unsure of personal property damage.
|
Align with streamline RI, Call Center Legacy updates
Remove Business only information
|
Application for Disaster Assistance Instructions
|
18. Check
Yes if the applicant has been without essential utilities for at
least 5 days. Check No if the applicant has essential utilities or
were without them for less than 5 days
|
18. Check
Yes if the applicant has essential utility needs.
Check
Yes
if
the
applicant
has
been
without
essential
utilities
for
3
days
or more.
Check
Yes if the utilities are out now (time of application)
|
Align with streamline RI, Call Center Legacy updates
|
Application for Disaster Assistance Instructions
|
New
Question
|
19. Check Yes if the applicant has trouble
accessing the home. (Example: Blocked Entry, or damage to
accessibility equipment like a ramp)
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Application for Disaster Assistance Instructions
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New
Question
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20. Check Yes if the applicant has vehicle
damage.
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Application for Disaster Assistance Instructions
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New
Question
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21.
Check Yes if the applicant has a need for food, clothing, shelter,
gas, medication, or medical equipment.
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Align with streamline RI, Call Center Legacy updates
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Application for Disaster Assistance Instructions
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19. Check
Yes if the applicant has increased financial burden due to new or
additional child care costs. Check No if the applicant does not
have child care costs or child care costs have not increased.
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22. Check
Yes if
the applicant
has any
new
or
additional
childcare
costs because of the disaster.
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Change to numbering
Question numbers shift with changes
Align with streamline RI, Call Center Legacy updates
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Application for Disaster Assistance Instructions
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New
Question
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23. Check
Yes if the applicant has any lodging expenses (Example: Hotel,
Motel, etc.)
If
Yes, did the applicant get assistance with temporary lodging
expenses from any other source.
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Application for Disaster Assistance Instructions
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26.
If the applicant incurred uninsured or under-insured medical,
dental, and/or funeral expenses as a direct result of the
disaster, check Yes for each applicable expense category. If the
applicant had insurance for the expense, list the insurance
company name.
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24. Check Yes if the applicant has any
Medical expenses as a result of the disaster.
Check
Yes if the applicant has any Dental expenses as a result of the
disaster.
Check
Yes if the applicant has any Funeral expenses as a result of the
disaster.
Representative:
If the applicant has any disaster caused funeral expenses include
the deceased in the Occupants tab with the relationship
‘deceased’. The social security and date of birth is
needed for the deceased.
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Change to numbering
Question numbers shift with changes
Change in question format
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Application for Disaster Assistance Instructions
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New
Question
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25.
Check Yes if the applicant has any Miscellaneous expenses as a
result of the disaster. (Example; Dehumidifier, chainsaw, etc)
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Application for Disaster Assistance Instructions
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20. Check
the level of disaster damage to applicant’s home and/or
personal property that best applies based on the provided options.
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26.
If the applicant reports home or personal property damages, check
the level of disaster damage to applicant’s home and/or
personal property that best applies based on the provided options.
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Change to numbering
Question numbers shift with changes
Improved instructions for ease of use
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Application for Disaster Assistance Instructions
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21. Check the location where the applicant
is currently living or staying.
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27.
Check
the location where the applicant is currently living or staying
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22. Check
the residence type for which the applicant is applying.
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28.
Check
the residence type for which the applicant is applying.
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Question numbers shift with changes
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Application for Disaster Assistance Instructions
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23. Check
Yes if the affected home is the applicant’s primary
residence (where the applicant lives more than 6 months of the
year, listed the address on their Federal Tax Return, or files a
homestead exemption at the address). Check No if the affected home
is a secondary residence or vacation home, or if the registration
is Business, Transportation, or Funeral ONLY.
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Became
question 19, aligned with home damage.
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Application for Disaster Assistance Instructions
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24.
Check Yes if the residence does not have restricted access,
applicant is able to both get to and leave the home, or if the
registration is Business, Transportation, or Funeral ONLY. If the
applicant is unable to access the home, check the appropriate
reason. Check No, due to mandatory evacuation if the residence is
inaccessible due to mandatory evacuation. Check No, due to damages
to roads or bridges in the area if the residence is inaccessible
due to damage caused by the disaster.
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29.
Check
Yes if the
applicant is able to both get to and leave the home, or
if the application is
Transportation, or Funeral ONLY.
If the
applicant is unable to access the home, check the reason.
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Change to numbering
Question numbers shift with changes
Additional options
Align with streamline RI, Call
Center Legacy updates
Plain language
Remove Business only
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Application for Disaster Assistance Instructions
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New
Question
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30.
Check Yes if the applicant needs help with moving and storage
expenses after the disaster.
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Application for Disaster Assistance Instructions
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25. List
all insurance types the applicant held at the time of the disaster
for the home and/or personal property, including but not limited
to sewer backup, earthquake, and/or flood, and the insurance
company name. Check I have no insurance for my home or personal
property if there was no insurance coverage for the home or
personal property losses.
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31.
List
all types
of insurance
the applicant held at the time of the disaster for the home and/or
personal property, including but not limited to sewer backup,
earthquake, and/or flood, and the insurance company name.
Check
I have no insurance for my home or personal property if there was
no insurance coverage for the home or personal property losses.
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Change to numbering
Question numbers shift with changes
Plain language
Sentence spacing for ease of use
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Application for Disaster Assistance Instructions
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New
Question
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32. If
the applicant had vehicle damages, how many vehicles does the
household have, only include those that were drivable before the
disaster?
How
many were drivable after the disaster. Did any of the damaged
vehicles have disability related accessibility features (Example:
Wheelchair lifts and ramps, pedal or seat belt extenders, hand
control and steering devices, etc.)
Did
any of the damaged vehicles have disability related accessibility
features (Example: Wheelchair lifts and ramps, pedal or seat belt
extenders, hand control and steering devices, etc.)
Were
any of the damaged vehicles covered by comprehensive (full
coverage) insurance?
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Align with streamline RI, Call Center Legacy updates
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Application for Disaster Assistance Instructions
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27.
Enter all vehicles owned by the applicant or anyone in the
household. Year: Enter the year the vehicle was manufactured.
Make: Enter the vehicle make. Model: Enter the vehicle model.
Damaged: Check Yes or No to indicate if the vehicle was damaged by
the disaster (if unknown, check No). Drivable: Check Yes or No to
indicate if the vehicle is currently drivable (if unknown, check
No). Comprehensive Insurance: Check Yes or No to indicate if the
vehicle is covered by comprehensive insurance. Liability
Insurance: Check Yes or No to indicate if the vehicle is covered
by liability insurance (if unknown, check No). Enter the insurance
company name if the vehicle is covered by comprehensive or
liability insurance. Registered: Check Yes or No to indicate if
the vehicle is registered.
|
33.
Enter
all vehicles owned by the applicant or anyone in the household.
Year: Enter the year the vehicle was manufactured. Make: Enter the
vehicle make. Model: Enter the vehicle model. Damaged: Check Yes
or No to indicate if the vehicle was damaged by the disaster (if
unknown, check No). Drivable: Check Yes or No to indicate if the
vehicle is currently drivable (if unknown, check No).
Comprehensive Insurance: Check Yes or No to indicate if the
vehicle is covered by comprehensive insurance. Liability
Insurance: Check Yes or No to indicate if the vehicle is covered
by liability insurance (if unknown, check No). Enter the insurance
company name if the vehicle is covered by comprehensive or
liability insurance. Registered: Check Yes or No to indicate if
the vehicle is registered.
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Change to numbering
Question numbers shift with changes
Align with streamline RI, Call Center Legacy updates
|
Application for Disaster Assistance Instructions
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28.
Check each emergency need (essential items for day-to-day
existence). Emergency needs do not include stored food.
|
34.
Check
each emergency need (essential items for day-to-day existence).
Emergency needs do not include stored food.
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Change to numbering
Question numbers shift with changes
Align with streamline RI, Call Center Legacy updates
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Application for Disaster Assistance Instructions
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Section
Division
|
Occupants
|
Ease of Use
|
Application for Disaster Assistance Instructions
|
29. Enter
the information for the applicant and all persons who considered
the home to be their primary residence at the time of the
disaster, whether or not they are related to the applicant.
Include the SSN for only the applicant and co-applicant (if
applicable).
|
35.
Enter
the information for the applicant and all persons who considered
the home to be their primary residence at the time of the
disaster, whether or not they are related to the applicant.
Include the SSN for only the applicant and co-applicant (if
applicable).
Representative:
If there are funeral expenses, include the deceased name, SSN, and
date of birth.
|
Change to numbering
Question numbers shift with changes
Align with streamline RI, Call
Center Legacy updates
Improved instructions
|
Application for Disaster Assistance Instructions
|
30. Check
Yes or No to indicate whether the household’s primary source
of income is from self-employment. Check Yes or No to indicate
whether the applicant owns or represents a business or rental
property affected by the disaster.
|
36.
Check
Yes or No to indicate whether the household’s primary source
of income is from self-employment. Check Yes or No to indicate
whether the applicant owns or represents a business or rental
property affected by the disaster.
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Change to numbering
Question numbers shift with changes
Align with streamline RI, Call Center Legacy updates
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Application for Disaster Assistance Instructions
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31. Enter
the number of dependents, including the applicant and those listed
as dependents on their Federal Tax Return.
|
37.
Enter
the number of dependents, including the applicant and those listed
as dependents on their Federal Tax Return.
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Change to numbering
Question numbers shift with changes
Align with streamline RI, Call Center Legacy updates
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Application for Disaster Assistance Instructions
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32. Enter
the pre-disaster household annual gross income (the total
household income before any deductions are subtracted, including
income from welfare, child support, stocks, interest, and/or
annuities. DO NOT include food stamps or HUD Section 8
assistance). If the applicant is "living off savings, family,
or friends," enter the approximate amount they receive
yearly.
|
38.
Enter
the pre-disaster household annual gross income (the total
household income before any deductions are subtracted, including
income from welfare, child support, stocks, interest, and/or
annuities. DO NOT include food stamps or HUD Section 8
assistance). If the applicant is "living off savings, family,
or friends," enter the approximate amount they receive
yearly. Enter
whole dollars only, no symbols or decimal points.
|
Change to numbering
Question numbers shift with changes
Align with streamline RI, Call
Center Legacy updates
Improved instructions
|
Application for Disaster Assistance Instructions
|
33. If
the applicant is found eligible for FEMA assistance and would like
funds directly deposited into their bank account, check Yes. If
Yes, enter the name of the applicant's financial institution,
their 9-digit routing number (the 9-digit number that appears in
the lower left corner of a check), the account type, and the
applicant's account number (found at the bottom of a check
immediately after the routing number). NOTE: Applicant’s
name must be on the account.
|
39.
If
the applicant is found eligible for FEMA assistance and would like
funds directly deposited into their bank account, check Yes. If
Yes, enter the name of the applicant's financial institution,
their 9-digit routing number (the 9-digit number that appears in
the lower left corner of a check), the account type, and the
applicant's account number (found at the bottom of a check
immediately after the routing number). NOTE: Applicant’s
name must be on the account.
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Change to numbering
Question numbers shift with changes
Align with streamline RI, Call Center Legacy updates
|
Application for Disaster Assistance Instructions
|
34. Check
the language in which the applicant prefers to receive FEMA
correspondence.
|
40.
Check the language in which the applicant prefers to receive FEMA
correspondence.
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Change to numbering
Question numbers shift with changes
Align with streamline RI, Call Center Legacy updates
|
Application for Disaster Assistance Instructions
|
Section
Division
|
Correspondence
|
Ease of Use
|
Application for Disaster Assistance Instructions
|
35. Check
the form of communication through which the applicant prefers to
receive FEMA correspondence.
|
41.
Check
the form of communication through which the applicant prefers to
receive FEMA correspondence.
Representative:
If the applicant chooses to receive email updates, they will not
receive any postal mail. They must have a disaster assistance
account at DisasterAssistance.gov to receive email updates. Verify
the email address entered in field 6.
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Change to numbering
Question numbers shift with changes
Align with streamline RI, Call
Center Legacy updates
Improved instructions for ease of use
|
Application for Disaster Assistance Instructions
|
36. Text
messaging is an optional service. Check Yes if the applicant wants
to receive text message status alerts in addition to e-mail or
postal mail. If Yes, enter the mobile phone number through which
the applicant would like to receive text messages. Check Yes or No
to indicate if the applicant agrees to the terms of text messaging
(FEMA text messages do not replace postal mail or e-mail; FEMA’s
text messaging number is 4FEMA [43362]. Please note you may also
receive a text message from a FEMA inspector to schedule an
appointment for your inspection; Standard text message rates
apply.).
|
42.
Text
messaging is an optional service. Check Yes if the applicant wants
to receive text message status alerts in addition to e-mail or
postal mail. If Yes, enter the mobile phone number through which
the applicant would like to receive text messages. Check Yes or No
to indicate if the applicant agrees to the terms of text messaging
(FEMA text messages do not replace postal mail or e-mail; FEMA’s
text messaging number is 4FEMA [43362]. Please note you may also
receive a text message from a FEMA inspector to schedule an
appointment for your inspection; Standard text message rates
apply.).
|
|
Application for Disaster Assistance Instructions
|
No
instruction to capture demographic questions
|
Representative:
Capture demographic information on the FEMA Form FF-256-FY-21-100-
Equity Demographics Questions.
|
Improved instructions for ease of use
|
Application for Disaster Assistance Instructions
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37. Enter
any comments.
|
43.
Enter
any comments.
|
|
Application for Disaster Assistance Instructions
|
38. Enter
name of the FEMA representative filling out the form.
|
44.
Enter
name of the FEMA representative filling out the form.
|
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