Recovery Questionnaire

If you have experienced damage to your home due to a weather event (flooding, snow storm, wind damage, etc.) please complete as much of the form as possible and submit. Our agency will follow-up with any other additional information that may be needed and/or updates we receive throughout the recovery process.

Photos of your property and damages must also be submitted at request of FEMA and Small Business Administration (SBA). Please email photos of your property/damages to tguth@ncem-pa.org – place your street address in the subject line when sending (Ex. 100 Gracedale Avenue).

    * Required Fields


    PhoneEmail




    *Any other damages experienced – please describe:

    *Is the structure still occupied?
    YesNo

    *Do you have Insurance?

    *Do you have Flood Insurance?

    *Do you have any private bridges or access roads damaged / destroyed?

    *Are any of your utilities out such as; gas, electricity, etc.

    *List your utilities that are out such as: gas, electricity, etc.

    If available, what are the estimated damage costs to your physical dwelling due to the event?

    How much is your insurance company covering?

    If available, what are the estimated damages costs to your land / property due to the event?

    How much is your insurance company covering?

    Total approximate value of ALL personal belongings within the entire home?

    Total approximate value of ONLY the damaged personal belonging within your home?

    Did you have damages to any of the following components of the home?

    Heating Source:

    Hot water heater type?

    ×