Community Homeowner - Hurricane Helene Relief

Insurance Deductible & Minor Repairs Assistance Application

This application is designed to assist Non-Habitat homeowners in Richmond and Columbia counties who have been affected by Hurricane Helene. This program is funded through a grant and all services provided must be in accordance with the parameters of said grant. Eligible applicants must comply with the HUD income limits in accordance with the Habitat for Humanity guidelines. Completing this application does not guarantee that your application will be selected and is not a guarantee of assistance.

Your Contact Information

Prefix (Mr., Mrs., Ms., Dr., etc.)

First Name *

Last Name *

Email *

Gender

Date of Birth

Address Line 1 *

Address Line 2

Phone *

City *

State *

Zip *

Homeowner Information

How long have you lived at this address? * The field How long have you lived at this address? is required.

Total number of people living in the home? * The field Total number of people living in the home? is required.

List all household members (Name, Age, Relationship to Applicant) * The field List all household members (Name, Age, Relationship to Applicant) is required.

Are you a US Veteran? The maximum length for the field Are you a US Veteran? is 500 characters.

Income & Insurance

Please complete this section, being certain to answer each question. Incomplete applications will not be considered for the grant opportunity.

Annual household income (You will be asked to supply proof of income) * The field Annual household income (You will be asked to supply proof of income) is required.

Do you currently receive any government assistance? (e.g. SNAP, SSI, FEMA aid)? * The field Do you currently receive any government assistance? (e.g. SNAP, SSI, FEMA aid)? is required.

Do you have homeowner's insurance? (Yes/No) * The field Do you have homeowner's insurance? (Yes/No) is required.

Have you filed a claim for Hurricane Helene damages? (Yes/No) * The field Have you filed a claim for Hurricane Helene damages? (Yes/No) is required.

Have you received any funds from your insurance provider toward the requested relief? * The field Have you received any funds from your insurance provider toward the requested relief? is required.

Have you received any other assistance towards the requested relief? (e.g. FEMA, Red Cross, grants)? (Yes/No, Explain) * The field Have you received any other assistance towards the requested relief? (e.g. FEMA, Red Cross, grants)? (Yes/No, Explain) is required.

If so, what was the dollar amount you receive and from whom? (You will be required to provide proof) * The field If so, what was the dollar amount you receive and from whom? (You will be required to provide proof) is required.

Insurance Deductible Request

Please complete this section if you are seeking assistance with an insurance deductible. If you are not seeking asssitance with your insurance deductible, please mark all sections with "N/A".

Be certain to answer each question. Incomplete applications will not be considered for the grant opportunity.

Are you requesting assistance with your insurance deductible request? (Yes/No/NA) * The field Are you requesting assistance with your insurance deductible request? (Yes/No/NA) is required.

Have you already paid your insurance deductible? (Yes/No/NA) * The field Have you already paid your insurance deductible? (Yes/No/NA) is required.

If so, what was the total amount paid? (You will be required to provide proof of payments) * The field If so, what was the total amount paid? (You will be required to provide proof of payments) is required.

If you have not paid your deductible, what is the total amount of assistance you are seeking? * The field If you have not paid your deductible, what is the total amount of assistance you are seeking? is required.

Minor Repair Request

Please complete this section if you are seeking assistance with an Minor Repairs Assistance. If you are not seeking asssitance with your Minor Repairs Assistance, please mark all sections with "N/A".

Be certain to answer each question. Incomplete applications will not be considered for the grant opportunity.

Are you requesting assistance with Minor Repairs Assistance? (Yes/No/NA) * The field Are you requesting assistance with Minor Repairs Assistance? (Yes/No/NA) is required.

Describe the damages that were a result of Hurricane Helene. (If not applicable, put NA) * The field Describe the damages that were a result of Hurricane Helene. (If not applicable, put NA) is required.

Have you gotten an estimate for the damages? If so, how much was the estimate? (You will be required to provide proof) * The field Have you gotten an estimate for the damages? If so, how much was the estimate? (You will be required to provide proof) is required.

Were you referred to this application by FEMA or an associate of FEMA? (Yes, No) The maximum length for the field Were you referred to this application by FEMA or an associate of FEMA? (Yes, No) is 500 characters.