DAMAGE REPORT FORM

This Damage Report Form is provided as a service to citizens of the City of Houston. This form does NOT replace forms necessary to receive disaster assistance from FEMA, or other relief agencies.

How to Apply For Disaster Assistance

Register for disaster assistance online, or by calling 1-800-621-FEMA (3362). Call TTY 1-800-462-7585 for people with speech or hearing disabilities.

The toll-free telephone numbers are available 24 hours a day, seven days a week until further notice. If you get a busy signal, try to call in the evening after 6:00 p.m. or on the weekends when call volumes tend to be lighter.

Applicants registering for aid should be prepared to provide basic information about themselves (name, permanent address, phone number, insurance coverage and any other information to help substantiate losses).

Please fill out and submit this form completely following an even

City Damage Report Form

First Name:

Last Name:

Email:

Address:

ZIP:

Subdivision:

Day Phone: Night Phone:

Brief Damage Description: