Natural Disaster Needs Assessment for Low-Income Households

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A. You need to be at 80% Area Median Income (AMI - see chart below to see if you qualify)

B. You need documentation (Photo ID, Social Security cards (for each household member), Proof of income of the last 90
days (see below,) Housing information, Utility documentation)

C. If you want help with:

1. Insurance Deductible: Insurance documentation, pictures of damage, and/or letter condemning your residence

2. Re-housing: pictures of damage, and/or letter condemning your residence (by L/L or insurance agent)- proof your L/L is
releasing you from your lease

3. Moving truck: the address where items are going to/from; and pics of what is moving

4. Furnishings: list of items needed for household (bedding, furniture, kitchen items, etc.)

5. Car repair or car deductible as a result of storm damage

6. Other - let us know what you cannot afford

Full Name *

Email Address (if available)

Zip Code

Phone number *

Number of people in your household and their ages (including yourself) *

Reason for referral/What do you need? (select all that apply) *

First month's rent

Security Deposit

Rent Assistance (for current place)

Furniture

Beds/Linens

Kitchen Essentials

Vehicle Repair

Utility Assistance

Insurance Deductibles **Select applicable deductibles below

**Homeowners

**Renters

**Vehicle

Other:

Required

Documentation needed for "Proof of Income" for the last 90 days:

Needed for you and everyone in your household over the age of 18.
Could include:
• Paystubs: If paid weekly – 13 paystubs | Bi-weekly – 7 paystubs | Monthly – 3 paystubs
• Child Support Printout for the last 90 days (If you have a Child Support Order the printout is required even if you are not
currently receiving payments)
• Social Security or SSI Award Letter
• Public Assistance: TANF |OWF| ADCR | DA Printout including the current month
• Unemployment – a summary printout of current claim history
• Self-Employed – Recent IRS Form 1040 with Schedule C
• Support Provided by Others – a letter with name, address, and contact information from person providing support,
describing how much they give and how often
• Zero or Limited Income – Documented proof of how you are meeting your needs.

See if your household is around 80% of Area Media Income (AMI)

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