Summary. Seventeen templates, in recovery order.
1. Damage documentation log
Fill this in as you photograph, before any cleanup.
DAMAGE DOCUMENTATION LOG
Property: ______________________ Disaster: ______________
Date of damage: ____/____/______ Date documented: ____/____/______
Documented by: ______________
ROOM: ______________
Water depth / high-water mark: ______ inches, measured at __________
Photos taken: #____ to #____
Video timestamp: ____________
DAMAGE OBSERVED
Flooring: ______________________________________
Walls: ______________________________________
Ceiling: ______________________________________
Windows/doors: ______________________________________
Electrical: ______________________________________
Cabinets/built-ins: ___________________________________
CONTENTS DESTROYED (see inventory, Template 3)
______________________________________________________
[Repeat for every room]
SYSTEMS AND STRUCTURE — the ones inspectors miss
Furnace / HVAC: [ ] damaged Photos #____ Notes: ________
Water heater: [ ] damaged Photos #____ Notes: ________
Electrical panel: [ ] damaged Photos #____ Notes: ________
Crawlspace: [ ] damaged Photos #____ Notes: ________
Attic: [ ] damaged Photos #____ Notes: ________
Subfloor / sill plate: [ ] damaged Photos #____ Notes: ________
Foundation: [ ] damaged Photos #____ Notes: ________
Roof: [ ] damaged Photos #____ Notes: ________
Well / septic: [ ] damaged Photos #____ Notes: ________
Ductwork: [ ] damaged Photos #____ Notes: ________
Insulation: [ ] damaged Photos #____ Notes: ________
ACCESSIBILITY FEATURES (state these explicitly — repairs may be covered)
Ramp: [ ] damaged Notes: ______________
Grab bars: [ ] damaged Notes: ______________
Roll-in shower: [ ] damaged Notes: ______________
Lift / stairlift:[ ] damaged Notes: ______________
Other: ______________________
EXTERIOR
Front / back / left / right photographed: [ ] [ ] [ ] [ ]
Vehicles damaged: ______________________ Photos #____
Outbuildings: ______________________ Photos #____
Debris pile photographed before collection: [ ] Photos #____
SAMPLES RETAINED
[ ] Flooring [ ] Drywall [ ] Insulation [ ] Other: ________
STORAGE
Photos backed up to: ______________________ on ________
Video backed up to: ______________________ on ________
(Store OFF-SITE. Do not leave the only copy on a phone.)
2. Receipt and expense tracker
DISASTER EXPENSE TRACKER
Household: ______________ Registration number: ______________
DATE VENDOR CATEGORY AMOUNT PAID BY RCPT
______ ____________________ __________________ $ ______ ______ [ ]
______ ____________________ __________________ $ ______ ______ [ ]
______ ____________________ __________________ $ ______ ______ [ ]
CATEGORIES — use these consistently
LODGING hotel, motel, short-term rental
MEALS only while without a kitchen
RENT alternate housing
CLEANUP supplies, gloves, masks, bags, disinfectant
EQUIPMENT generator, pump, dehumidifier, fans (rent or buy)
MATERIALS tarps, plywood, fasteners, lumber
TOOLS chainsaw, wet vac, hand tools
FUEL generator fuel, disaster-related driving
STORAGE unit rental
MOVING truck, labor, boxes
CONTRACTOR deposits, draws, final payment
MEDICAL disaster-caused treatment, prescriptions, equipment
CHILD CARE disaster-caused
ESSENTIALS clothing, bedding, car seat, school supplies
PET boarding, food, veterinary
DOCUMENTS replacement fees
MILEAGE date, purpose, miles
MILEAGE LOG
DATE PURPOSE FROM/TO MILES
______ __________________________________ __________________ _____
______ __________________________________ __________________ _____
RUNNING TOTALS
Lodging $ ________ Contractor $ ________
Meals $ ________ Medical $ ________
Rent $ ________ Essentials $ ________
Cleanup $ ________ Other $ ________
Equipment $ ________ TOTAL $ ________
NOTE: keep receipts even for items you think are not covered. Insurance,
federal assistance, state programs, long-term recovery groups, and the
casualty loss tax deduction all draw on different parts of this list.
3. Personal property inventory
PERSONAL PROPERTY INVENTORY
Household: ______________ Registration/claim number: ______________
Prepared: ____/____/______
ROOM: ______________
ITEM (specific: brand, model) AGE/PURCHASED ORIGINAL REPLACEMENT
COST COST TODAY
______________________________ ____________ $ ______ $ ________
______________________________ ____________ $ ______ $ ________
______________________________ ____________ $ ______ $ ________
ROOM SUBTOTAL: $ ________
[Repeat, room by room. Walk mentally through each room in order —
it recovers far more than listing by category.]
DON'T FORGET THESE CATEGORIES
[ ] Clothing — by person, counted realistically (coats, shoes, work
uniforms, children's clothes by size)
[ ] Bedding, towels, linens
[ ] Kitchen — small appliances, cookware, dishes, utensils, pantry
[ ] TOOLS REQUIRED FOR A TRADE (potentially covered, often expensive)
[ ] COMPUTERS AND BOOKS REQUIRED FOR SCHOOL
[ ] Medical equipment and supplies
[ ] ASSISTIVE DEVICES — wheelchair, hearing aid, walker, shower chair
[ ] Children's items — car seat, stroller, crib
[ ] Sports and hobby equipment
[ ] Seasonal items stored in a basement or attic
[ ] Lawn and garden equipment
[ ] Refrigerator and freezer food
[ ] Pet supplies
[ ] Musical instruments
[ ] Cash-value items: jewelry, collections (note any separate coverage)
SOURCES USED WHERE RECEIPTS ARE GONE
[ ] Photographs from before the disaster — INCLUDING BACKGROUND
OBJECTS in ordinary family photos and real estate listing photos
[ ] Card and bank statements
[ ] Email receipts (search by store name and by "order confirmation")
[ ] Store loyalty account purchase history
[ ] Warranty registrations and manuals
[ ] Delivery confirmations
[ ] Current retail prices for equivalent items
GRAND TOTAL: $ ____________
I certify that this inventory is accurate to the best of my knowledge and
that these items were destroyed or damaged as a result of the disaster.
______________________ Date: ________
ACCURACY WARNING: overstating an inventory is fraud and can convert a
recovery into a prosecution. An honest, specific, thorough list is both
correct and more persuasive.
4. Occupancy self-declarative statement
SELF-DECLARATIVE STATEMENT OF OCCUPANCY
I, ______________, declare under penalty of perjury:
1. I resided at ______________________________ [full address] as my
primary residence from ____/____/______ until the disaster on
____/____/______.
2. I lived there with the following household members:
Name ______________ Relationship ____________ Age ____
Name ______________ Relationship ____________ Age ____
3. I am unable to provide standard documentation of occupancy because:
[ ] My documents were destroyed in the disaster.
[ ] Utilities were included in my rent and were never in my name.
[ ] I paid rent in cash and received handwritten receipts, which are
[enclosed / were destroyed].
[ ] I had an oral rental agreement with ______________.
[ ] I lived with family and did not hold accounts in my name.
[ ] Other: ______________________________
4. The following supports my occupancy and is enclosed:
[ ] Rent receipts (handwritten receipts count)
[ ] Signed statement from my landlord (Template 5)
[ ] Bank or credit card statements showing the address
[ ] Pay statements showing the address
[ ] Driver's license / state ID
[ ] Voter or vehicle registration
[ ] School records for a child at the address
[ ] Medical or pharmacy records showing the address
[ ] Letter from [public official / social service organization /
shelter / faith organization]
[ ] Mail addressed to me at the address
[ ] Statements from neighbors (Template 6)
5. This residence was my primary and only residence. I did not own or
rent another residence.
I understand that a false statement may result in denial of assistance,
recovery of any assistance paid, and criminal penalties.
______________________ Date: ________
[Name] · [Current address] · [Phone] · Registration number ____________
5. Landlord verification letter
[Landlord letterhead, or handwritten with contact information]
[Date]
To Whom It May Concern:
I am the owner/manager of the property at ______________________________.
______________ [tenant name] rented [unit ____ at] this property from
____/____/______ until ____/____/______ [or: and remains the tenant of
record].
The monthly rent was $ ______, paid by [check / cash / transfer].
[If cash: I provided handwritten receipts.]
The following people lived in the unit: ______________________________.
The property was damaged by the disaster on ____/____/______. The damage
was: ______________________________________________.
The unit is [ ] uninhabitable and cannot be occupied
[ ] habitable
[ ] uninhabitable until repairs are completed, which I
estimate will be ____/____/______
[If applicable:] The lease has been [terminated / suspended] as a result
of the damage, effective ____/____/______.
[If applicable:] The security deposit of $ ______ [has been returned /
will be returned by ________ / is not being applied to disaster damage].
I can be reached at [phone] and [email] to verify this information.
______________________
[Name, printed]
[Title / relationship to property]
[Address] · [Phone] · [Email]
6. Neighbor or third-party statement
STATEMENT REGARDING RESIDENCE
I, ______________, residing at ______________________________, declare:
1. I have lived at my address since ________. My home is [next door to /
across the street from / ______ from] ______________________________.
2. I have personally known ______________ [applicant] since ________.
3. To my direct personal knowledge, [applicant] lived at
______________________________ as [his/her/their] home from about
________ until the disaster on ____/____/______.
4. The basis for my knowledge is: [Be specific. "I saw them come and go
daily." "We shared a driveway." "I collected their mail when they
traveled." "Our children walked to school together." "I helped them
move in on [date]."]
5. [If applicable:] I observed the damage to the property after the
disaster. What I saw was: ______________________________.
I declare under penalty of perjury that the foregoing is true.
______________________ · [Phone] Date: ________
[Attach a copy of photo identification.]
7. Ownership self-declarative statement — heirs' property
SELF-DECLARATIVE STATEMENT OF OWNERSHIP
(For property held without a recorded deed in the applicant's name)
I, ______________, declare under penalty of perjury:
1. THE PROPERTY. I own and reside at ______________________________.
Parcel or tax ID: ______________.
2. HOW THE PROPERTY CAME TO ME.
The property was originally owned by ______________, my
[grandparent / parent / other relationship], who [purchased it in
______ / built it in ______].
[Name] died on ____/____/______. [ ] No will was probated.
[ ] The estate was never opened.
[ ] A will exists but was not filed.
Since that time, the property has been occupied and maintained by
[me / my family], specifically: ______________________________.
I have lived in the home since ________. I am [__] years old and have
lived here [my whole life / for ______ years].
3. WHY THERE IS NO DEED IN MY NAME.
No probate was opened, and title was never formally transferred. This
is common where [the cost of probate was not affordable / the family
was not advised that a transfer was necessary / multiple heirs hold
undivided interests].
[If applicable:] The other heirs are ______________________, and
[they do not reside at the property / they consent to my occupancy and
have signed the attached statements].
4. WHAT I HAVE DONE AS THE OWNER.
[ ] I have paid the property taxes since ________. Receipts enclosed.
[ ] I have maintained homeowner's insurance since ________. Policy
enclosed.
[ ] The utility accounts have been in my name since ________.
[ ] I have paid for the following major repairs and improvements:
____________ in ______, cost $ ______ [receipt enclosed]
____________ in ______, cost $ ______ [receipt enclosed]
[ ] I have never paid rent to anyone for this property.
[ ] No one else claims a right to possess the property.
5. ENCLOSED IN SUPPORT
[ ] Property tax bills and receipts, years ______ to ______
[ ] Homeowner's insurance policy and premium receipts
[ ] Utility accounts in my name
[ ] Receipts for repairs and improvements
[ ] Death certificate of ______________
[ ] Obituary or funeral program showing family relationships
[ ] The original owner's deed, showing the property in the family
[ ] My birth certificate showing the family relationship
[ ] Statements from relatives or neighbors (Template 6)
I understand that a false statement may result in denial of assistance,
recovery of assistance paid, and criminal penalties.
______________________ Date: ________
[Name] · [Address] · [Phone] · Registration number ____________
NOTE: Heirs' property is a recognized situation. A family living in and
maintaining a home inherited without a probate is not disqualified from
disaster assistance. The mechanism exists — it must be invoked.
8. Inspection notes and reinspection request
INSPECTION NOTES — complete the same day
Registration number: ______________
Inspection date: ____/____/______ Time: ________
Inspector name: ______________ Company: ______________
Duration of inspection: ______ minutes
WHAT I SHOWED THE INSPECTOR
[ ] Every room [ ] Crawlspace
[ ] Water line on walls [ ] Attic
[ ] Furnace / HVAC [ ] Electrical panel
[ ] Water heater [ ] Subfloor / sill plate
[ ] Roof (from ground) [ ] Well / septic
[ ] Destroyed personal property [ ] Accessibility features
[ ] Photographs on my phone [ ] Exterior, all sides
WHAT THE INSPECTOR DID NOT EXAMINE
______________________________________________________________
______________________________________________________________
WHAT THE INSPECTOR SAID
______________________________________________________________
DAMAGE DISCOVERED OR REVEALED AFTER THE INSPECTION
Date discovered: ________ What: ______________________________
How discovered: [contractor opened the wall / mold appeared /
the floor failed / other]: ____________________________________
---
REQUEST FOR REINSPECTION
[Date]
RE: Request for reinspection
Name: ______________ Registration number: ______________
Disaster number: ______________
Damaged property: ______________________________
Inspection conducted: ____/____/______
I request a reinspection of my property. The original inspection did not
capture the full extent of the damage, for the following reasons:
[ ] Damage was not visible at the time of inspection and has since been
revealed. Specifically: [a contractor opened the wall on ________
and found ____________ / mold appeared on ________ / the subfloor
failed on ________].
[ ] The inspector did not examine [crawlspace / attic / mechanical
systems / _______________].
[ ] The inspection lasted approximately ____ minutes and did not
include ______________________.
[ ] I was not present and could not point out damage.
[ ] The inspection report contains errors: ______________________.
ENCLOSED IN SUPPORT
[ ] Contractor's written itemized estimate dated ________
[ ] Photographs dated ________ showing [what]
[ ] Structural or engineering assessment
[ ] Mold or air quality assessment
[ ] My inspection notes from the original visit
Please contact me at [phone] to schedule. I am available [days/times].
______________________ · [Address] · [Phone]
9. Appeal letter
The core template. Put identifying information on every page.
[Date] FILE BY THE DEADLINE STATED IN THE DECISION LETTER: ________
[Agency appeals address from the decision letter]
RE: APPEAL OF DECISION
Applicant: ______________
Registration number: ______________
Disaster number: ______________
Damaged property: ______________________________
Decision letter dated: ____/____/______, received ____/____/______
I am appealing the decision described above.
1. THE DECISION I AM APPEALING
The letter states: "[QUOTE THE STATED REASON EXACTLY.]"
2. WHY THE DECISION IS INCORRECT
[Answer THAT reason and nothing else. Plain language. Examples:]
INSUFFICIENT DAMAGE:
"The home is not habitable. The enclosed itemized estimate from
[licensed contractor, license #____] dated ________ identifies
$ ______ in required repairs, including [structural item], [mechanical
system], and [systems]. The photographs at Exhibits __ through __,
taken on ________ before any cleanup, show [what]. The inspection on
________ lasted approximately ____ minutes and did not include
[crawlspace / attic / mechanical systems]. I request a reinspection."
INSURANCE:
"My homeowner's policy excludes flood damage. The exclusion appears at
page ____ of the policy, enclosed at Exhibit __. My insurer denied the
claim in writing on ________; that denial is Exhibit __. I did not
have a separate flood policy. My losses are therefore uninsured."
OCCUPANCY NOT VERIFIED:
"I resided at this address from ________ until the disaster. Enclosed
are [list]. My utilities were included in the rent and were never in
my name, which is why a utility bill is unavailable. My self-
declarative statement is Exhibit __."
OWNERSHIP NOT VERIFIED:
"This is heirs' property. I have lived in and maintained this home
since ________. My self-declarative statement of ownership is
Exhibit __, with property tax receipts, insurance, utility accounts
in my name, and receipts for major repairs I paid for."
DUPLICATION OF BENEFITS:
"The payment cited does not duplicate this loss. The [state grant /
insurance payment] of $ ______ was for [structural repair]. The
assistance at issue was for [personal property]. These are different
losses for different purposes and no portion of either compensates the
other."
3. DOCUMENTS ENCLOSED AND WHAT EACH SHOWS
Exhibit A — ______________________ shows ______________________
Exhibit B — ______________________ shows ______________________
Exhibit C — ______________________ shows ______________________
4. WHAT I AM REQUESTING
[ ] Reversal of the denial and an award for [category]
[ ] A reinspection of the property
[ ] Reconsideration in light of the enclosed documents
[ ] An increase in the award for [category] to reflect $ ______
[ ] Other: ______________________
I declare that the information in this appeal and the enclosed documents
is true and correct to the best of my knowledge.
______________________ Date: ________
[Name] · [Current mailing address] · [Phone] · [Email]
[If a third party prepared this:]
AUTHORIZATION: I, ______________, authorize ______________ to act on my
behalf regarding this application and appeal.
______________________ Date: ________
SENT BY: [ ] certified mail, tracking ____________
[ ] fax to ____________, confirmation retained
[ ] online portal, confirmation number ____________
Screenshot/copy of proof retained: [ ]
10. Insurance documentation submission
[Date]
RE: Submission of insurance documentation
Applicant: ______________ Registration number: ______________
Disaster number: ______________
I am submitting insurance documentation in support of my application.
MY INSURANCE SITUATION
[ ] I had NO insurance covering this peril.
[ ] I had a homeowner's policy that EXCLUDES this peril
(flood / earthquake / other: ____________). The exclusion appears
at page ____, Exhibit __. My claim was denied in writing on
________, Exhibit __.
[ ] My claim was DENIED for another reason: ______________.
Denial letter, Exhibit __.
[ ] My claim was PAID, but the settlement does not cover all losses.
Settlement documentation, Exhibit __.
Total loss: $ ____________
Insurance settlement: $ ____________
Deductible applied: $ ____________
UNCOVERED LOSS: $ ____________
The settlement did not cover: ______________________________
[Specific items or categories, with the reason each was excluded.]
[ ] My claim is still PENDING. It was filed on ________ and the
insurer has not issued a determination. Correspondence, Exhibit __.
I request interim assistance and will submit the settlement when
received.
ENCLOSED
[ ] Declarations page
[ ] The exclusion page(s), highlighted
[ ] Insurer's written denial or settlement statement
[ ] Adjuster's itemized estimate
[ ] My contractor's itemized estimate, for comparison
[ ] Correspondence with the insurer
[ ] Proof of premium payment
I understand assistance is secondary to insurance and is available only
for losses insurance does not cover.
______________________ · [Phone] · [Address]
11. Continued rental assistance request
[Date] SUBMIT BEFORE THE CURRENT ASSISTANCE PERIOD ENDS: ________
RE: Request for continued rental assistance
Applicant: ______________ Registration number: ______________
Current assistance period ends: ____/____/______
I request continued rental assistance.
1. CONTINUING NEED
My pre-disaster home at ______________________________ remains
uninhabitable. Specifically:
[ ] Repairs are underway and are scheduled to be complete on
________. Contractor's letter and schedule enclosed.
[ ] Repairs have not begun because [insurance settlement pending /
contractor availability / permit delay / funding gap of $______].
[ ] The property has been declared unsafe by ______________ on
________. Notice enclosed.
[ ] I am a renter and my former unit is uninhabitable. Landlord's
statement enclosed.
2. HOW PRIOR ASSISTANCE WAS USED [THE MOST COMMON REASON THESE ARE
DENIED IS MISSING PROOF OF THIS]
I received $ ______ in rental assistance covering ________ to ________.
I used it for rent at ______________________________.
Enclosed:
[ ] Lease or rental agreement
[ ] Rent receipts for each month, or landlord's ledger
[ ] Bank statements or canceled checks showing rent payments
3. CURRENT HOUSING AND COST
Current address: ______________________________
Monthly rent: $ ______ Utilities: $ ______
Landlord: ______________ Phone: ______________
4. MY PERMANENT HOUSING PLAN
[Write this out. It is required and it is the part people skip.]
My plan is to [return to my repaired home / secure permanent rental
housing / purchase a replacement home].
Steps I have taken:
________ ______________________________________________
________ ______________________________________________
________ ______________________________________________
[Examples: applications submitted to __ rental properties; placed on
the waiting list at ____________ on ________; hired contractor
____________ on ________; applied for ____________ grant on ________;
permit application filed ________.]
Obstacles I am facing:
[ ] Rental market: I have applied to ____ units and been declined or
found no availability. List enclosed.
[ ] Funding gap of $ ______ between repair cost and available
resources.
[ ] Contractor availability: earliest start ________.
[ ] Permit or inspection delays.
[ ] Other: ______________________
Expected date of permanent housing: ____/____/______
5. HOUSEHOLD FINANCIAL SITUATION
Monthly income: $ ______ Monthly necessary expenses: $ ______
Household members: ______________________________
I request continued rental assistance for the next available period.
______________________ · [Phone] · [Current address]
12. Contractor bid comparison and verification
CONTRACTOR VERIFICATION AND BID COMPARISON
FOR EACH BIDDER — verify BEFORE signing anything
BIDDER 1 BIDDER 2 BIDDER 3
Company name ____________ ____________ ____________
Physical local address ____________ ____________ ____________
State license number ____________ ____________ ____________
VERIFIED with board on ____________ ____________ ____________
License status ____________ ____________ ____________
Complaints on file ____________ ____________ ____________
General liability ins. ____________ ____________ ____________
Certificate obtained [ ] [ ] [ ]
Workers' comp ____________ ____________ ____________
Years in business locally ____________ ____________ ____________
Local references (3) [ ] [ ] [ ]
References CALLED [ ] [ ] [ ]
Better Business/AG check ____________ ____________ ____________
BID COMPARISON — require ITEMIZED scope, not a lump sum
LINE ITEM BIDDER 1 BIDDER 2 BIDDER 3
Demolition/debris removal $ ________ $ ________ $ ________
Structural repair $ ________ $ ________ $ ________
Framing $ ________ $ ________ $ ________
Electrical $ ________ $ ________ $ ________
Plumbing $ ________ $ ________ $ ________
HVAC $ ________ $ ________ $ ________
Insulation $ ________ $ ________ $ ________
Drywall $ ________ $ ________ $ ________
Flooring $ ________ $ ________ $ ________
Paint $ ________ $ ________ $ ________
Cabinets/fixtures $ ________ $ ________ $ ________
Permits $ ________ $ ________ $ ________
Cleanup $ ________ $ ________ $ ________
TOTAL $ ________ $ ________ $ ________
Start date __________ __________ __________
Completion date __________ __________ __________
Payment schedule __________ __________ __________
Warranty __________ __________ __________
RED FLAGS — any one is disqualifying
[ ] Knocked on the door unsolicited
[ ] Wants a large deposit in CASH
[ ] Pressure to sign today
[ ] Offers to "waive your deductible" <- generally insurance fraud
[ ] Asks you to sign an ASSIGNMENT OF BENEFITS
[ ] No local physical address
[ ] No license, or will not give the number
[ ] Will not provide proof of insurance
[ ] One-page "estimate" with no scope of work
[ ] Asks you to obtain the permit yourself
[ ] Will not put anything in writing
BEFORE SIGNING
[ ] Contract read entirely, INSIDE, not on the doorstep
[ ] Slept on it
[ ] Right to cancel period checked for my state: ______ days
[ ] Scope of work, schedule, and payment terms all in the contract
[ ] Payment schedule tied to milestones, not dates
[ ] Deposit is a reasonable percentage, paid by check or card
[ ] Insurer informed before signing anything affecting the claim
DURING AND AFTER
[ ] LIEN WAIVER obtained with each payment
[ ] Photographs taken at each stage
[ ] Change orders in writing, signed, before the work
[ ] Permits pulled by the contractor and posted
[ ] Inspections passed before covering work
[ ] COMPLETION CERTIFICATE NOT SIGNED until work is complete and
inspected
[ ] Final lien waivers from the general contractor AND every
subcontractor and supplier
13. Lien waiver request
[Date]
[Contractor name and address]
RE: Lien waiver — payment for work at ______________________________
Payment: $ ____________ Date: ____/____/______
Invoice or draw number: ______________
Enclosed is payment of $ ______ for the work described above.
As a condition of this payment, I request a signed LIEN WAIVER covering
this payment, from:
[ ] You, as general contractor
[ ] Each subcontractor who performed work covered by this payment:
______________________ ______________________
______________________ ______________________
[ ] Each material supplier for materials covered by this payment:
______________________ ______________________
Please provide the waivers before or upon receipt of this payment.
Note: I understand that a subcontractor or supplier who is not paid may
file a mechanic's lien against my property even though I have paid you
in full. The lien waivers protect me against that outcome.
For the FINAL payment, I will require final unconditional lien waivers
from you and from every subcontractor and supplier, and a certification
that all subcontractors and suppliers have been paid in full.
______________________ · [Address] · [Phone]
---
LIST OF SUBCONTRACTORS AND SUPPLIERS — request this at contract signing
I request a list of all subcontractors and material suppliers who will
perform work or provide materials for this project, including name,
address, phone, and scope, and I request notice of any additions during
the project.
14. Recoupment response and waiver request
[Date] RESPOND BY THE DEADLINE IN THE NOTICE: ________
RE: Response to notice of improper payment / debt
Applicant: ______________ Registration number: ______________
Disaster number: ______________
Notice dated: ____/____/______ Amount claimed: $ ____________
I am responding to the notice above. I request the following, in the
alternative:
PART 1 — REQUEST FOR THE BASIS
Please provide in writing:
1. The specific payment(s) at issue: date, amount, and category.
2. The specific reason each is now considered improper.
3. The other source of funds said to duplicate it, if duplication is
the basis, including what that payment was for.
4. The determination and the documents relied on.
5. The date the determination was made.
PART 2 — APPEAL [if the determination is wrong]
I appeal this determination because:
[ ] There is no duplication. The payment cited was for [purpose A]; the
assistance at issue was for [purpose B]. These are different losses
for different purposes. Documentation enclosed.
[ ] I met the eligibility requirement at the time and still do.
Documentation enclosed: ______________________
[ ] The insurance settlement cited did not cover this loss. The
settlement documentation and the itemization are enclosed.
[ ] The assistance was used for its intended purpose. Receipts are
enclosed.
[ ] The amount is incorrect: the correct figure is $ ______ because
______________________.
PART 3 — REQUEST FOR WAIVER OF THE DEBT
If any portion of the debt is valid, I request a waiver.
A. I WAS NOT AT FAULT.
I provided complete and accurate information at every stage. I did
not conceal anything, misrepresent anything, or fail to report
anything I was asked about. Specifically:
______________________________________________________________
[If the overpayment resulted from an agency error, a later insurance
settlement, or a determination the applicant could not have
anticipated, say so directly.]
B. REPAYMENT WOULD BE AGAINST EQUITY AND GOOD CONSCIENCE / WOULD
CREATE FINANCIAL HARDSHIP.
Monthly household income: $ ________
Sources: ______________________________
Necessary monthly expenses:
Housing $ ________
Utilities $ ________
Food $ ________
Transportation $ ________
Medical and prescriptions $ ________
Child care $ ________
Insurance $ ________
Debt payments $ ________
TOTAL $ ________
Monthly surplus or (shortfall): $ ________
Household: ______ adults, ______ children (ages ______)
[ ] A household member has a disability or serious illness:
______________________
[ ] I am still displaced from my home.
[ ] I spent the assistance on the disaster-related purpose and no
longer have the funds. Receipts enclosed.
[ ] Repayment would prevent me from [completing repairs / keeping
housing / obtaining medical care].
ENCLOSED: pay statements · benefit award letters · bank statements ·
medical documentation · lease or mortgage · receipts showing use of the
assistance · [other]
PART 4 — COMPROMISE
If a waiver is not granted, I request a compromise of the debt for a
lesser amount that I am able to pay: $ ______.
PART 5 — PAYMENT PLAN
If neither is granted, I request a payment plan of $ ______ per month.
I request that collection activity, including any offset of tax refunds
or federal payments, be suspended while this response is under
consideration.
______________________ · [Address] · [Phone] · [Email]
cc: Disaster Legal Services / legal aid · [congressional office]
Sent certified mail, tracking ____________
15. Congressional inquiry request
[Date]
The Honorable ______________
Attn: Constituent Services — Casework
[District office address]
RE: Request for assistance — federal disaster assistance case
Constituent: ______________
Address: ______________________________
Registration number: ______________
Disaster number: ______________
I am a constituent residing at the address above. I am requesting your
office's assistance with a disaster assistance matter.
CHRONOLOGY
____/____/____ Disaster occurred; property damaged
____/____/____ Registered for assistance
____/____/____ Inspection conducted
____/____/____ Decision received: ______________________
____/____/____ Appeal filed
____/____/____ [Further events]
As of today: ______________________________
THE PROBLEM
[ ] No decision has been issued in ______ days.
[ ] My appeal filed on ________ has received no response in ______
days.
[ ] The decision is based on incorrect information, specifically:
______________________________
[ ] Documents I submitted on ________ (proof enclosed) are recorded as
not received.
[ ] I am unable to reach anyone who can address the issue. I have
called on ________, ________, and ________.
[ ] Other: ______________________
CONSEQUENCE OF THE DELAY
[Be concrete: I am living in [a motel / my car / with relatives] with
______ children; my rental assistance ends on ________; my contractor
cannot start without funding; a household member requires ____________
and cannot access it from our current location.]
ENCLOSED
[ ] Signed privacy release authorizing your office to inquire
[ ] Decision letter(s)
[ ] My appeal and proof of submission
[ ] Correspondence log
[ ] Supporting documentation
Thank you for any assistance your office can provide.
______________________ · [Phone] · [Email]
16. Document replacement tracker
DOCUMENT REPLACEMENT TRACKER
DOCUMENT WHERE TO REQUEST REQUESTED RECEIVED FEE
Driver's license/ID State motor vehicle ________ ________ ___
(fees often WAIVED after
a declaration — ask)
Social Security card Social Security Admin. ________ ________ ___
Birth certificate Vital records of the ________ ________ ___
STATE OF BIRTH
Death certificate Vital records, state of ________ ________ ___
the death
Marriage certificate Vital records or the ________ ________ ___
issuing county
Divorce decree The court that issued it ________ ________ ___
Passport State Department ________ ________ ___
Immigration documents Immigration agency ________ ________ ___
(fee waiver available)
Military discharge National personnel ________ ________ ___
records center
DEED / MORTGAGE COUNTY RECORDER — holds ________ ________ ___
the legal record; a
destroyed deed does NOT
affect ownership
Property tax records County tax assessor ________ ________ ___
Vehicle title State motor vehicle ________ ________ ___
Insurance policies Insurer or agent ________ ________ ___
Bank records The institution ________ ________ ___
Tax returns Tax authority transcripts ________ ________ ___
(FREE)
Medical records Each provider ________ ________ ___
Medication history Your pharmacy (FREE) ________ ________ ___
Will / trust / POA The drafting attorney ________ ________ ___
Diplomas/transcripts School registrar ________ ________ ___
Professional licenses Each licensing board ________ ________ ___
Benefit award letters Each benefits agency ________ ________ ___
AFTER REPLACEMENT
[ ] Complete duplicate set stored OFF-SITE:
Location 1: ______________________
Location 2 (different region): ______________________
[ ] Digital copies in encrypted cloud storage: ______________
[ ] Grab-and-go folder assembled: ID copies, insurance policies,
contact list, registration number
17. Master case log
DISASTER RECOVERY CASE LOG
Household: ______________
Registration number: ______________ Disaster number: ______________
Damaged property: ______________________________
Current mailing address: ______________________________
Current phone: ______________ Email: ______________
KEY DATES
Disaster: ____/____/______
Registered: ____/____/______
Insurance claim filed: ____/____/______ Claim # ________
Inspection: ____/____/______
Decision received: ____/____/______
APPEAL DEADLINE: ____/____/______
Appeal filed: ____/____/______
SBA application: ____/____/______
Disaster Unemployment applied: ____/____/______
Disaster SNAP applied: ____/____/______
Rental assistance period ends: ____/____/______
CONTINUED ASSISTANCE DUE BEFORE: ____/____/______
Insurance proof of loss deadline: ____/____/______
Insurance suit limitation: ____/____/______
CONTACT LOG
DATE TIME WHO / AGENCY SUBJECT WHAT I WAS TOLD
______ _____ ____________________ ________________ ________________
______ _____ ____________________ ________________ ________________
______ _____ ____________________ ________________ ________________
DOCUMENTS SENT
DATE WHAT HOW SENT CONFIRMATION
______ ____________________________ ______________ ________________
______ ____________________________ ______________ ________________
DECISIONS RECEIVED
DATE WHAT IT SAID DEADLINE ACTION TAKEN
______ ____________________________ ______________ ________________
______ ____________________________ ______________ ________________
MONEY RECEIVED
DATE SOURCE PURPOSE AMOUNT
______ ____________________________ ______________ $ ______________
______ ____________________________ ______________ $ ______________
TOTAL: $ ______________
HELP CONTACTS
Disaster Legal Services: ______________________
Legal aid: ______________________
Disaster case manager: ______________________
Long-term recovery group: ______________________
Congressional caseworker: ______________________
State insurance department: ______________________
State attorney general: ______________________
Insurance adjuster: ______________________
Contractor: ______________________
Related documents
- Disaster Assistance and FEMA Appeals: Applications, Denials, and Recoupment
- Applying for Disaster Assistance and Appealing a Denial
- Disaster Assistance Checklist
- First-Party Insurance Toolkit
- Public Benefits Toolkit
Templates only, not legal advice. Adapt to your facts and verify current forms and deadlines for your declaration. Framework: 42 U.S.C. § 5121 · § 5174 · 44 C.F.R. Part 206.
