Form 90-69 Electronic Version

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Loca?e or Li5.t Rental Prctpettles
Guide to d~sasterassistance
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Apply by phone
Call 1-800-621-FEMA (3362)
Call 1-800-462-7585 CTTY)
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katrlna Recovery trilaps
The U.S. Department of Homeland Security and
2005 Hurricane Recovery lnformat~cln
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Kids, a family-friendly tool to help parents and
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teachers educate children, ages 8-1 2 , about
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better prepare. The Ready Kids Web site at
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well step-by-step instructions on what families can :: STORM WATCH S: CURREHT WEATHER
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kids can play i n that effort. [Read More]
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aster Communities

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Before you apply
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Fill out the online application

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Wait 24 Hours..
After 24 hours you will be able to
check the status of your application.

1. Enter your personal
information into the system
2. Follow the steps in the
3. Create an account to save

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Apply for Assistance Online

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Education & Training

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If you do not wait 24 hours you may
not see your registration. This does
not mean you are not registered. It
may simply mean that your
registration has not been processed
yet. Please do not re-register.
Registering more than once will result
in a delay of your application.

Ctleok ttre Status of your

1. Use your pin and password to
2. Review your claim online
3. If you do not see your claim
AND it has been more than 24
hours since you received your
pin and password, please call
1-800-621 -FEMA 13362).

+ Frecluer-~tlyk k e d Questions

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Individual Assistance Center
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If you have been affected by a disaster you may be eligible for federal assistance. Please select one of two options below:
Register for Assistance or Review your Application. For disaster assistance information you may want to read the Applicant
Guide, view information about Federally Declared Disasters by Calendar Year, or review support from other available Agencies

Request Disaster Help

Heyistef for ASSiSldtlCe

Call 1-800-621-FEMA (3362)
The speech or hearing impaired may call (TTY) 1-800-462-7585

Review my Request for Disaster Help

Review your Application

Call 1-800-621-FEMA (3362)
The speech or hearing impaired may call (TTY) 1-800-462-7585

If you have technical problems usingthis application, or would like to send FEMA written correspondence concerning your registration, please use the Contact Us link below.

Individual Assistance Center

Contact Us
OMB No. 1660-0002, Exp. 9-30-2006
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I n d i v i d u a l Assistance C e n t e r

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If you have been affected by a disaster, you may be eligible for federal assistance. Review the instructions below to ensure you
are ready to complete the application process.
If you are applying for multiple disasters, you will need to complete an Online registration for each disaster.

If you are filing for both home and business disaster assistance, you will complete a single registration for the combined losses.

-

The application process will take 18 20 minutes and is authorized by the Office of Management and Budget under Control
number 16600002.
For technical problems with this site, please contact FEMA's Technical Helpdesk at 1-800-7450243 or (TTY] 1-800462-7585 for
the speech and hearing impaired.
You will need the following information to complete the registration:
Social Security Number
You will be asked to provide your social security number; if you are registering for a business, your tax ID number should be provided. If you do not have a social
security number, your household may still be able to receive assistance if there is a minor child in the household who is a U.S. Citizen, Non-Citizen National, or
Qualified Alien with a social security number.

Insurance information
You will be asked to identify the type(s) of insurance coverage you have.

Financial information
You will be asked to enter your family's gross total household income at the time of the disaster.

Contact information
Along with the address and phone numberwhere the damages occurred, you will be asked for information on how FEMA can contact you. It is very important that you
provide FEMAwith your current mailing address and phone numbers where you can be contacted.

Electronic Funds Transfer [EFT)IDirect Deposit Information (optional)
If you are determined to be eligible for assistance and would prefer that funds be transferred to your account, you will be asked for your banking information, which
includes; the institution name, type of account, routing and account number.
.

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Instructions

Application Progress

Registration lnstructions

Instructions
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889888888e89
OMB NO.1660-0002, EX^. 2-28-2007

The application process will take approximately 18 - 20 minutes. An asterisk fl identifies required fields which you must
answer to complete the registration.
PAPERWORK BURDEN DISCLOSURE NOTICE FEMA Form 90-69
Public reporting burden for this form is estimated to average 18 minutes per response. The burden estimate includes the time for reviewing instructions, searching
existing data sources, gathering and maintainingthe data needed, and completing and submitting the form. you are not required to respondto this collection of
information unless a valid OMB control number is displayed in the upper right corner of this form. Send comments regarding the accuracy of the burden estimate
and any suggestions for reducing the burden to: Information Collections Management, Department of Homeland Securly, Federal Emergency Management Agency,
500 C Street, SW,
Washington, DC 20472, Paperwork Reduction Project [I
660-0002). NOTE: Do not send your completed form to this address.

You will be presented with a series of screens. Each screen has important information andlor a set of related questions.
For help on any field click the Help for this page. This will provide helpful information about how to answer each question
a s you progress through the application.
Read the information carefully and answer the questions on the screen. When you have read the information and
answered all ofthe required questions, select the "Nexl" button at the bottom of the page to continue the registration
process.
As you progress through the registration process, the tabs at the top of the screen change. You can review any ofthe
information you previously submitted by selecting the appropriate tab.
You can cancel your application at any time by selecting "Delete this Registration".
At this time this application i s not available online in Spanish. Individuals who would like to apply for assistance in
Spanish should call 1-800-621-FEMA (3362). Applicants may click on the following links to download a copy of the paper
application to understand the type of information that is required to apply and a copy ofthe privacy act form in Spanish.
En este momento, esta solicitud no esta disponible por el internet en espafiol. Sugerimos que individuos que quisieran
solicitar ayuda de desastre en espafiol deben llamar a 1-800-621-3362 para registrarse u oprima esta conexion para
obtener una solicitud del internet que pueda llenar a mano y una copia del Acta de Privacidad. Tambien se explica la
informacion necesaria para solicitar ayuda de desastre.

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This application is best viewed in full screen mode.

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Personal Identification

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To register for disaster assistance, please provide the following information.

* Prefix:
* First Name:

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* Last Name: )

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of Birth MMIDDNYYY: (
Email Address:

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Individual Assistance Center
Contact UsOM0 NO.1660-0002,EX^. 9-30-2006
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Contact Phone Numbers
otle Numbers

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Please provide the phone number used in the damaged dwelling whether it is worklng or not and currenualternate phone
number(s) In case w e need to call regarding your registration for disaster assistance.
Area Code

Phone Number

Ext.

Note

Damaged Phone:

r My Current Phone is the same as my Damaged Phone - If selected, please do not provide Current Phone.
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Individual Assistance Center
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OMB NO. 1660-0002, EXP.9-30-2006
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dress

Please provide the address where the damages occurred.

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Damaged Dwelling Address

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In Care Of: (
* Street Address:

Individual Assistance Center
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OMB NO.1660-0002,EX^. 9-30-2006
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Where did the damage occur?

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Vn what countymarish did the damage occur? DENTON

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OM8 NO.1660-0002, EX^. 9-30-2006
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@ Disaster Selection

Application Progress

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* In the following list, select the disaster that has affected you. lfyou do not see a choice that describes your situation,
select"None ofthe disasters above match my situation".

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EXTREME WLDFlRE THREAT

12C01ROO5 - Present Time

HURRICANE RITA

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None of the disasters above match my situation

Individual Assistance Center
Contact Cls
OMB NO.1660-0002, EX^. 9-30-2006
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How were you affected by the disaster?
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W a s your home damaged by the disaster?
'Was any of your personal property not including vehicles damaged bythe disaster?

* Have you been without your essential utilities for 5 consecutive days or more?

Individual Assistance Center

Contact Us
OMB NO.1660-0002,EX^. 9-30-2006

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c YES C NO C UNKNOWN
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Please provide the following information about the damaged dwelling.

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* Are you currently able to get to your home?

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Yes, I am able to get to my home.
I am unable to return to my home due to a mandatory evacuation.
I am unable to return to my home because damages to the roads or bridges in the area prevent it.

IndividualAssistance Center
Contact Us
OMB NO. 1660-0002,EX^. 9-30-2006
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Have you incurred uninsured or under-insured expenses as a result of the disaster?

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* Do you have FUNERAL expenses a s a result o f t h e disaster?

* Do p

u have MOVING AND STORAGE expenses a s a result o f t h e disaster?

Individual Assistance Center
Contad Ids
OM6 NO.1660-0002,EX^. 9-30-2006

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Disaster Related Vehicle Damage

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* Do you, your spouse, or one of your dependents own a vehicle that was damaged by the disaster?

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OM0 NO.1660-0002,
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Enter information about each vehicle in the household separately.

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* Is this vehicle currently registered?

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Individual Assistance Center
Contact Us
OMB No. 1660-0002, Exp. 9-30-2006

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OMB No. 1660-0002,EX^. 9-30-2006

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Do you have any disaster related emergency needs for food, clothing, or shelter?
If yes, please indicate which needs you have below. Please note: Reimbursement for storedfood is not an eligible item.

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,File Typeapplication/pdfFile Modified2007-02-28File Created2007-02-23