Corps of Engineers Civil Works Questionnaires Generic Clearance

RESIDENTIAL FLOOD DAMAGE QUESTIONNAIRE

(Personal Interview)

OMB 0710-0001

Expires: 30 September 2012

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RESIDENTIAL FLOOD DAMAGE QUESTIONNAIRE

1. How many years have you lived at this address?

________________ YEARS

2. Before the flooding from _________, had your home ever

been flooded?

(CIRCLE)

1. NO – (skip to question 4)

2. YES

2. Approximately how many times, including the _______ flood, has your home

been flooded since you have lived here?

______ TIMES

4. Do you own or rent your home? (CIRCLE)

1. OWN (or have mortgage)

2. RENT

3. OTHER (Please Specify:) _________________

5. How old is your home?

______ YEARS OLD

6. Prior to this last flood how many years ago had you completed any of the following renovations?

Renovation Years Ago

New Roof _____

New Heating or Air Conditioning System _____

New Floors or Floor Coverings _____

Kitchen Remodeling _____

New Siding _____

New Room(s) _____

Other ____________________________ _____

7. Not counting your basement, attic, or garage, how many square feet of living area are in your home? (If respondent is unsure, ask for the dimensions and calculate.)

___________ SQUARE FEET

8. Does your home have a basement? (CIRCLE)

1. NO (Skip to 9)

2. YES

8a. If yes, please indicate the total basement area, in square feet, and the amount or proportion that is finished and unfinished? (If respondent is unsure, ask for the dimensions and calculate.)

TOTAL BASEMENT AREA: ________________ SQUARE FEET

FINISHED BASEMENT AREA: _____________ SQUARE FEET

UNFINISHED BASEMENT AREA: __________ SQUARE FEET

9. Do you have a garage on this property? (CIRCLE)

1. NO (Skip to 10)

2. YES

9a. Is the garage attached to the structure? (CIRCLE)

1. NO

2. YES

9b. How large is the garage in square feet? (If respondent is unsure, ask for the dimensions and calculate.)

_________ SQUARE FEET

10. Do you have a carport? (CIRCLE)

1. NO

2. YES

10a. How large is the carport in square feet? (If respondent is unsure, ask for the dimensions and calculate.)

_________ SQUARE FEET

PART II – FLOOD EMERGENCY RESPONSE

The next group of questions is to determine how you learned about the approaching flood and how you responded at the time.

11. Just before the _______ flood, how did you first become aware that

flooding might reach your home?

1. TV

2. RADIO

3. TELEPHONE BY A PUBLIC OR EMERGENCY WORKER

4. TELEPHONE BY OTHER

5. FACE TO FACE BY PUBLIC OR EMERGENCY WORKER

6. FACE TO FACE BY OTHER

7. LOUDSPEAKER

8. SIREN

9. C.B., HAM RADIO or POLICE SCANNER

10. NEWSPAPER

11. OBSERVING THE CREEK OR RIVER WATER LEVELS

12. OTHER ______________________________________

11a. How many hours were there between the time you became aware that flooding might reach your home until the water actually reached your property?

______ HOURS

12. What actions, if any, did you take to safeguard your property immediately prior to

flooding and what were the damages prevented by each action?

(PLEASE CIRCLE ALL THAT APPLY AND INDICATED THE DOLLARS DAMAGES PREVENTED FOR EACH ACTION.)

Damage Preventive Action	Value of Items Protected	Was the Preventive Action Successful?
1. Moved contents to higher ground
2. Elevated contents to a higher spot in the building
3. Shut off electrical equipment
4. Sandbagged the outside of the building
5. Used another type of temporary barrier
6. Moved vehicles to higher ground
7. Other action _______________________
8. None

PART III - COSTS AND DAMAGES

The next group of questions is to determine flood damages to different types of property from the __________ flood.

13. Please indicate how high in feet and inches that the water was relative to the first

floor of the inside of your home.

______FEET; ______INCHES (ABOVE, BELOW) FIRST FLOOR LEVEL

[CIRCLE]

14. How long did the water remain in this building?

_____________ DAYS ____________ HOURS

15. Did the flooding make it necessary for you or other members of your household to stay in temporary residence due to evacuation or while your home was being repaired?

(CIRCLE)

1. NO (Skip to 16)

2. YES

15a. How many days did you spend in temporary residence due to the evacuation or while flood damage to your home was being repaired?

_____ DAYS

15b. How much money did your household spend on travel, beyond your normal travel expense, and lodging (including trailer rental) due to your evacuation(s) for the ___________ flood?

______ DOLLARS

15c. Due to your evacuation, how much money did your household spend on food in excess of what you normally would have spent?

______ DOLLARS

16. For each motor vehicle, including cars, trucks, recreational vehicles, boats, and motorcycles, located at this residence during the flood, please indicate the dollar value, whether or not it was moved, the amount of damage to the vehicle, if any, and the level, in feet and inches, that the flood water reached above the bottom of the vehicle’s wheels.

Vehicle Category and Year (Categories include: sedan, van, sports utility, sports cars, pickup trucks, and motorcycles)	Dollar Value	Was it Moved? (Yes or no)	Dollar Damage	Depth Above Ground At Vehicle
Vehicle 1:
Vehicle 2:
Vehicle 3:
Vehicle 4:
Vehicle 5:
Vehicle 6:

The following questions are to determine the dollar cost and unpaid hours for repair and cleanup of your home, and repair, replacement, and cleanup to the contents of your home that resulted from the _________ flood.

17. What was the cost of the structural damage to your home? (Structural damage is defined as damage to any building components, including foundation, walls, floors, windows, roof, electrical systems, heating and cooling systems, plumbing, attached carpeting, attached shelves and cabinets, and built-in equipment and appliances.)

$_______________

17a. Which of the following is the primary source of your structure damage value?

(circle one)

1. Contractor estimate (before repairs)

2. Contractor invoice (after repairs)

3. Your own assessment

4. Other _______________________

17b. What was the dollar cost to you for labor and supplies to clean up your home after the flood?

$________

17c. What was the total number of unpaid hours that you and others spent on repair and cleanup to your home?

______ HOURS

18. a.	Please list your total real estate damages into the following categories.
b.	Please also itemize any additional time that was spent on repairs other than paid labor hours.

Area of Damage	Value of Damages
	In % of total Or in dollars		Unpaid Hours to repair or install, in addition to $ spent
1. Built-in shelves and appliances	%	$
2. Electrical	%	$
3. Plumbing	%	$
4. Exterior walls, windows, doors (painting included), and roofing	%	$
5. Footings and foundation	%	$
6. Interior doors and walls (painting included)	%	$
7. Interior floors, carpet and ceilings	%	$
8. Mechanical systems - heat, A/C, sump pump, built-in vacuum	%	$
9. Outbuildings, decks, fireplaces and garages	%	$
10. Outside property and landscaping	%	$
11. Septic, sewer, and water systems	%	$
Total	100 %	$

19. What was the dollar cost of flood damage to the contents of your home, garage, and shed, excluding motor vehicles? (Only include content replacement and repairs, do not include repairs to the structure of the house).

$___________________

(Content damage refers to damage to personal property kept inside the home or the garage that is not permanently affixed to the home.)

20. What was the total number of unpaid hours that you and others spent on repair of appliances, furniture, and other contents of your home?

______ HOURS

21. How much, if anything, did each of the following cost you in actual dollar expenditures as a result of the _______ flood?

a) Costs for moving furniture and other belongings? $______

b) Costs for storing furniture and other belongings? $______

c) Vandalism, looting, or theft costs? $______

d) Costs from flooding-related medical problems? $______

e) Any other costs due to the _______ flood. $______

Describe: __________________________________________

__________________________________________________

To be answered by interviewer:

1. What is the five-digit zip code of this home?

_____________

2. Classify the quality of this building.

e.g. Fair/Average 2.5

1. Low

2. Fair

3. Average

4. Good

5. Very Good

6. Excellent

3. What is the condition of this building?

e.g. Average/Good 3.5

1. Worn Out

2. Badly Worn

3. Average

4. Good

5. Very Good

6. Excellent

4. What is the effective age of this building?

_______ YEARS

5. What category best describes the style of this building?

(CIRCLE)

1. One-Story 5. 1-1/2 Story Finished 9. 3-1/2 Story Finished

2. Two-Story 6. 1-1/2 Story Unfinished 10. 3-1/2 Story Unfinished

3. Three-Story 7. 2-1/2 Story Finished 11. Bi-Level

4. Split Level 8. 2-1/2 Story Unfinished 12. Mobile Home

6. What category best describes the heating and cooling system in this building?

(CIRCLE)

Heating Only:

1. Forced Air 6. Ceiling, Radiant Electric

2. Gravity Furnace 7. Baseboard, Electric

3. Floor Furnace 8. Baseboard, Hot Water

4. Wall Furnace 9. Radiators, Hot Water

(No Heat Ducts) 10. Radiators, Steam

5. Floor, Radiant Hot Water

Heating and Cooling:

11. Warmed and Cooled Air

12. Heat Pump System

Cooling Only:

13. Evaporative Water Cooler (Single or Short Ducts)

14. Refrigerated, with Condenser and Ducts

7. What is the primary exterior wall covering on this building?

(CIRCLE)

1. Plywood 4. Siding 7. Common Brick

2. Hardboard 5. Shingle 8. Face Brick

Sheets 6. Masonry 9. Stone

3. Stucco Veneer 10. Concrete Block

8. What is the primary roof covering of this building?

1. Composition Shingle 5. Concrete Tile 10. Plastic Tile

2. Built-up Rock 6. Clay Tile

3. Wood Shingle 7. Galvanized Metal

(Embedded in Asphalt) 8. Slate

4. Wood Shake 9. Composition Roll

9. How many fireplaces are in this home?

_______ FIREPLACES

10. How many square feet of each of the following types of porches are there in this home? (If respondent is unsure, ask for the dimensions and calculate.)

Open Slab ___________ SQUARE FEET

Slab on Ground ___________ SQUARE FEET

Slab with Roof ___________ SQUARE FEET

Wood Deck ___________ SQUARE FEET

Enclosed Slab Porch ___________ SQUARE FEET

Enclosed Wood Porch ___________ SQUARE FEET

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