Hurricane Sandy
Step 1 - Client Name(s)
*
*
Example: 212-555-1212
Example: 212-555-1212
Example: 212-555-1212
Step 2 - Damaged Property Address
Example: 12345-0000
Step 3 - Current Address
Example: 12345-0000
Step 4 - Rent / Own
Step 5 - Family Information

Participation in some of HCR's programs is dependant on veteran status, income or age.
Step 6 - Housing Plan
Step 7 - Status of Assistance Search
Step 8 - Other Information
Include any assistance sought from DHCR (Appartment Rental, Mobile Home Rental, Home Ownership, Mobile Home Ownership, Section 8 Voucher or Weatherization)
Note: Text will be limited to 4,000 characters (1 page of 12 point Times New Roman single spaced text is approximately 4,000 characters).
Step 9 - HCR internal use only
Date form was completed:  Click to open/close calendar