Form Center

2. Owner's First Name*

   (must match Harris County Property Tax Records)

   
   

3. Owner's Last Name*
5. Address*
7. City*
8. State*
9. Zip Code*
11. Mailing Address (if different):

    (Street, City, State, Zip)

    
    

13. Email Address*
14. Phone Number*
16. Foundation Type:*
    -- Select One --Crawl SpaceSlab on GradeElevated on Piers, Piles Posts or ColumnsOther
18. If you selected "other" as the Foundation Type, explain here:
20. How many stories is your house?*
21. Is the home a rental home?*
23. How many people live in your home?*
24. How many of those people work?*
26. Is there a reason to suspect hazardous and/or toxic material contaminants on the property?*
    -- Select One --YesNo
28. Proof of current NFIP Flood Insurance Coverage*

    Example

29. Color photos of each side of the house*

    Example

31. FEMA Flood Loss History*

    Example

32. Elevation Certificate*

    Online Form (fill out, save as PDF, and upload here)

    
    

34. FEMA Declaration and Release*

    Online Form (fill out, save as PDF, and upload here)

35. Acknowledgement of Conditions for Mitigation of a Property in a SFHA with FEMA Grant Funds*

    Online Form (fill out, save as PDF, and upload here)

37. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
39. Electronic Signature
Leave This Blank:


41. 1. Receive an email copy of this form.
42. Email address

    This field is not part of the form submission.

43. Submit

* indicates a required field