Follow the steps to fill out the form online effectively.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin filling out your information in the 'Head of Household' section. Provide the last name, first name, and date of birth. If applicable, fill in your spouse’s name and date of birth as well.
3. In the 'Address of Damaged Home' field, enter the complete address where the damage occurred. If you are currently residing at a different address, include that in the 'Current Address' section.
4. Provide your current contact numbers, including home, cell, and work phone numbers. Indicate whether you own or rent your damaged home and confirm if it is your primary residence.
5. Fill in the landlord’s name, address, and phone number if applicable. Specify the type of home by selecting options such as single family, duplex, or apartment.
6. Indicate the total number of people living in your home. Break down this number into categories: elderly, adults, disabled, and children, also including their ages.
7. Choose the race of household members from the provided options and specify the primary language spoken in your household.
8. Document your insurance coverage details, including homeowner, flood, contents, and sewer backup. Confirm if you have contacted your agent and enter the claim number and settlement amount if applicable.
9. Answer whether you have received assistance from other agencies, specifying whom you received it from and for what purpose, as well as the amount.
10. Describe the type of damage to your home by checking applicable boxes related to water damage and detail any foundation or furnace issues.
11. Under 'Immediate Needs', check off any assistance you require such as debris removal, temporary housing, or counseling services.
12. Once you have completed all sections, review the information for accuracy. Save your changes, and you may choose to download, print, or share the completed form.

Complete your IN Disaster Initial Intake/Assessment Form online to ensure timely assessment and support.