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Flood Relief

This form is required to be completed by the individual(s) requesting aid due to losses they sustained from the storms in March 2019.

Please do NOT complete this form on behalf of another.

To apply and qualify for assistance, you must complete the following:

Applicant Information
Summary of Losses
Rate Severity of Damage
Types of Damage (check all that apply)
Provide a detailed description of loss incurred. Include physical location of damage (especially important if mailing address is PO Box or different than location of damage). Describe who is impacted. Number in household, size and makeup of group or community. Include quantity of loss/damage/expense, household items damaged, furniture, appliances, vehicles, number livestock, number of acres, number of additional miles to work/school/doctor. Describe other assistance you have applied for and results, if known.
Financial Impact
To the best of your ability, based on actual costs and estimates as well as claims and assistance provided or qualified for, please complete the following. (Documentation may be requested)
Financial Impact in dollars
Total estimated insurance payments
Total additional assistance received
Documentation Required: Utility bill or other verification of address. Documentation requested: Pictures of damage; invoices or quotes for remediation, repair or replacement of damaged items. Upload file size limit is 30 MB. If you have files that exceed that amount, please reduce the size of your files or provide them via email using the address below.
No file selected

Verification (Please list two non-family references who can verify the information you have submitted.)
Reference 1
First Name
Last Name
Country
Address Line 1
City
State
Postal Code
Reference 2
First Name
Last Name
Country
Address Line 1
City
State
Postal Code

Electronic Signature

I agree to sign this application electronically and my electronic signature is the legal equivalent of my manual signature on this application.
All information provided is true to the best of my knowledge and is submitted by the applicant who sustained losses from the March 2019 storms.
I agree to pay back any distributions made based on false or fraudulent information.


Questions? Contact the Catholic Social Services Flood Relief Committee at floodrelief@cssisus.org

Catholic Social Services established a Disaster Relief Fund to provide emergency aid to Nebraska families and communities affected by March 2019 storms and flooding.

The funds collected will be administered by our Flood Relief Committee convened by Catholic Social Services.

If you have any questions, please contact the committee at floodrelief@cssisus.org

  • Individuals served last year

    27,670

  • Square Miles of the Diocese of Lincoln

    24000

  • Acts of Mercy performed last year

    127000

  • Cash and in-kind assistance provided across southern Nebraska last year

    $1834491

  • Immaculate Heart of Mary Counseling Center

© 2019 Catholic Social Services of Southern Nebraska

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