Exit this survey Irene Damage Assessment survey 1. Default Section Question Title * 1. Please provide the following contact information: Name: * Address: * City/Town: State: -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP: Email Address: Phone Number: Question Title * 2. Has your residence or business sustained STRUCTURAL damage due to flooding or wind damage from Irene? Yes No Other (please specify) Question Title * 3. Is damage visible from the outside of the structure?This will help damage assessment teams determine if appointments will need to be scheduled with property owners Yes No Question Title * 4. Is this property a: Single Family home Multi-Family home Business (including neighborhood associations reporting damage to bridges or seawalls) Mobile home Other (please specify) Question Title * 5. Brielfly describe the structural damage to your residence or business Question Title * 6. If you're reporting other property damage, such as fallen trees and limbs, or cars that were damaged due to flood waters or trees, please describe the damage below. Question Title * 7. Is this property occupied by: Owner Renter Question Title * 8. Is this propery accessible for inspection at a later date? Yes No Question Title * 9. Are you still able to live in the home or stay open for business? Yes No Question Title * 10. What type of insurance do you have for this property? Structure and Contents Contents Flood None Question Title * 11. Have you contacted your insurance company and also documented the damage for your own records (ie photos, video)? Yes No Unsure Question Title * 12. For business owners: did you have to close your business as a result of the storm, if yes, please briefly describe impact on your operations (ie # of days closed, income lost, etc) Done