Hurricane Irma Relief/Recovery Survey

Please complete the Partners for Self-Employment Business Damage Assessment survey on how Hurricane Irma may have affected local business operations in Miami Dade County. This will help us determine how we can offer assistances to your business.

* 1. What is your full contact information? (Email, phone number, Address)

* 2. What is the name and type of business you have?

* 3. Did your business suffer damage due to the Hurricane?

* 4. Did you or will you lose business due to this emergency/disaster?

* 5. Do you have an estimate of the cost to your business due to this emergency/disaster?

* 6. Are you currently open for business?

* 7. How many employees (Full Time and Part Time) do you currently have?

* 8. Did you lay-off employees, or will you lay off employees?

* 9. Have you registered with FEMA?

* 10. Other key factors hindering business operations (Select all that apply)