Needs Assessment / Request Assistance

PLEASE NOTE: THIS IS NOT THE FEMA REPORTING FORM.

THIS FORM IS ONLY FOR INDIVIDUALS IN LEWIS COUNTY WHO NEED ASSISTANCE WITH DISASTER-RELATED CLEAN UP/REPAIRS!

For FEMA disaster assistance, visit: https://bit.ly/4c68SQd

Following Winter Storm Fern, residents of Lewis County, Tennessee, along with community leaders, faith-based organizations, and local non-profits formed Lewis County United Relief to support individuals and families impacted by disasters in our county. As part of our early planning efforts, the Lewis County United Relief steering committee is working to better understand the needs within the community in order to coordinate appropriate recovery resources.

This form serves as an initial intake for households seeking assistance related to damages or hardships caused by natural disasters and unexpected events. Information collected will help identify unmet needs and guide recovery planning as resources and partnerships are developed.

As recovery efforts move forward, it will be necessary to prioritize certain needs. Immediate health, safety, and essential living needs will take precedence over less critical concerns to ensure the well-being of affected residents.

Recovery following a disaster is a long-term process and may take months or even years to complete. While assistance may not be immediate, the Lewis County Long-Term Recovery Group is committed to working collaboratively to identify resources and support recovery efforts as they become available. Only one submission per household is needed at this time.

Contact Information

Full Name Please enter your full name.

Phone Number Please enter your phone number.

Can you receive texts at this number?

Yes No

Please select an option.

Email

Address Impacted by This Event Please enter the impacted address.

Is this address in the city or county? Available services may differ depending on location.

This address is within the city limits. This address is in Lewis County, but not in the city limits.

Address Where You Are Currently Residing (if different from primary residence)

Family

Names and Ages of Family Members Please list the name and ages of other members of your family living in the same residence (do not include yourself.) Please list your family members.

Impact Assessment

Please select one answer for each question below:

Health Impact

This event caused severe injury or death for multiple members of my family. This event caused severe injury or death for one member of my family. This event caused injury requiring hospital care for multiple members of my family. This event caused injury requiring medical care at the hospital for one member of my family. N/A

Please select an option.

Residence Impact

This event completely destroyed our residence. This event severely damaged our residence and we are unable to live there. This event heavily damaged our residence. We still live there, but have large holes in the roof/walls. This event moderately damaged our roof or windows. We still live there. N/A

Please select an option.

Insurance

We do not have home owner's or renter's insurance. We have home owner's or renter's insurance, and the damage is covered under our policy. We have home owner's or renter's insurance, but the damage is not covered by our policy.

Please select an option.

Ownership Status

I owned my home and we are unable to live there anymore. I own my home and we will be able to return there after major repairs. I rented, and we are unable to live there anymore. I own my home and we still live there. I rent and we still live there.

Please select an option.

If you reported trees/debris in your yard, is this blocking access to essential parts of your property? (i.e. cannot access front door, cannot use driveway, etc.)

Yes No N/A

Please select an option.

Please share any additional information you think may be helpful (optional.)

Electronic Signature By typing your name below, you confirm that the information provided is accurate and complete. Electronic Signature (Type Full Legal Name) Please type your full legal name.

Thank You!

Thank you for submitting your information. Our team will review your request and reach out as resources become available. Recovery is a long-term process — we are committed to working with you through it. Questions? Call (931) 306-6657.