Notice of Casualty Loss

Notice of Casualty Loss Electronic Notification
Please use this portal to report to DCA both Casualty Loss, and completed repairs of previously reported Casualty Losses.

Attach any relevant documents such as a report from emergency responders, insurance estimates or reports showing repairs are complete .

The Department of Community Affairs (DCA) should be notified of a Casualty Loss within 72 hours of the loss.

DCA should be notified if the loss results from a major event such as; hurricane, fire, flood, or any incident that results in a household being transferred or removed from the unit for more than 48 hours, or if an occupied unit or common area will not pass a Uniform Physical Condidtions Standards inspection.

For assistance with this form, please contact: compliance@dca.ga.gov
Please tell us why you are filing this report
Reason for Report*

Self ReportLoss discovered by DCA during a reviewLoss reported to DCA by tenantDamage previously reported a on Casualty Loss has been repaired
Date of Loss*

MonthDayYear
Date Repaired

MonthDayYear
Project GA ID *
Project Name*
Brief Description of Loss*
Was the loss incurred by a natural disaster? (tornado, hurricane, flood, etc.)*

YESNO
What type of natural disaster has occurred on your property?*

Tropical StormHurricaneTornadoFloodWind StormEarthquakeWildfireOther
What was the name of the disaster (ex: Hurricane Florence)*
Please describe loss and indicate BINS and units affected*
Were any residents displaced as a result of the incident?*

YESNO
How many units had displaced tenants?*
List the unit numbers that had displaced tenants?*
Do you have knowledge of where the tenants were relocated to?*

YESNO
List the property or area the tenants were relocated to
Has an insurance claim been filed?*

YESNO
Please upload a copy of the insurance claim here

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Please list the point of contact at your property/ company for this event:
Name
E-mail*
Phone Number*

Area CodePhone Number
Please provide the address where the loss occurred:
Address
City
Zip
Check all applicable funding for this project*

HOMENSPPermanent Support Housing Program(PSHP)ExchangeTax Credit
What will be done to bring BINS and units back into compliance
Estimated dates the units will be ready for occupancy

MonthDayYear
Date all work completed

MonthDayYear
Upload additional documents

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Notice of Casualty Loss Electronic Notification