Apply for Assistance (Individual) - Rebuild Hot Springs Area

Step 1: Personal Information

First Name

Last Name

Phone/Mobile

Primary Residence

Address Line 1

Address Line 2

City

State

Zip Code

Different Mailing Address?

My mailing address is different from my primary residence

Mailing Address

Address Line 1

Address Line 2

City

State

Zip Code

Join our Newsletter

Yes, I’d like to receive emails with news and updates from RHSA.

Step 2: Eligibility Criteria

Select all that apply

I live in Hot Springs

I work in Hot Springs

My primary residence in Hot Springs was physically damaged during the flood

Employment Information

Did you lose your job or suffer reduced hours due to the flood?

I lost my job

I have had reduced hours

I did NOT lose my job

Are you self-employed or an independent contractor?

Yes

Self-Employment/Independent Contractor Information

Please describe your business and how it has been impacted by the flood.

Employer Information

Place of Employment

Employer's Name

Employer's Phone Number

Were you employed at the time of the flood?

Yes

What is your job role currently or before the flood?

Consent to Contact Employer

I understand that RHSA may contact my employer for further confirmation of my employment if required.

Was your home damaged during the flood?

Yes

Is your primary residence in the 28743 zip code?

Yes

Residence Damage Details

Do you rent or own your home?

Rent

Own

What is your household size?

Describe how your residence/possessions were damaged.

Documentation

Please upload up to 10 images (5mb or less) to show damages to your residence or property. This is not required initially, but someone with RHSA may reach out if we need further information regarding your request.

File Upload

Choose Files

Request Financial Assistance

Please note that although we will do our best to provide assistance, we may not be able to provide the full amount requested. We would still like to understand your overall need to better assess the situation.

What is the total estimated damages to your residence?

Describe how funds will be used. I.e., fixing damage to residence, temporary housing, replacing lost possesions, etc.

Are you receiving any other sources of relief? I.e., charities, grants, etc. Please list those below. If none, leave blank.

If you qualify, is a one-time payment necessary for your needs or would it be acceptable to pay you in scheduled payments over time as more funds become available?

One-time payment is neccesary

Payments over time are fine

Additional Assistance

Have you applied for additional assistance? Check all that apply

FEMA Disaster Survivor Assistance

Unemployment

SNAP Benefits

Small Business Administration Loans

Filed a Claim with Insurance

Would you like help from RHSA applying for assistance?

Yes

Confirm your application

By checking this box, you confirm that all the information you have provided is true and accurate, and you understand that an RHSA representative may contact you for additional documentation or information if necessary.