Name:
Disaster number: DR-4720-VT
Last 4 Soc. Sec. Number:
Date of birth:
Place of birth:
FEMA ID #:
Pre-disaster address:

Date:

FEMA National Processing Service Center
P.O. Box 10055
Hyattsville, MD 20782-7055
Or: Fax to 800-827-8112 (Attention: FEMA)

APPEAL OF FEMA DECISION

Applicant Contact Information

Name:
Current Address:
Telephone:
Alternate Telephone:
Email:

Dear FEMA Appeals Officer:

With this letter I am appealing FEMA’s decision on my application for assistance. Enclosed is a copy of FEMA’s eligibility notification letter, dated __, and the FEMA cover sheet with bar code.

I had the following interactions with FEMA (including visits from inspectors, conversations with FEMA representatives and correspondence with FEMA) on the following dates:

FEMA awarded me $ __ for __.

FEMA gave the following reasons for its decision:

I believe FEMA made this decision in error because:

Also, FEMA did not take into account the following damages or expenses resulting from the disaster:

Enclosed are copies of additional materials that I am sending in support of my appeal letter:

I reserve the right to supplement this appeal, including after I receive information from my FEMA file, which I am formally requesting with the submission of this appeal. Thank you for your consideration.

If you have any questions or need additional information, please do not hesitate to contact me at the phone number provided on the first page.

I hereby declare under penalty of perjury that the foregoing is true and correct.

Sincerely,

Signed:

Name:

Date:

---

Name:
Disaster number: DR-4720-VT
Last 4 Soc. Sec. Number:
Date of birth:
Place of birth:
FEMA ID #:
Pre-disaster address:

Date:

FEMA National Processing Service Center
P.O. Box 10055
Hyattsville, MD 20782-7055
Or: Fax to 800-827-8112 (Attention: FEMA)

REQUEST FOR INFORMATION FROM FEMA FILE

Applicant Contact Information

Name:
Current Address:
Telephone:
Alternate Telephone:
Email:

Dear FEMA Records Management Office:

With this letter I am requesting a copy of the information in my FEMA file in accordance with Section 206.115(d) of Title 44 of the Code of Federal Regulations. Please send it to me at my current post-disaster address as soon as possible.

I hereby declare under penalty of perjury that the foregoing is true and correct.

Signed:

Name:

Date: