Montana Case Management Program Interest Form English

Please complete this form if you are a survivor of the Montana Flooding (DR-4655). If you have been impacted and still have a disaster related need, please fill out the interest form and one of our Disaster Case Managers will contact you to complete an eligibility screening.

I authorize my disaster case management organization to share and receive my personal information, including, but not limited to, name, address, assistance received for disaster recovery, in order to coordinate available resources and services.
Disaster relief agencies, voluntary organizations and government agencies active in disaster recovery are committed to respecting your privacy. It is necessary at times for organizations to share personal information gained during your partnership to coordinate and provide disaster relief assistance. Therefore, your written consent to share and receive information for disaster-related services is necessary. By signing below, you affirm the organization can share or receive your household’s information appropriately to advocate on your behalf and avoid duplication of services.

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