FEMA-DR-4516-NH: COVID-19

This form is for eligible, critical/essential Private Non-Profits (PNP) only.

Unsure if your PNP is eligible? See FEMA’s PNP eligibility list online here.

Public Assistance Application Form for Private Non-Profits

Which Disaster Are You Applying For?*
Private Non-Profit Organization Name*
County Where Facility(ies) Is/Are Located*
Only select counties where facilities are located that you would like to submit a reimbursement for. Hold down the shift key and click on multiple county names to select more than one.
County Where Organization Headquarters is Located*
Hold down the shift key and click on multiple county names to select more than one.
What type of services does your PNP provide?*
Primary Contact Name*
First Last
Primary Contact Title*
Primary Contact Phone Number*
Primary Contact Email*
Enter Email Confirm Email
Alternate Contact Name*
First Last
Alternate Contact Title*
Alternate Contact Phone Number*
Alternate Contact Email*
Enter Email Confirm Email
Organization Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Is the Organization Mailing Address the Same as the Location Address?*
- Yes
- No
Organization Mailing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Employee Identification Number (EIN)*

This IRS number will likely be known by your financial personnel.
DUNS Number*

If your organization does not yet have a DUNS number, or you are unsure what the number is, please visit the Dun & Bradstreet website (http://fedgov.dnb.com) or call (866) 705-5711 to register or search for a DUNS number.
Non-Profit Documentation
One of the following items of documentation must be provided for your application to be processed:
A current ruling letter from the U.S. Internal Revenue Services (IRS) granting tax exemption under sections 501(c), (d), or (e) of the Internal Revenue Code of 1954
- OR -
Documentation substantiating this organization is a non-revenue producing, non-profit entity organized or doing business under State law.
Documentation Upload*
Max. file size: 1 GB.

FEMA-DR-4516-NH: COVID-19

This form is for eligible, critical/essential Private Non-Profits (PNP) only.

Unsure if your PNP is eligible? See FEMA’s PNP eligibility list online here.

Public Assistance Application Form for Private Non-Profits

Non-Profit Documentation