Manitoba Infrastructure

Application for Disaster Financial Assistance

Javascript must be enabled to complete this form. Please see https://www.enablejavascript.io for more information.

Application for Disaster Financial Assistance

Any personal information you provide through the Emergency Management Organization Disaster Financial Assistance (DFA) application is collected in compliance with The Freedom of Information and Protection of Privacy Act. The personal information you provide is used only for the purposes for which it is collected, and not in any other way without your consent.

This information is collected as part of the applicant's request for Disaster Financial Assistance. Emergency Management Organization has responsibility for administering the Disaster Financial Assistance program as per The Emergency Measures Act.

Find more information refer to the Disaster Financial Assistance information webpage.

Applicant Information

Claimant Name:

Must be name(s) that appear on property tax or rental agreement.

Mailing Address: City, Town, Village:

Province:

Please Specify:

Postal Code:

Is the contact person's name different than above? Yes No

Contact Person's Name:

Phone Numbers

Primary Number:

Name:

Secondary Number:

Name:

Tertiary Number:

Name:

Email Addresses

Primary Email:

Name:

Secondary Email:

Name:

Date of Loss or Damage

From:

To:

Type of Event

Example: Flood, heavy rains, windstorm, tornado, etc.

Damaged Property Information

According to the Property Tax Bill for the damaged property, is the property address different than the address given above? Yes No

Address(es) of Damaged Property according to Property Tax Bill(s):

Local Authority of Damaged Property:

Other Local Authority:

Tax Roll Number(s) of Damaged Property:

Claim Information

Claim Type: Residential

A principal residence inhabited by the owner, tenant or occupant for the majority of the year.

Farm

A farming operation engaged in activities such as crop cultivation, livestock, dairy farming, operating a nursery or greenhouse, tree farming etc. To qualify for Disaster Financial Assistance a farm must:

have yearly gross revenues of between $10,000 and $2 million
employ no more than 20 full time workers
not be a hobby farm
be owner-operated and the owner-operator must be the day-to-day manager
have an owner-operator who owns at least 50% of the business

Small Business

To qualify for Disaster Financial Assistance a small business must:

have yearly gross revenues of between $10,000 and $2 million
employ no more than 20 full time workers
not be a hobby business
be owner-operated and the owner-operator must be the day-to-day manager
have an owner-operator who owns at least 50% of the business

Not-for-profit

An organization such as a church, charity, community club, volunteer agency or not-for-profit business cooperative which:

contributes significantly to the community
provides a service in the interest of the community
has property that is fully available to the community and provides an essential service

Residential Claim

Applicant Type: Homeowner Tenant

Number of occupants evacuated:

Evacuated From Date:

Evacuated To Date:

Is this application for damage to my principal residence? Yes No

Is the home habitable? Yes No

Farm/Small Business Claim

Please check all that apply: My farm or business has gross annual revenues between $10,000 - $2,000,000 per year. I am the day to day manager of my farm or business. My damages are for crop losses only.

Do you own or rent the damaged property: Own Rent Own and Rent

Briefly describe the damages and / or losses:

What is the source of flooding? Overland Flooding

Occurs when water flows over land and enters a building through windows, doors or any other opening in a building. Overland flooding is typically caused by an overflowing body of water or excess surface water from snowmelt or rainfall when surface and underground infrastructure is unable to drain excess water.

Seepage

Occurs when water enters building below ground level by seeping through cracks, small holes, joints or porous materials in building foundations. Seepage is typically caused by a rise in the underground water table.

Back-up or Escape of Water / Sewage

Occurs when either water or sewage escape or back-up through a sewer, septic system, plumbing system, sump pump, sump pit, weeping tiles or floor drain. Back-up may be caused by a number of factors, including but not limited to:

Damage to sewer mains or connectors
Overload of municipal sewer systems
Overload of domestic sump or septic pumps
Failure of domestic sump or septic systems due to power or mechanical failure
Groundwater entering through sewer systems, septic systems, sump systems, weeping tiles or floor drains

Were you at the property when damage occurred? Yes No

What was the depth of the water?

Basement: Feet: Inches:

Main Floor: Feet: Inches:

Have you contacted your insurance provider? Yes No

Briefly describe the status of your insurance related to the damages:

Important Information for Applicants

The Manitoba Emergency Management Organization (“EMO”) makes Disaster Financial Assistance (“DFA”) available when a Disaster Financial Assistance Program (“DFA Program”) is established by the Government of Manitoba. DFA Programs may be established following natural disasters that cause wide-spread damage that is mostly uninsurable, and creates a significant financial burden for those impacted. Once a DFA Program is established EMO accepts applications for 90 days.
To qualify for DFA an Applicant must have incurred and paid certain out-of-pocket expenses for goods and services, necessitated by the natural disaster, for which insurance coverage is not available (referred to herein as “Eligible Expenses”). DFA Programs do not reimburse Applicants for 100% of an Eligible Expense. DFA Program guidelines dictate the maximum amount of DFA that can be paid to an Applicant in relation to an Eligible Expense. The total amount of DFA an Applicant qualifies for is subject to a 20% deductible, with a few exceptions. The DFA Program also establishes the maximum amount of DFA an Applicant may receive. The Applicant will be notified by letter if EMO determines they do not qualify.
DFA is not a substitute for private insurance. DFA is not available if insurance coverage for the damage claimed by the Applicant was readily available from an insurance broker or agent. Prior to providing any DFA, EMO will require the Applicant's insurer to complete a written statement regarding the types of insurance coverage available to the Applicant prior to the natural disaster.
Joint property owners or co-tenants must submit one application.
Once this Application is submitted EMO will conduct a preliminary screening to determine if the Applicant may be eligible for DFA. If the preliminary screening suggests the Applicant may be eligible for DFA, an onsite inspection of the land, building and/or other property in relation to which the Applicant is claiming DFA will be conducted. By submitting this Application, the Applicant agrees to permit any person designated by EMO to enter upon the Applicant's property, at an agreed time and date, to complete the inspection.
After the inspection is completed, EMO will determine if the Applicant's claim qualifies for DFA, based on the DFA Program's guidelines and policies. The Applicant is required to submit to EMO copies of receipts, invoices and other documents when requested regarding:
1. Eligible Expenses for which the Applicant wishes to receive DFA (proof of payment must be included); and
2. details of all insurance payouts and/or compensation received from another source (government, charity or otherwise) or pursuant to a Court Order, which the Applicant received in relation to the loss being claimed (hereinafter collectively referred to as “Compensation”).
The Applicant must have paid all Eligible Expense and provide all required supporting documentation to EMO within one year of the DFA Program being announced.
Using the inspection information, receipts, invoices and other documents submitted in support of the Applicant's claim, EMO will determine what amount of DFA, if any, the Applicant is entitled to based on the DFA Program's guidelines and policies. EMO may reduce or deny DFA that an Applicant is otherwise entitled to if, in the opinion of EMO: the damage being claimed existed prior to the natural disaster; the Applicant did not take reasonable action before, during or after the natural disaster to prevent or limit the damage to their property; or after the natural disaster, the Applicant has neglected or shown indifference towards the damage for which DFA has been claimed.
The Applicant must immediately advise EMO of any additional Compensation it receives after submitting this Application. Manitoba may reduce the amount of DFA an Applicant receives to reflect that additional Compensation.
EMO may pay DFA in multiple installments.
Where joint owners or co-tenants are entitled to DFA, unless both parties instruct EMO otherwise, in writing, EMO will issue all cheques in both parties' names.
If after paying DFA to an Applicant, Manitoba determines that the Applicant knowingly:
1. submitted a receipt, invoice or other document for ineligible expenses, for which it received DFA; or
2. the Applicant has failed to report any Compensation it received; the Applicant will be required to repay all DFA received from Manitoba, within 30 days of Manitoba's demand for repayment. That amount will be a debt due and owing to the Government of Manitoba, and if not repaid within the 30 day period, will accrue interest until repaid in full, at the rate of interest set out in the Government of Manitoba's Financial Administration Manual, from time-to-time.
The DFA Program's guidelines and policies are subject to change from time-to-time without notice. Any DFA granted to the Applicant as a result the damages claimed in this Application is discretionary and gratuitous.
Notice about Collection of Personal Information: The term “personal information” has the meaning ascribed to it in The Freedom of Information and Protection of Privacy Act, C.C.S.M. c. F175 (“FIPPA”). The personal information collected from the Applicant in this Application, and any personal information that is subsequently collected from the Applicant, is collected under the authority of clauses 36(1)(a), 36(1)(b) and 37(1)(m) of FIPPA, for the purposes of:
1. administering and evaluating the DFA Program;
2. determining and verifying the Applicant's eligibility for DFA;
3. reporting under the Government of Canada's Disaster Financial Assistance Arrangements ("DFAA"); and
4. for disaster and climate risk analysis and for program development and planning across Manitoba government departments.
By submitting this Application, you consent to EMO collecting the Applicant's personal information, and to EMO disclosing the Applicant's personal information for the purposes indicated above in accordance with subsections 44(1)(b) and 44(1)(i) of FIPPA. Your consent is voluntary and can be withdrawn at anytime however withdrawal will result in the Applicant not receiving DFA. Your personal information will be kept strictly confidential, and will not be disclosed, except in accordance with FIPPA.
Non-identifying data collected from and about the Applicant’s claim may be used and/or disclosed to third parties for the purposes of, but not limited to, research and planning; policy analysis; assessment of risk and/or program development.

Acknowledgement

I/We acknowledge and agree that:

to the best of my/our knowledge and belief, the information and documentation I/we have provided in this Application, or will provide in future in support of this Application, are true and correct in every respect;
I/We understand that it is an offence under the Criminal Code of Canada to knowingly make any false statement or representation in a document of this nature, or to furnish any false or misleading information or documentation for the purpose of obtaining funding from a government program;
I/We have read and understand the “Important Information for Applicants” section; and
The DFA Program's guidelines and policies are subject to change from time-to-time, without notice, and any DFA granted to the Applicant by EMO is discretionary and gratuitous.

Click here to confirm you have read, understand and agree with the above statements.

Preferred method of correspondence: Email Regular Mail

Please click the SUBMIT button to submit your application for Disaster Financial Assistance to Manitoba Emergency Management Organization for preliminary assessment. A written confirmation that your application is received will be sent to you within two weeks.

If you do not receive this confirmation, please contact Manitoba Emergency Management Organization at (204) 945-3050 or toll-free at 1-888-267-8298.

Close Window