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Application for Resiliency Assessment

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Thank you for your interest in the free Risk Assessment and Grant Program from the Department of Small Business Services. Eligible businesses can receive a one-on-one, on-site risk assessment that will:

Help you identify and understand physical, operational and financial risks that your business faces.
Provide you with personalized recommendations to improve your business preparedness and resiliency.
Make you eligible for a grant of up to $3,000 towards recommended items or certain types of equipment.

Use the form below to submit your application. PLEASE NOTE: Only businesses that experienced flooding or power outage during Hurricane Sandy in 2012 are eligible for this Program.

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Business Name*

Street Address*

Apt./Suite #

City*

State*

Zip Code(plus-4-code optional)*

Borough*

Phone Number(extension optional)*

Email*

Business Owners First Name*

Business Owners Last Name*

Preferred Language for Assistance*

Preferred Contact Method*

How did you hear about us?*

Business Sector*

Do you own or rent your business location?*

Number of Employees*

Was your business in operation prior to October 2012?*

Was your business located in the Superstorm Sandy flood zone at the time of the storm (October 2012)?*

Did your business experience flooding and/or power outage as a result of Superstorm Sandy (October 2012)?*

Please briefly describe the damage or interruption your business experienced as a result of Superstorm Sandy*

Has your business location changed since October 2012 (have you moved since Superstorm Sandy)?*

Is your business still located in the Hurricane Sandy flood and/or power outage zone?*

Please identify your business market sector by entering the relevant code from the North American Industry Classification System (NAICS). NAICS codes can be found online at www.census.gov/eos/www/naics

Auxiliary aids and services are provided for individuals with a disability upon request. Please check the aid/service(s) that you need:

Accessibility for wheelchairs/other mobility devices
Sign Language Interpreter
Induction Loop System
Assistive Listening System
Braille
Large Print
Real Time Captioning
Other
Please note: requests must be made no later than 72 hours prior to an event/meeting.