NCORR RebuildNC NC-HRP Application Header

Before you begin

"Disclaimer: If you have previously applied to ReBuild NC, do not complete this application.  Please call 833-ASK-RBNC (833-275-7262) for the status of your current application and next steps."

1. Online Application Guidance: An email address will be required in order to submit a complete application. As you are completing the application, please do not hit the back or refresh button on your internet browser, as information may be lost. Additionally, It is strongly recommended that you download a copy of the following documents:

2. Completing the application: The application is the first part of the Homeowner Recovery Program Process. In order to complete Step 1 and move into the eligibility review (Step 2) stage of the program, you will need to submit all required forms and supporting documentation as referenced on the Required Document Checklist.

*For forms that request an Application ID, this field may be left blank, as your Application ID is issued once your application is submitted.  If you complete these forms after your application is submitted online, please include the Application ID that will be provided to you in your application submission confirmation email. 

3. Need help completing the online application: Please do not hesitate to call 833-ASK-RBNC

(833-275-7262) to speak with a program representative if assistance completing the application is needed.


4.  Saving the application: You may choose to save the application to complete and submit later.  When you click the Save button, you will be prompted to enter an email address and password. You will receive an email confirmation that the response was saved including a link for returning to your online application.  Emails from the online application platform may fall into your spam folder so please be sure to monitor all folders in your email. 


5. Resume saved application: You may resume a saved application at any time prior to completing and submitting the application. You will need the email address and password that you provided when you saved the application.

6. After submitting the applicationAn email notification confirming that your application has been submitted will be sent to you with additional documentation for you to review. A Program Representative will reach out to you to discuss next steps and request any additional supporting documentation that may be needed to move forward. You may also call 833-ASK-RBNC (833-275-7262) for any additional information. 

Last Updated: 12/09/2021

Page 1 of 12

Section A1: Primary Applicant (Owner-Occupant)

Section A2: Co-Applicant (Owner)

Page 2 of 12
Section B: Eligibility Information

Page 3 of 12
Section C: Household Member(s)
Complete the following section for all household members who occupy the property as a primarresidence. Note that the Primary Applicant does NOT need to be the head of household. 

Click here for Section C Question Guide 

For any individual(s) 17 years of age or younger ONLY, the number of months out of one year that the individual(s) currently lives in the household.

For any individual(s) 17 years of age or younger ONLY, the number of months out of one year that the individual(s) currently lives in the household.

For any individual(s) 17 years of age or younger ONLY, the number of months out of one year that the individual(s) currently lives in the household.

For any individual(s) 17 years of age or younger ONLY, the number of months out of one year that the individual(s) currently lives in the household.

For any individual(s) 17 years of age or younger ONLY, the number of months out of one year that the individual(s) currently lives in the household.

This information is being collected to ensure compliance with Federal Fair Housing and Equal Opportunity regulations.

Power of Attorney (POA)

Page 4 of 12
Section D: Damaged Property Information
Provide basic information concerning the damaged property (i.e., physical address of damaged property, floodplain information, and other names on the deed).

Click here for Section D Question Guide

Page 5 of 12
Section E: Homeowner's Completed Repairs to Damaged Property - If your home was damaged by the disaster and you have made repairs, please complete the following questions.  Please collect and retain all your receipts should the program request them.

Page 6 of 12
Section F: Homeowner's Insurance - If a mortgage exists, a homeowner's insurance policy is likely in place.

Section G: Other Insurance & Disaster Assistance Sources

Flood & Other Insurance

Federal Emergency Management Agency (FEMA)

Small Business Administration (SBA)

Please only include numbers and a decimal point. Do not include any symbols such as $

Please only include numbers and a decimal point. Do not include any symbols such as $

Other Sources

Page 7 of 12
Required Forms and Documentation Upload

Household members 18 years or older without income must additionally complete the Certification of Zero Income certifying that they receive no income.


Page 8 of 12
Declaration of Lawful Presence
In order to be eligible to receive housing benefits, a member of the household must be a citizen, non-citizen national, or qualified alient of the United States.  If this status is not met, the household may not be eligible for assistance.  Please read this Declaration carefully.  Please consult an immigration attorney or other expert of your choosing if you have questions regarding this declaration.

Declaration of Lawful Presence

Page 9 of 12
I authorize the State, its agents, assigns, and contractors to obtain information about me that is pertinent to determining my eligibility for participation in the Program. I acknowledge that:

  1. A photocopy of this form is as valid as the original; AND
  2. I have the right to review information received using this form; AND

  3. I have the right to a copy of information provided to NCORR and ReBuild NC and to request correction of any information I believe to be inaccurate; AND

  4. All applicants will sign this form and cooperate with NCORR and ReBuild NC for purposes of eligibility verification.

WARNING: Title 18, Section 1001 of the U.S. Code states that a person is guilty of a felony for knowingly and willingly making false or fraudulent statements to any department of the United States Government.

Application Authorization


Equal Opportunity: In accordance with the provisions of the Equal Opportunity Act and ReBuild NC policies, there will be no discrimination against an applicant for these benefits on the basis of age, source of income, sex, race, marital status, sexual orientation, national origin, religion, or handicap. If you or a member of your household is an individual with a disability, you have the right to request reasonable accommodation for that disability. ReBuild NC and its contractors are committed to assuring that each individual has an equal opportunity to the use and enjoyment of the benefits of this program.

Confidentiality: In order to process an application, ReBuild NC may supply and receive information as detailed in the “ReBuild NC Consent to Release” form that you will execute. Information may also be released to comply with the auditing requirements of program funders. With these two exceptions, all personal and identifying information on an application remains fully confidential.


Page 10 of 12
It is the policy of the North Carolina Office of Recovery and Resiliency (NCORR) that all information contained in this application be verified prior to award. Please read the following certifications carefully and acknowledge each by initialing primary applicant name and dating where indicated.

Application Certifications

Primary Applicant Initials

1. All information provided and submitted in support of this application is true and complete to the best of my knowledge and belief. I am aware that any misrepresentation in this application will result in the forfeiture of my right to participate in the ReBuild NC Homeowner Recovery Program and may result in legal action being taken against me.

2. Every person entitle to claim an ownership interest in the damaged property has given consent to the application or was not located after reasonable effort, and as a Primary Applicant, I attest that I am responsible for all certifications herein.  

3. I agree to accept services provided by the Program and authorize the Program to provide guidance regarding its related services for my property. I further agree to hold harmless the employees, members and officers of the Program in connection with acts performed by them, including, but not limited to: consultation(s), technical advice, property inspection(s), and other related activities.

4. I authorize program staff to obtain records including, but not limited to: personal income reports, property title and tax records, inspections reports, repair specifications, cost estimates, contractor bids, and such other reports that program staff deem necessary.  I understand that information in this application may be shared with outside parties for the purpose of third-party verification and for funding compliance.

5. I understand that funding for the ReBuild NC Homeowner Recovery Program is contingent upon the availability of Community Development Block Grant-Disaster Recovery (CDBG-DR) funds provided by the U.S. Department of Housing and Urban Development (HUD). Because program funding is limited, I understand that it is possible that not all eligible applicants will receive benefits under the ReBuild NC Homeowner Recovery Program.

6. I certify that I have received a copy of the Appeals Procedures for the Homeowner Recovery Program and understand that I may appeal any determination made by NCORR or its agents regarding my eligibility for the Program or potential grant amounts.

7. I certify that I have received a copy of the “Protect Your Family from Lead in Your Home” brochure.

8. I understand that completion of the application does not guarantee my eligibility for this program. Further, I understand that participation in the Homeowner Recovery Program is voluntary and that I may withdraw at any time.  I also understand that if I choose to withdraw from participating in the Program, federal law states that I must return any funds disbursed to me. 

9. I understand that federal law requires me to stop all work on the damaged property once this application is submitted, or I will be determined ineligible for assistance by the Homeowner Recovery Program.  Prior to executing a potential future grant agreement, I understand that I must seek prior approval from the Program prior to conducting any repair activities.  If I am currently under contract for repairs, I will let the Program know immediately, including about my ability to end that contract and/or its expiration.  

10. I understand that any changes to my property ownership, damages, repairs, tenant occupancy, or any financial disaster assistance I have applied for, committed, or received must be reported to the Program at the earliest opportunity. I understand that any disaster assistance I have received may be considered a duplication of benefits and may impact award amount(s) for which I am eligible, if such offer(s) is/are made by the Program. I agree to disclose to the Program all disaster assistance I have applied for, committed, and/or received. Further, I agree to assign and/or enter into a repayment agreement for such funds to NCORR and/or the ReBuild NC Homeowner Recovery Program if necessary.

11. I certify that I have included all information regarding mortgages, liens, and judgments on my property and that I am not currently in default or undergoing foreclosure proceedings

12. I understand that, as the Primary Applicant, I must not transfer the damaged property or any interest in it, whether voluntarily or involuntarily, until the repair/rehabilitation or reconstruction to be performed under the Program has been completed and the Program has completed closeout of the application. 

My signature below indicates that I have read, understood, and agree to all statements in this application.  Under penalty of perjury, I affirm that all information provided in this application is true and accurate to the best of my knowledge.  I agree to hold harmless the Rebuilt NC Homeowner Recovery Program, its employees, agents, and assigns from liability for any damages that may arise as a  result of my participation in this program. 

Warning:  Any person who knowingly makes a false claim or statement to HUD may be subject to civil or criminal penalties under 18 U.S.C. 287, 1001 and 31 U.S.C. 3729.
Page 11 of 12
Read Before You Submit Your Application

Please do not hit the Back button on your web browser, refresh, or the Submit button twice. Following the guidelines below will aid in timely and accurate processing of your application.

1.   If you are not ready to submit your application, you may use the Save button to save your application and resume at a later time.

2.   Once you hit the Submit button, you will see a message that your application is  “Processing”.  It may take up to 15 minutes before you receive a confirmation message. Once you hit Submit, do not hit the Back button on the web browser, refresh or Submit twice.

3.   Following the submission of your application, a confirmation email will be sent to the email address you entered for the Primary Applicant.  If you saved and resumed the application using a different email address, the confirmation email will still be sent to the Primary Applicant email address.

4.   If you do not receive the confirmation email within 15 minutes of submitting your application, we recommend that you check your Junk E-mail, Bulk-mail, or Spam folder.  If so, please select the confirmation message and click Not Junk or Not Spam, which will allow future messages to get through.

5.   If you do not receive the confirmation email, call 833-ASK-RBNC (833-275-7262) for assistance. Do not submit another application.

6.   If you need to make changes to your application, provide additional information or submit supporting documents, call 833-ASK-RBNC (833-275-7262) for assistance.  Do not submit another application.

Following these recommendations will help prevent the submission of duplicate applications, allowing ReBuild NC timely and accurate review of your application submission.

Page 12 of 12