Household Information

Staff, please record information about the affected household. If another person should be contacted (spouse, landlord, guardian, etc.) record their information in Alternate Contact.

Household Composition

Yes
No
Yes
No

General Information

Yes
No
Own / Primary
Own / Seasonal or Other
Rent
Not Applicable
Single Family
Multi-Family
Seasonal / Vacation
Rental
Business
Other
Mobile Home / Manufactured
Permanent Slab / Basement
Other
Not Applicable
Slab
Crawl Space
Michigan Basement / Dirt Floor
Full Basement (Finished)
Full Basement (Unfinished)
Other
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