OHCS Risk Mitigation Pool (RMP) Appeals Form
Owner Information
Building Owner:
*
Mailing Address:
*
City:
*
State
*
Zip:
*
Person Completing this Claim Form:
*
Organization:
*
Title:
*
Phone Number:
*
Phone
Email:
*
Property & Unit Information
Property Name:
*
Property Address:
*
City:
*
Zip Code:
*
Total # PSH Units on Property:
*
Total Amount of Claim Being Requested:
*
Appeal Narrative
Please describe in detail why you are appealing the denied RMP claim:
Property Owner or Manager:
*
I agree the information provided is true and accurate.
Yes
No
Send me a copy of my responses
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