Hurricane Response Hub Technical Assistance Request Form
Thank you for reaching out to the Hurricane Response Hub with your disaster-related morbidity and mortality surveillance, environmental health or occupational workforce needs.
Please complete this short form to request technical assistance and a Hurricane Response Hub Technical Assistance Center representative will contact you within 1 business day.
Contact Information (email or phone)
Organization or Agency Name
Select your state or territory from this drop down list.
TA Request Topic
Please select the TA request topic from the drop down list. If Other, please describe in the text box below.
Disaster-related Morbidity and Mortality Surveillance
Disaster-related Environmental Health
Disaster-related Occupational Health
TA Request Type1
Please tell us what type of TA you are seeking: Resources, Training, or Other. If you select other, please describe in the text box below.
Technical Assistance Request Description
Please briefly tell us more about your workforce or training technical assistance needs.
TA Goal or Outcome
Describe the goals and outcomes you would like to achieve as a result of this TA.
Flag for URGENT items only
Please attach anything that will help us with your request.
How did you hear about the Hurricane Response Hub?
Please tell us how you learned about this initiative (optional).
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