Power Safety Shutoff Resources Application

If you are at risk of being adversely affected by Public Safety Power Shutoffs, use this form to apply for resources.

The Disability Disaster Advisory Committee will make the ultimate determination on who qualifies for backup batteries and other resources through an application process. Medical needs and income will be considered as part of the application process.

[Downloadable PDF version]

Contact Info




Your Address





Is your mailing address the same as where you live?





Resource Questionnaire



Select a Living Arrangement

If the power were to go out at your home, do you have any backup source of electricity to use?


Are you on the Medical Baseline Program?(Links to external application page)

Do you have a personal or household emergency plan?

Are you willing to work on and use it?

Are you receiving or are you eligible for any type of public benefits?



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