Homeowner Information Last Name, First Name * House Number * Street name * Email * Phone Number * Fire Mitigation Hours Select "Single Date" to input hours for a single a day. If you need to add more than one day of hours, then select "Date Range" an input a start date and an end date for all hours worked for fire mitigation. Single Date Date Range Single Date or Date Range * Date * MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day Year20222023202420252026 Year Hours Worked * - Select -123456789101112131415161718192021222324 Start Date * MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day Year202320242025 Year End Date * MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day Year202320242025 Year Hours Worked * Cost (dollars spent on mitigation) $ Leave this field blank Submit