Flash Flood Relief Request | New Mexico Public Schools Insurance Authority

Flash Flooding Emergency Response Request

For displaced members in Chaves County

Important Documents:

Read: NMPSIA Notice Regarding Flash Flood Emergency Order

Required Fields: All fields marked with an asterisk (*) are required.

First name

Please enter your legal first name

Last name

Please enter your legal last name

Last four digits of Employee SSN

Enter only the last 4 digits of your Social Security Number

Employer ID

Select your school district or employer

Zip code

Enter your 5-digit zip code

Important Notice: Under no circumstances should an individual seek any such relief if he or she does not qualify for relief. Any application for such benefits which knowingly relies on false information is subject to denial of coverage and may be in violation of state statutes.

By my electronic signature, I acknowledge that I have read, understand, and agree to the policies and requirements outlined above.