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Report Period Enter Report Start Date: Enter Report End Date (Plus 1 Day): 10/1/10 7/1/12
Providers Reporting Information in this Report CT HMIS Reporting Demo - HOPWA(942) CT HMIS Reporting Demo - HOPWA - SubProvider(1149)
Special Notes Part 2: Section 2 Part 3: Section 1. Part 3: Section 1. b. Part 3: Section 2. Part 3: Section 3. Part 2: C. Part 2: C : Lines 13 - 14 Utilization Beneficiaries include those living with HIV/AIDS AND all associated members of their household receiving HOPWA housing assistance Area Median Income (AMI) is taken from the Head of Household when a family. Excludes those with a Housing Assistance type of "Receiving NO HOPWA housing assistance" Housing placement assistance activities numbers are taken from values provided by report prompts. Utilization rate calculated by looking at number of Beds or Units used in period vs available capacity. Unmet need numbers are taken from values provided by report prompts. In the case of families with more than 1 HIV/AIDS + persons, only one person will be counted in section 1. Individuals
1. Service Area:
1. Total number of households that have unmet housing needs c. Housing Facilities, such as community residences, SRO dwellings, other housing facilities Not Provided by HMIS Not Provided by HMIS
From Item 1, identify the number of households with unmet housing needs by type of housing assistance. a. Tenant-Based Rental Assistance (TBRA) b. Short-Term Rent, Mortgage and Utility payments (STRMU) Assistance with rental costs Assistance with mortgage payments Assistance with utility costs c. Housing Facilities, such as community residences, SRO dwellings, other housing facilities = = = = = = 5 9 4 3 2 1
Section 1. Individuals
HOPWA Eligible Person: A low-income person with HIV/AIDS who qualifies the household for HOPWA assistance. This person may be considered Head of Household. When the APR asks for information on eligible individuals, report on this person only. Where there is more than one person with HIV/AIDS in the household, the additional PWA(s), would be considered a beneficiary(s).
1.
Category Continuing to receive HOPWA support from the prior operating year
New Individuals who received HOPWA Housing Assistance support during Operating Year 2. 3. 4. 5. Place not meant for human habitation (such as a vehicle, abandoned building, bus/train/subway station/airport, or outside) Emergency shelter (including hotel, motel, or campground paid for with emergency shelter voucher) Transitional housing for homeless persons Total number new individuals who received HOPWA Housing Subsidy Assistance with a Prior Living Situation that meets HUD definition of homelessness (Sum of Rows 2 4) Permanent housing for formerly homeless persons (such as Shelter Plus Care, SHP, or SRO Mod Rehab) Psychiatric hospital or other psychiatric facility Substance abuse treatment facility or detox center Hospital (non-psychiatric facility) Foster care home or foster care group home Jail, prison or juvenile detention facility Rented room, apartment, or house* House you own* Staying or living in someone elses (family and friends) room, apartment, or house* Hotel or motel paid for without emergency shelter voucher Other Dont Know or Refused* TOTAL of HOPWA Eligible Individuals( Sum of Rows 1 and 5-17) 0 0 0
0 0 0 0 0 0 0 0 1 0 0 0 1 26 0
Note: Items with Asterisk are combined picklist values of similar nature Individual Clients with NULL Prior Living Situation (ERROR)
Client ID 132472 138819 138822 138824 143453 143454 143466 143503 143504 143506 143508 143509 143512 143513 143515 143519 143525 143530 143531 143532 143886 143891 143895 144858 144859 144860
Entry 11/4/09 12/21/10 4/21/09 4/21/09 2/17/10 11/2/09 3/1/10 6/15/08 10/15/09 11/3/09 12/1/09 1/1/10 2/1/10 4/1/10 5/1/10 7/1/10 2/17/10 12/1/09 10/31/10 9/1/10 3/1/10 2/1/10 4/1/10 9/30/10 1/1/10 2/1/10
Group ID None None None None None None None None None None None None None None None None None None None None 126761 126764 126769 None None None
DV
Living Sit.
HIV/AIDS Yes
Yes (HUD) Emergency shelter, including hotel or Yes (HUD) for with emergency shelter voucher(HUD) motel paid Yes Yes No (HUD) Owned by client, with housing subsidyNo (HUD) (HUD) No (HUD) Emergency shelter, including hotel or No (HUD) for with emergency shelter voucher(HUD) motel paid No Yes No (HUD) Emergency shelter, including hotel or Yes (HUD) for with emergency shelter voucher(HUD) motel paid Yes Yes Yes (HUD) Rental by client, no housing subsidy (HUD) Yes (HUD) Yes Yes Yes (HUD) Emergency shelter, including hotel or No (HUD) for with emergency shelter voucher(HUD) motel paid Yes Yes No (HUD) Emergency shelter, including hotel or Yes (HUD) for with emergency shelter voucher(HUD) motel paid No Yes No (HUD) Staying or living in a family member's No (HUD) room, apartment or house (HUD) No Yes No (HUD) Place not meant for habitation inclusive of 'non-housing service site(outreach programs only)'(HUD) No (HUD) No Yes No (HUD) Emergency shelter, including hotel or No (HUD) for with emergency shelter voucher(HUD) motel paid No Yes No (HUD) Transitional housing for homeless persons (including homeless youth) Yes No (HUD) No (HUD) No (HUD) Permanent housing for formerly homeless persons(such as SHP, S+C,YesSRO Mod Rehab)(HUD) No (HUD) No or No (HUD) Psychiatric hospital or other psychiatric facility (HUD) No (HUD) No (HUD) Foster care home or foster care groupNo (HUD) home (HUD) No (HUD) Jail, prison or juvenile detention facility (HUD) No (HUD) No (HUD) Owned by client, no housing subsidy (HUD) No (HUD) No (HUD) Other (HUD) No (HUD) Don't Know (HUD) No (HUD) X No (HUD) No (HUD) No (HUD) No No No No No No No No No No No No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No (HUD) Substance abuse treatment facility or No (HUD) (HUD) No detox center
No (HUD) Rental by client, no housing subsidy (HUD) No (HUD) No (HUD) Owned by client, no housing subsidy (HUD) No (HUD) No (HUD) Rental by client, no housing subsidy (HUD) No (HUD) No (HUD) Rental by client, no housing subsidy (HUD) No (HUD) No (HUD) Rental by client, no housing subsidy (HUD) No (HUD) No (HUD) Owned by client, no housing subsidy (HUD) No (HUD)
Section 2. Beneficiaries
a. Total Number of HOPWA Beneficiaries Served with Housing Assistance
Individuals and Families Served with Housing Assistance 1. Number of individuals with HIV/AIDS who qualified the household to receive HOPWA housing subsidy assistance (equals the number of HOPWA Eligible Individuals reported in Part 3A,Section 1,Chart a, Row 7) 2. Number of other persons residing with the above eligible individuals in HOPWA-assisted housing 3. Number of ALL other persons not diagnosed as HIV positive who reside with the HOPWA eligible individual identified in Row 1 and who benefited from the HOPWA housing subsidy 4. TOTAL Number of ALL Beneficiaries Served with HOPWA Housing Subsidy Assistance (Sum of Rows 1, 2, & 3) Total Number
26 3 3 32
All Other Beneficiaries (Chart a, Rows 2 and 3) A. Male 6. 7. 8. 9. 10. Under 18 18 to 30 years 31 to 50 years 51 years and Older Subtotal (Sums of Rows 1-4) 0 0 0 0 0 B. Female 0 2 0 0 2 C. Trangender M to F 0 0 0 0 0 D. Trangender F to M 0 0 0 0 0 E. Total (Sum of Columns A-D) 0 2 0 0 2
Total Beneficiaries (Chart a, Row 4) 10. TOTAL (Sum of Rows 5 & 10) 18 13 0 0 31
1. 2. 3. 4. 5. 6.
Category American Indian/ Alaskan Native Asian Black/African American Native Hawaiian/Other Pacific Islander White American Indian/ Alaskan Native & White Asian & White
1 1
0 0
0 0
0 0
7. 8.
Black/African American and White 9. American Indian/ Alaskan Native & Black/African American 10. Other Multi-Racial
11. Column Totals (Sum 3 of Rows 1-10) 29 10 ERROR: Primary and Secondary Race are the same (remove or change secondary race answer). ERROR: Don't Know / Refused ERROR: Null Primary Race ERROR: Null Ethnicity
Section 3. Households
Household Area Median Income.
Percentage of Area Median Income 1. 0-30% of area median income (extremely low) 2. 31-50% of area median income (very low) 3. 51-80% of area median income (low) 4. Total (Sum of Rows 1-3) ERROR: AMI above 80% Households Served with HOPWA Housing Assistance 8 2 11 21 5
Date Check:
The total reported above in Part 3. Section 3 Row 4 should match the total in Part 3, Section 1, Chart a.
Race & Ethnicity by row/category American Indian / Alaskan Black / Afr. Amer. Native Amer / Black
Asian
Hawaiian
White
Indian / White
Asian/White
Black / White
Other
Client ID
1a Non-H
1b Hisp. 1
2a Non-H 1
2b Hisp. 0
3a Non-H 7
3b Hisp. 4
4a Non-H 1
4b Hisp. 0
5a Non-H 9
5b Hisp. 0
6c Non-H 1
6d Hisp. 1
7c Non-H 1
7d Hisp. 0
8c Non-H 2
8d Hisp. 1
9c Non-H 1
9d Hisp. 1
10c Non-H 4
10d Hisp. 2
Totals:
132472
138819
138821
138822
138824
143453
143454
143466
143503
Race & Ethnicity by row/category American Indian / Alaskan Black / Afr. Amer. Native Amer / Black
Asian
Hawaiian
White
Indian / White
Asian/White
Black / White
Other
Client ID
1a Non-H
1b Hisp. 1
2a Non-H 1
2b Hisp. 0
3a Non-H 7
3b Hisp. 4
4a Non-H 1
4b Hisp. 0
5a Non-H 9
5b Hisp. 0
6c Non-H 1
6d Hisp. 1
7c Non-H 1
7d Hisp. 0
8c Non-H 2
8d Hisp. 1
9c Non-H 1
9d Hisp. 1
10c Non-H 4
10d Hisp. 2
Totals:
143504
143506
143508
143509
143512
143513
143515
143519
143525
Race & Ethnicity by row/category American Indian / Alaskan Black / Afr. Amer. Native Amer / Black
Asian
Hawaiian
White
Indian / White
Asian/White
Black / White
Other
Client ID
1a Non-H
1b Hisp. 1
2a Non-H 1
2b Hisp. 0
3a Non-H 7
3b Hisp. 4
4a Non-H 1
4b Hisp. 0
5a Non-H 9
5b Hisp. 0
6c Non-H 1
6d Hisp. 1
7c Non-H 1
7d Hisp. 0
8c Non-H 2
8d Hisp. 1
9c Non-H 1
9d Hisp. 1
10c Non-H 4
10d Hisp. 2
Totals:
143530
143531
143532
143886
143891
143892
143893
143895
144858
Race & Ethnicity by row/category American Indian / Alaskan Black / Afr. Amer. Native Amer / Black
Asian
Hawaiian
White
Indian / White
Asian/White
Black / White
Other
Client ID
1a Non-H
1b Hisp. 1
2a Non-H 1
2b Hisp. 0
3a Non-H 7
3b Hisp. 4
4a Non-H 1
4b Hisp. 0
5a Non-H 9
5b Hisp. 0
6c Non-H 1
6d Hisp. 1
7c Non-H 1
7d Hisp. 0
8c Non-H 2
8d Hisp. 1
9c Non-H 1
9d Hisp. 1
10c Non-H 4
10d Hisp. 2
Totals:
144859
144860 29
Race & Ethnicity by row/category American Indian / Alaskan Black / Afr. Amer. American Indian / White Black Afr. Amer. / White American Indian / Black
Asian
Hawaiian
White
Asian / White
Other
Client ID
1a Non-H
1b Hisp. 0
2a Non-H 0
2b Hisp. 0
3a Non-H 1
3b Hisp. 0
4a Non-H 0
4b Hisp. 0
5a Non-H 0
5b Hisp. 0
6c Non-H 0
6d Hisp. 0
7c Non-H 0
7d Hisp. 0
8c Non-H 1
8d Hisp. 1
9c Non-H 0
9d Hisp. 0
10c Non-H 1
10d Hisp. 0
Totals:
138820
143887
143896 3
1. Performance and Expenditure Information by Activity Type Housing Development (Construction and Stewardship of [1] HOPWA Assistance Outputs: Facility-Based Housing) Households 1. Tenant-Based Rental Assistance 4 2a. Permanent Housing Facilities: Received Operating Subsidies/Leased units 2b. Households in transitional/short-term facilities that receive operating subsidies 3a. Permanent Housing Facilities: Capital Development Projects placed in service during the operating year 3b. Transitional/Short-term Facilities: Capital Development Projects placed in service during the operating year 4. Short-term Rent, Mortgage, and Utility Assistance 5. Permanent Housing Placement Services 6. Adjustment for duplication (subtract) 7. TOTAL Housing Assistance Recieved NO HOPWA housing assistance 8. Facility-Based units being developed with capital funding but not yet opened (identify units of housing planned) 9. Stewardship units subject to 3- or 10year use periods 10. TOTAL Housing Development ERROR: Housing Assistance Type is NULL
2 5 0 0 15 6
Not Provided by HMIS Not Provided by HMIS Not Provided by HMIS Not Provided by HMIS Not Provided by HMIS
Not Provided by HMIS Not Provided by HMIS Not Provided by HMIS Not Provided by HMIS Not Provided by HMIS Not Provided by HMIS 0
Supportive Services 11a. Supportive Services provided by project sponsors also delivering HOPWA housing assistance (as reported in Part 5 D, 1a) 11b. Supportive Services provided by project sponsors serving households who have other housing arrangements (as reported in Part 5, D, 1b) 12. Adjustment for duplication (subtract) 13. TOTAL Supportive Services
15
Not Provided by HMIS Not Provided by HMIS Not Provided by HMIS [2] Outputs: Amount of HOPWA Funds Expended Not Provided by HMIS Not Provided by HMIS [2] Amount of HOPWA Funds Expended Not Provided by HMIS
Housing Information Services 14. Housing Information Services 16. TOTAL Housing Placement Assistance Grant Administration and Other Activities 17. Resource Identification to establish, coordinate and develop housing assistance resources 18. Technical Assistance (if approved in grant agreement) 19. Project Outcomes/Program Evaluation (if approved in grant agreement) 20. Grantee Administration (maximum 3% of total of HOPWA grant) 21. Project Sponsor Administration (maximum 7% of portion of HOPWA grant awarded) 22. Other Activity (if approved in grant agreement). Specify: 23. TOTAL Grant Administration and Other Activities Total Expended 24. TOTAL Expenditures (Sum of Rows 6, 9, 12, 16 & 23)
Not Provided by HMIS Not Provided by HMIS Not Provided by HMIS Not Provided by HMIS Not Provided by HMIS [2] Amount of HOPWA Funds Expended Not Provided by HMIS
Part 4: Section 1
Section 1. Housing Stability: Assessment of Client Outcomes on Maintaining Housing Stability (Permanent Housing and Facilities)
In Column [1], report by type the total number of households that received HOPWA housing subsidy assistance. In Column [2], enter the number of households continuing to access each type of HOPWA housing subsidy assistance into the following year. In Column [3], report the housing status of all households that exited the program. Note: Refer to the destination codes that appear in Part 6: Appendix: Worksheet on Determining HOPWA Outcomes and Connections with HMIS. A. Permanent Housing Assistance [A] Permanent Housing Assistance [1] Total Number of Households Receiving Housing Assistance [2] Assessment: Number of Households Continuing with this Housing (per plan or expectation for next year) Missing "Plan or Expectati on" [3] Assessment: Number of Exited Households and Housing Status [4] HOPWA Client Outcomes
1 Emergency Shelter/Streets
0 0 0 0 0 0 0 0 0
4 Other HOPWA 5 Other Subsidy 6 Institution 7 Jail/Prison 8 Disconnected/Unknown 9 Death 1 Emergency Shelter/Streets
Unstable Arrangements Life Event Unstable Arrangements Temporarily Stable, with Reduced Risk of Homelessness
2 Temporary Housing
0 0 0 0 1 0 0 0
3 Private Housing
0 0 1 0 0 1 0 0
Part 4: Section 2. Prevention of Homelessness: Assessment of Client Outcomes on reduced risks of homelessness (Short-Term Housing Assistance)
Maintain private housing without subsidy (e.g. Assistance provided/completed and client is stable, not likely to seek additional support) Other Private Housing without subsidy Other HOPWA support (PH) Other housing subsidy (PH) Institution (e.g. residential and long-term care) Likely to maintain current housing arrangements, with additional STRMU assistance Transitional Facilities/Short-term (e.g. temporary or transitional arrangement) Temporary/Non-Permanent Housing arrangement (e.g. gave up lease, and moved in with family or friends but expects to live there less than 90 days) Emergency Shelter/street Jail/Prison Disconnected Death Still Enrolled
0 0
Stable/Permanent Housing (PH)
0 0 1 0 1
Temporarily Stable, with Reduced Risk of Homelessness
0 0 0 0 1 2
Life Event Still Ongoing (No Outcome) Unstable Arrangements
1a. Total number of those households that received STRMU Assistance in the prior operating year, that received STRMU assistance in the current operating year 1b. Total number of those households that received STRMU Assistance in the two (2 years ago) prior operating years, that received STRMU assistance in the current operating year
Group ID 126761
Likely to maint. current housing w/add. STRMU
Exit Date
Plans to continue ?
143886
73434
3/1/10
Yes
Still Enrolled
Still Enrolled
No
Group ID 126764
Likely to maint. current housing w/add. STRMU
Exit Date
Plans to continue ?
143891
73435
2/1/10
Yes
Still Enrolled
Still Enrolled
No
Group ID 126769
Likely to maint. current housing w/add. STRMU
Exit Date
Plans to continue ?
143895
73436
4/1/10
Yes
Still Enrolled
Still Enrolled
No
Exit Date
Housing Assistance Type Short-term Rent, Mortgage, and Utility Assistance (STRMU) Permanent housing facilities developed with capital funds, and placed in service during the operatin
HUD Exit Destination Foster care home or foster care group home (HUD)
Plans to continue ?
138819
12/21/10
12/21/10
Yes
138824
4/21/09
10/1/10
Yes
143453
2/17/10
Yes
Still Enrolled
Still Enrolled
Yes
143466
3/1/10
Yes
Still Enrolled
Still Enrolled
Yes
143503
6/15/08
Yes
Still Enrolled
Still Enrolled
Yes
143504
10/15/09
Yes
Still Enrolled
Still Enrolled
No
Exit Date
Housing Assistance Type Short-term Rent, Mortgage, and Utility Assistance (STRMU) Transitional/short-term facilities developed with capital funds, and placed in service during the op Transitional/short-term facilities that receive operating subsidies Permanent housing facilities developed with capital funds, and placed in service during the operatin
Plans to continue ?
143506
11/3/09
10/1/10
Yes
Deceased (HUD)
Yes
143508
12/1/09
Yes
Still Enrolled
Still Enrolled
No
143509
1/1/10
Yes
Still Enrolled
Still Enrolled
No
143512
2/1/10
Yes
Still Enrolled
Still Enrolled
No
143515
5/1/10
Yes
Still Enrolled
Still Enrolled
No
143519
7/1/10
10/30/10
Yes
Short-term Rent, Mortgage, and Utility Assistance (STRMU) Transitional/short-term facilities developed with capital funds, and placed in service during the op
No
143525
2/17/10
10/1/10
Yes
Other (HUD)
No
Yes
Exit Date
Plans to continue ?
143530
12/1/09
10/1/10
Yes
No
143531
10/31/10
Yes
Still Enrolled
Still Enrolled
No
144858
9/30/10
Yes
Still Enrolled
Still Enrolled
Yes
144859
1/1/10
Yes
Still Enrolled
Still Enrolled
Yes
144860
2/1/10
Yes
Still Enrolled
Still Enrolled
Yes
Client ID
Entry Date
Exit Date
132472
11/4/09
1/3/11
138819
12/21/10
12/21/10
138822
4/21/09
138824
4/21/09
10/1/10
143453
2/17/10
143454
11/2/09
143466
3/1/10
143503
6/15/08
Housing Assistance Type lities that receive operating Permanent housing facisubsidies/lease d units Short-term Rent, Mortgage, and Utility Assistance (STRMU) lities that receive operating Permanent housing facisubsidies/lease d units Permanent housing facilities developed with capital funds, and placed in service during the operatin Tenant-Based Rental Assistance (TBRA) lities that receive operating Permanent housing facisubsidies/lease d units Tenant-Based Rental Assistance (TBRA) Tenant-Based Rental Assistance (TBRA)
Obtained Employment
Yes
No
No
Yes
Yes
No
Yes
Yes
Yes
Yes
Yes
No
Yes
Yes
No
Yes
Yes
No
Yes
No
Yes
No
No
No
No
No
No
Yes
Client ID
Entry Date
Exit Date
143506
11/3/09
10/1/10
143508
12/1/09
143509
1/1/10
143512
2/1/10
143513
4/1/10
143515
5/1/10
143519
7/1/10
10/30/10
143525
2/17/10
10/1/10
Housing Assistance Type Short-term Rent, Mortgage, and Utility Assistance (STRMU) Transitional/short-t erm facilities developed with capital funds, and placed in service during the op Transitional/short-t erm facilities that receive operating subsidies Permanent housing facilities developed with capital funds, and placed in service during the operatin lities that receive operating Permanent housing facisubsidies/lease d units Tenant-Based Rental Assistance (TBRA) Short-term Rent, Mortgage, and Utility Assistance (STRMU) Transitional/short-t erm facilities developed with capital funds, and placed in service during the op
Obtained Employment
Yes
No
No
No
No
No
No
No
Client ID
Entry Date
Exit Date
143530
12/1/09
10/1/10
143532
9/1/10
10/1/10
144858
9/30/10
144860
2/1/10
Housing Assistance Type Transitional/short-t erm facilities that receive operating subsidies lities that receive operating Permanent housing facisubsidies/lease d units Short-term Rent, Mortgage, and Utility Assistance (STRMU) Short-term Rent, Mortgage, and Utility Assistance (STRMU)
Obtained Employment
No
No
No
No
Part 4: Section 3. Access to Care and Support: Assessment of Client Outcomes on Access to Care and Support
a. Housing Subsidy Assistance (duplicated)- TBRA, STRMU, PHP, Facility-Based Housing, and Master Leasing b. Case Management c. Adjustment for duplication (subtraction) d. Total Households Served by Project Sponsors/Subrecipients with HOPWA Housing Subsidy Assistance (Sum of Rows a. & b. minus Row c.) 2. For Project Sponsors/Subrecipients did NOT provide HOPWA Housing Subsidy Assistance: Identify the total number of households that received the following HOPWA-funded services: a. Case Management b. Total Households Served by Project Sponsors/Subrecipients without Housing Subsidy Assistance
21 1 0 6
1 6
Part 4: Section 3 Access to Care and Support: Assessment of Client Outcomes on Access to Care and Support 1b. Status of Households Accessing Care and Support
[1] For project sponsors/subrecipients that provided HOPWA housing subsidy assistance, identify the households who demonstrated the following:
4
[2] For project sponsors/subrecipient s that did NOT provide housing subsidy assistance, identify the households who demonstrated the following:
0
Outcome Indicator
1. Has a housing plan for maintaining or establishing stable on-going housing 2. Has contact with case manager/benefits counselor consistent with the schedule specified in clients individual service plan. 3. Had contact with a primary health care provider consistent with the schedule specified in clients individual service plan. 4. Has accessed and can maintain medical insurance/assistance. 5. Successfully accessed or maintained qualification for sources of income.
Support for Stable Housing Access to Support Access to Health Care Access to Health Care Sources of Income
2 2 4 3
0 0 0 0
1C. Number of Households Obtaining Employment [2] For project sponsors/subrecipient that did NOT provide HOPWA housing subsidy assistance, identify the households who demonstrated the following:
[1 For project sponsors/subrecipients that provided HOPWA housing subsidy assistance, identify the households who demonstrated the following:
Client ID
Entry Date
Exit Date
143504
10/15/09
143531
10/31/10
143886
3/1/10
143891
2/1/10
143895
4/1/10
144859
1/1/10
Housing Assistance Type Receiving NO HOPWA housing assistance Receiving NO HOPWA housing assistance Receiving NO HOPWA housing assistance Receiving NO HOPWA housing assistance Receiving NO HOPWA housing assistance Receiving NO HOPWA housing assistance
Obtained Employment
Yes
No
No
No
No
No
Part 5: Summary of Each Project Sponsor(s)/Subrecipient(s) Information B. Rental Assistance, Short-Term Rent, Mortgage and Utility Assistance Programs, and Permanent Housing Placement Assistance
1. Rental Assistance (RA) Enter the total number of households served in Column [1] and the amount of HOPWA funds expended Column [2] by the project sponsor/subrecipient on RA. [2] Output: Total HOPWA Funds [1] Output: Number of Expended during Operating Year HOPWA Housing Subsidy Assistance Category: RA Households Served by Project Sponsor/Subrecipient a. Tenant-based rental assistance (TBRA) Other Rental Assistance (RA) Programs (if approved in grant agreement) Direct program delivery costs (e.g., program staff time) TOTAL Rental Housing Assistance (For Column [1] sum of Row a. & Row b., for Column [2] sum of rows a. c.) 4 Not Provided by HMIS
b. c.
d.
2. Short-Term Rent, Mortgage and Utility Assistance (STRMU) [1] Output: Number of Households Served 5 [2] Output: Total HOPWA Funds Expended on STRMU during Operating Year Not Provided by HMIS
Housing Subsidy Assistance Categories (STRMU) a. Total Short-term mortgage, rent and/or utility (STRMU) assistance Of the total STRMU reported on Row a, total who received assistance with mortgage costs ONLY. Of the total STRMU reported on Row a, total who received assistance with mortgage and utility costs. Of the total STRMU reported on Row a, total who received assistance with rental costs ONLY. Of the total STRMU reported on Row a, total who received assistance with rental and utility costs. Of the total STRMU reported on Row a, total who received assistance with utility costs ONLY. Direct program delivery costs (e.g., program operations staff)
b.
c.
d.
e.
f. g.
3. Permanent Housing Placement Services [2] Output: Total HOPWA Funds Expended on STRMU during Operating Year Not Provided by HMIS
[1] Output: Number of ing Subsidy Assistance Category: Permanent Housing Placement Assistance Served Households a. Permanent Housing Placement Services Direct program delivery costs (e.g., program staff time) TOTAL Permanent Housing Placement Services (Sum of Rows a. and b.) 0
b. c.
0 0 1 0 1 1 1 3
Not Provided by HMIS Not Provided by HMIS Not Provided by HMIS Not Provided by HMIS Not Provided by HMIS Not Provided by HMIS Not Provided by HMIS Not Provided by HMIS
15. 16.
17
Transportation BT Other Activity (if approved in grant agreement). See Table 2.1 below for total & breakdown Sub-Total Households receiving Supportive Services (Sum of Rows 1-14) Adjustment for Duplication (subtract) TOTAL Households receiving Supportive Services (unduplicated)
13 # Households Receiving HOPWA Categories Number of Households Receiving HOPWA Assistance Assistance 0 0 0 0
Table 2.1: OTHER Supportive Services Total: Service Name Clowning Clubs Real Estate Auctions Synchronized Swimming AIRS Code PS-8200.1350-150 BH-6820 PL-7000.8830 3 Number of Households Receiving HOPWA Assistance 1 1 1
3 9 Stable/Permanent Housing
1 1
0 0
Unstable Arrangements
Life Event
3 12
1 1
0 1
1 1
# of Individuals in Beds 17
Client Info Client ID 132472 138819 138820 138821 138822 138824 143453 143454 143466 143503 143504 143506 143508 143509 143512 143513 143515 143519 143525 143530 143531 143532 143886 143887 143891 55 32 49 24 27 51 48 23 33 30 40 39 27 21 24 48 20 64 24 22 29 Age at Entry 49
Household Info HoH No No Yes No No No No No No No No No No No No No No No No No No No Yes No Yes 126761 126761 126764 HH of 1 HH of 1 HH of 1 HH of 1 HH of 1 HH of 1 122581 122581 Group ID
Program Stay Entry Date 11/4/09 12/21/10 12/21/09 12/21/09 4/21/09 4/21/09 2/17/10 11/2/09 3/1/10 6/15/08 10/15/09 11/3/09 12/1/09 1/1/10 2/1/10 4/1/10 5/1/10 7/1/10 2/17/10 12/1/09 10/31/10 9/1/10 3/1/10 3/1/10 2/1/10 Exit Date 1/3/11 12/21/10 12/1/10 12/1/10 Ongoing 10/1/10 Ongoing Ongoing Ongoing Ongoing Ongoing 10/1/10 Ongoing Ongoing Ongoing Ongoing Ongoing 10/30/10 10/1/10 10/1/10 Ongoing 10/1/10 Ongoing Ongoing Ongoing
Program LOS (Days) 969 557 922 922 1,166 1,166 864 971 852 1,476 989 970 942 911 880 821 791 730 864 942 608 668 852 852 880
Report Stay Entry 10/1/10 12/21/10 10/1/10 10/1/10 10/1/10 10/1/10 10/1/10 10/1/10 10/1/10 10/1/10 10/1/10 10/1/10 10/1/10 10/1/10 10/1/10 10/1/10 10/1/10 10/1/10 10/1/10 10/1/10 10/31/10 10/1/10 10/1/10 10/1/10 10/1/10 Exit 1/3/11 12/21/10 12/1/10 12/1/10 6/30/12 10/1/10 6/30/12 6/30/12 6/30/12 6/30/12 6/30/12 10/1/10 6/30/12 6/30/12 6/30/12 6/30/12 6/30/12 10/30/10 10/1/10 10/1/10 6/30/12 10/1/10 6/30/12 6/30/12 6/30/12
Report LOS (Days) 94 0 61 61 639 0 639 639 639 639 639 0 639 639 639 639 639 29 0 0 609 0 639 639 639