Homeless Management Information System …\Docs2\HMIS\Broward CoC PPManual v9.docx Homeless...

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U:\Docs2\HMIS\Broward CoC PPManual v9.docx

Homeless Management Information System (HMIS)

Policies and Procedures

Broward County Continuum of Care (CoC)

September 2012 Version IV

U:\Docs2\HMIS\Broward CoC PPManual v9 revision history.docx

Revision History

Date Author Description

1/04/2012 Jeremiah Smith, et al First draft distributed

1/25/2012 Jeremiah Smith, et al First draft distributed and discussed

3/07/2012 Jeremiah Smith, et al Second/Third draft distributed and discussed

4/04/2012 Jeremiah Smith, et al Fourth draft distributed and discussed

5/02/2012 Jeremiah Smith, et al Fifth draft distributed and finalized

7/02/2012 Jeremiah Smith, et al Sixth draft distributed and finalized

9/05/2012 Jeremiah Smith, et al Seventh draft distributed and finalized

9/28/2012 Jeremiah Smith, et al Manual approved by HIP Board; Eighth version reflects minor

revisions (consent v. acknowledgment)

5/01/2013 HMIS Data Committee

Chair: Don Cotton

Ninth version reflects revisions to:

“Term and Structure” under “HMIS Governing Committee

Mandate” (p. 2); and

I. Roles & Responsibilities, e. HMIS Data Committee (p. 4)

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Broward County CoC

HMIS Data Committee

HMIS Governing Committee Mandate

Description: This committee mandate establishes a committee to “support, encourage, and

oversee the HMIS.”

Purpose: To guide the planning and implementation of a community-wide Homeless

Management Information System for the Broward County Continuum of Care.

Mandate: In the tradition of the Continuum of Care process, a joint planning committee has

been established. Broward County’s Homeless Initiative Partnership (HIP) is the lead agency in

implementing and operating the HMIS project and received Continuum-wide support to apply

for a HUD grant to fund the project. A leadership team including representatives from major

homeless service providers and stakeholders, the City of Fort Lauderdale and Broward County

are working together to support, encourage and oversee the HMIS system across the Broward

County Continuum of Care.

Work of the committee includes: 1. Planning, decision-making, evaluation and facilitation for the implementation of the HMIS.

2. Coordination and gathering of incentives, resources, and leverages available to assist

programs with participation.

3. Coordination of system administration and data aggregation issues.

4. Determination of the long-term policy and procedures for the system.

5. Recommendation about the software application, data elements to be collected, and intervals

for data gathering.

6. Consideration of a community-wide centralized intake process.

7. Encouragement and research to support the lead agency in linking the HMIS with other

community databases.

8. Supporting the rights and privacy of the homeless in determining policy and procedures

development.

Meetings: The committee meets monthly or as needed, with work group meetings throughout

the month. Work groups are chosen as necessary and may consult with additional agencies and

resources in the community.

Term and Structure: The HMIS Data Committee (sub-committee to HIP) will serve as an

advisory board and make recommendations to the CoC’s Homeless Providers and Stakeholders

Council and the Homeless Initiative Partnership Board. The committee chair shall be a member

of the HIP Board. Participating members of the CoC’s Homeless Providers and Stakeholders

Council have been specifically asked to send representatives to the committee.

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Introduction

The United States Department of Housing and Urban Development (HUD) requires all

homeless services grantees and sub-grantees to participate in a localized Homeless Management

Information System (HMIS). This policy is consistent with the Congressional Direction for

communities to provide data to HUD on the extent and nature of homelessness and the

effectiveness of its service delivery system in preventing and ending homelessness. The HMIS

and its operating policies and procedures are structured to comply with HUD’s 2004 HMIS Data

and Technical Standards (Revised March 2010) that allow for the collection of standardized

client and program-level data on homeless service usage among programs within a community

and across all communities. The 2004 and 2010 revision of the HMIS Standards ensure that

every HMIS captures the information necessary to fulfill HUD reporting requirements while

protecting the privacy and informational security of all persons experiencing homelessness.

Recognizing that the Health Insurance Portability and Accountability Act (HIPAA) and other

Federal, State and local laws may further regulate agencies, the Broward County Continuum of

Care (CoC) may negotiate its procedures and/or execute appropriate business agreements with

Covered Homeless Organizations (CHO) so they are in compliance with all applicable laws.

The Broward County CoC HMIS project is a collaboration between the Homeless

Initiative Partnership (HIP) and CHO’s. A CHO is any organization (including its employees,

volunteers, affiliates, contractors, and associates) that record, use or processes any Protected

Personal Information (PPI) of homeless clients for an HMIS. According to HUD, PPI is defined

as ”any information maintained by a CHO about a living homeless client or homeless individual

that: (1) identifies, either directly or indirectly, a specific individual; (2) can be manipulated by a

reasonably foreseeable method to identify a specific individual; or (3) can be linked with other

available information to identify a specific individual.”

The CoC has recommended that all homeless service providers take part in HMIS,

regardless of funding source. However, participation in HMIS is mandated for all county and/or

HUD funded CHOs. HMIS will enable homeless service providers to collect uniform client

information over time. This system is part of an essential effort to streamline client services and

informed public policy while homeless clients benefit from improved coordination in and

between agencies, informed advocacy efforts, and policies that result in targeted services.

Analysis of information gathered through HMIS is critical to accurately calculate the size,

characteristics, and needs of homeless populations; the data is necessary to service and systems

planning, and advocacy. CHOs share a common interest in serving the homeless population,

those at risk of homelessness, with the ultimate goal of reducing and eventually ending

homelessness in Broward County. The purpose of this manual is to outline the agreements

reached for the implementation, maintenance, coordination, and operation of the HMIS.

Participation Requirements:

Mandatory Participation:

All agencies that are funded to provide homeless services by HUD (pass through and non-pass

through grants), Broward County, and/or the State must meet the minimum HMIS participation

standards as defined by this Policy and Procedure manual pursuant to their respective funders’

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requirements. These participating agencies will be required to comply with all applicable

operating procedures and must agree to execute and comply with an HMIS CHO Memorandum

of Understanding (MOU1).

Voluntary Participation:

Although funded agencies are required to participate in HMIS, the Broward County CoC

strongly encourages all providers of services to persons experiencing homelessness, or at risk of

homelessness, to participate in the HMIS. The CoC will work closely with non-funded agencies

to articulate the benefits of the HMIS and to strongly encourage their participation in order to

achieve a comprehensive and accurate understanding of homelessness in Broward County.

I. Roles and Responsibilities

a. Project Management: The Broward County Board of County Commissioners

Homeless Initiative Partnership (HIP Board) is responsible for the HMIS under the

direction of the Broward County Community Partnerships Division, Homeless

Initiative Partnership Section (HIP Section), HMIS Project Manager and HMIS Data

Committee.

b. Project Staffing: The HMIS Project Manager has primary responsibility for

coordination and administration of the HMIS and reports to the HIP Section

Administrator. The HMIS Project Manager will be assisted in accomplishing CoC

HMIS goals through support from the HMIS Data Committee.

c. CHO: Any organization (including its employees, volunteers, affiliates, contractors,

and associates) that record, use or processes any Protected Personal Information (PPI)

of homeless clients for an HMIS.

d. Project Agency Contact Person: Each CHO will designate an HMIS Security Officer2

to serve as primary contact between the HMIS Project Manager and the CHO, and

each HMIS Security Officer must have a valid email address with the CHO. Each

CHO should choose its HMIS Security Officer and send that person’s name and

contact information to the HMIS Project Manager. Changes to that information

should be promptly reported to the HMIS Project Manager.

e. HMIS Data Committee: Each CHO is advised to contribute at least one HMIS End

User and/or Security Officer to participate in the HMIS Data Committee. The Data

Committee works with the HMIS Project Manager to advise the CoC HMIS

operations, policies and procedures, and provide feedback on a regular basis. The

Data Committee Chairperson is responsible for conducting and organizing regular

meetings and making regular committee reports to the CoC Homeless Providers and

Stakeholders Committee and the HIP Board.

1 Attachment I – Memorandum of Understanding

2 Attachment II – Security Officer Agreement

4


f. HMIS End Users: In addition to an HMIS Security Officer, CHOs may designate

other individuals to access the system, End Users. The HMIS Project Manager will

work with CHOs to determine the appropriate User Access Level designation for each

End User3. There is no upper limit to the number of End Users each CHO may

authorize, but the HIP may assess participation fees to recover the cost of licenses

beyond that of the HMIS Security Officer. All End Users, including HMIS Security

Officer must complete an End User or Security Officer agreement with the HMIS

Project Manager on an annual basis. End User accounts with expired End User

Agreements may be locked or removed to maintain the security, confidentiality, and

integrity of the system.

g. Communication: General communications from the HMIS Project Manager will be

directed toward a CHO’s HMIS Security Officer. Specific communications will be

addressed to the person or people involved. The HMIS Project Manager will be

available via email, phone, and U.S. mail. The HMIS Data Committee will also

distribute HMIS information to members of the CoC and HIP Board. Participating

CHOs are responsible for communicating needs, questions, and concerns regarding

the HMIS directly to the HMIS Project Manager. Questions and concerns regarding

Broward County CoC HMIS Policies and Procedures, Data Standards, Client

Consent/Revocation, or User Agreements should be directed to the HMIS Project

Manager.

h. System Availability: The Broward County CoC will provide a highly reliable

database environment and will inform HMIS Security Officers and End Users in

advance of any planned interruption in service. Whenever possible, if the database

server is unavailable due to disaster or routine maintenance, HMIS Project Manager

will inform Security Officers and End Users of the cause and duration of the

interruption in service. The HMIS Project Manager will log all downtime for

purposes of system evaluation.

i. Client Confidentiality4: Broward County CoC, HMIS Project Manager, and CHOs

will strive to ensure and safeguard the confidentiality of all client data. No

identifiable client data will be shared among CHOs within the HMIS without client

acknowledgment (written or verbal), and no identifiable client data will be shared

outside of the limits of that consent. Only individuals authorized to view or edit

individual data will have access to that data.

j. Client Grievances: Clients will contact the CHO with which they have a grievance for

resolution of HMIS problems. CHOs will provide a copy of the Broward County

HMIS Policies and Procedures Manual upon request, and respond to client issues.

CHOs will send written notice to the HMIS Project Manager of any HMIS-related

client grievance. The HMIS Project Manager will record all grievances and will

report these complaints to the HMIS Data Committee for review.

3 Attachment III – User Agreement

4 Attachment IV – Acknowledgment of Electronic Data Collection

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II. Security and Access

a. End User Accounts: The HMIS Project Manager will provide an End User

Account username and initial password to each authorized End User. End User

Accounts are assigned on a per-person basis, rather than to a particular position or

role. End User Accounts are not to be exchanged, shared, or transferred between

personnel at any time. Sharing of End User Accounts is a breach of these Policies

and Procedures and a violation of the MOU. Under no circumstances shall a CHO

demand that an End User hand over his or her username and password. CHOs

shall inform the HMIS Project Manager of any changes in personnel or other

requests to revoke or transfer accounts. Non-compliance may result in suspension

of HMIS privileges.

b. End User Inactivity: End Users who have not logged into the system in the

previous 90 days will be flagged as inactive. Inactive End Users may have their

HMIS accounts locked or removed to maintain the security, confidentiality, and

integrity of the system. HMIS Project Manager will inquire with CHO HMIS

Security Officer about an Inactive End User account prior to any decision to

remove account.

c. Passwords: End User Account passwords must be changed every 90 days; every

90 days, the system will automatically prompt each End User to change his or her

password. End Users may keep passwords written down in and stored in a purse,

wallet, or other container kept on their person. Passwords should never be written

on any item left in their office, desk, or other workspace, and passwords should

never be in view of any other person.

d. Connectivity and Computer Systems: CHOs will connect to HMIS independently

via the internet and are responsible for providing their own internet connectivity

and computer systems sufficient for doing so. The Broward County HMIS Data

Committee or Project Manager may provide consultation or advice in securing

sufficient internet connectivity and computer systems. The Broward County

HMIS provides technical support to CHOs solely for HMIS.

e. Workstation Security: At a minimum, the primary workstation used by each End

User to log in to HMIS should be configured to meet the following best practices:

i. Password-protected log on for the workstation itself;

ii. Password-protected (aka locked) screensaver after five minutes or more of

inactivity;

iii. Operating system updated with manufacturer’s latest patches at least

weekly;

iv. Ports firewalled; and

v. Systems scanned at least weekly for viruses and malware.

The Broward County HMIS may provide some recommendations or advise in

pursuing these best practices, but proper workstation configuration remains the

responsibility of each CHO.

6


f. Local Data Storage and Transfer: CHO HMIS End Users and/or Security Officers

are responsible for maintaining the security and confidentiality of any client-level

data extracted from the database and stored locally, including all data used in

internal reporting. No identifiable client-level data is to be transmitted unless it is

properly protected. Security questions should be addressed to the HMIS Data

Committee and/or HMIS Project Manager.

g. Remote System Access: CHO HMIS End Users and/or Security Officers must

abide by these Policies and Procedures and ensure the security and confidentiality

of client data regardless of the computer used to log in to the system. For this

reason, End Users are strongly cautioned against extracting and storing personally

identifiable client information on their personal computers and internet devices.

h. Training: The HMIS Project Manager will coordinate adequate and timely HMIS

training for all End Users prior to issuing an End User Account. Additionally, the

HMIS Project Manager will post training aids, reference material, and other

support on the HIP website. The HMIS Data Committee will assist in the

development and distribution of End User aids, reference material, and other

supports, including “train the trainer” curricula.

III. Data Collection and Entry

a. Standard Data Collection: CHOs will collect a required set of common data

variables for each client. These common data elements will meet standards for

HUD Universal Data Element5 (UDE) collection and Program-Specific Data

Element6 (PDE) collection.

i. Client Identifiers include Name, Date of Birth, Social Security Number,

and Gender.

ii. Universal Data Elements (UDE’s) include all Client Identifiers, Race,

Ethnicity, Veteran Status, Disabling Condition, Residence Prior to

Program Entry, Last Permanent ZIP Code, Housing Status, Household

Membership, Program Entry Date, and Program Exit Date (if applicable).

iii. Program-Specific Data Elements (PDE’s) include Income Amounts &

Sources, Non-Cash Benefit Amounts & Sources, Physical Disability,

Developmental Disability, Chronic Health Condition, HIV/AIDS

Diagnosis, Mental Health Condition, Substance Abuse, and Domestic

Violence, Reason for Leaving (if applicable), and Destination (if

applicable).

iv. Service and Shelter Records include an AIRS Taxonomy Code, Start and

End Dates, Bed Assignment (if applicable), Amount or Units of

Assistance (if applicable), HPRP Assistance Category (if applicable),

5 Attachment V – UDE Quick View October 2011rev

6 Attachment VI – UDE Quick View October 2011 Program Specific

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Funding Source (if applicable), and Current or Arrears Designation (if

applicable).

v. Extended Data are optional and include Case Notes, Goals, Action Steps,

Follow-Up Plans, Needs, Referrals, Self-Sufficiency Matrix

measurements, and Case Manager(s).

b. Client Acknowledgment for Electronic Data Collection: CHOs will collect and

retain signed acknowledgment forms before any client data will be entered into

the HMIS. In instances where a client gives verbal acknowledgment, CHO staff

will complete the form accordingly. CHO staff will thoroughly explain the

acknowledgment form to each client. HMIS Data Committee will provide a

standard Client Acknowledgment for Electronic Data Collection form to all

CHOs. If client acknowledgment is not obtained, the CHO will not be permitted

to share that client record with other agencies in the HMIS. Clients may, at any

time, revoke their consent.

c. Appropriate Data Collection: HMIS End Users will only collect client data

relevant to the delivery of services to people experiencing homelessness or a

housing crisis in Broward County. The HMIS Project Manager will periodically

audit pick-lists and agency-specific fields to ensure the database is being used

appropriately.

d. Data Element Customization: Data element customization will be provided as

needed, e.g. special projects such as preventive homeless projects in which the

HMIS database is used for this data collection. Data customization will only be

done after approval by the HMIS Data Committee and under the direction of the

HMIS Project Manager. NOTE: Fee may be required for extensive or specialized

programmatic changes. If fees are necessary, no work will be performed without

prior written authorization from the requesting agency.

IV. Quality Assurance

a. Commitment to Data Quality: CHOs are responsible for timely, accurate, and

complete entry of client-level data.

b. Universal Data Element Completion: The program’s percentage of “null/missing”

and “unknown/don’t know/refused” for all clients served will be no higher than

the percentages indicated in the chart below for the appropriate program type:

(THE REMAINDER OF THIS PAGE INTENTIONALLY LEFT BLANK)

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Universal Data Elements Standard (percentage no greater than)

Emergency Shelter

Transitional Housing

Permanent Housing

Services Only

Outreach Prevention Rapid Re-housing

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1. Name 0% 5% 0% 0% 0% 0% 0% 0% 15% 10% 0% 0% 0% 0%

2. Social Security Number (SSN) 0% 10% 0% 5% 0% 5% 0% 10% 15% 10% 0% 0% 0% 0%

3. Date of Birth 0% 10% 0% 1% 0% 1% 0% 10% 15% 10% 0% 0% 0% 0%

4. Race 0% 10% 0% 1% 0% 1% 0% 10% 15% 10% 0% 0% 0% 0%

5. Ethnicity 0% 15% 0% 10% 0% 10% 0% 15% 15% 10% 0% 0% 0% 0%

6. Gender 0% 5% 0% 5% 0% 5% 0% 5% 15% 10% 0% 0% 0% 0%

7. Veteran Status 0% 15% 0% 10% 0% 10% 0% 15% 15% 10% 0% 0% 0% 0%

8. Disabling Condition 0% 10% 0% 5% 0% 5% 0% 10% 15% 10% 0% 0% 0% 0%

9. Residence Prior to Program Entrance 0% 10% 0% 10% 0% 10% 0% 10% 15% 10% 0% 0% 0% 0%

10. Zip Code of Last Permanent Residence 0% 10% 0% 10% 0% 10% 0% 10% 15% 10% 0% 0% 0% 0%

11. Homeless Status 0% 10% 0% 10% 0% 10% 0% 10% 0% 0% 0% 0% 0% 0%

12. Program Entry Date 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0%

13. Program Exit Date 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0%

14. Personal Identifier (Unique ID) 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0%

15. Household Identifier 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0%

c. Program Specific Data Element Completion: The program’s percentage of

“null/missing” and “unknown/don’t know/refused” for all clients served will be

no higher than the percentages indicated in the chart below for the appropriate

program type. Highlighted data elements are required Program-specific data

elements for HUD programs:

Program-Specific Data Elements Standard (percentage no greater than)

Emergency Shelter

Transitional Housing

Permanent Housing

Services Only

Outreach Prevention Rapid

Rehousing

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1. Income and Sources 0% 10% 0% 5% 0% 5% 0% 5% N/A N/A 0% 0% 0% 0%

2. Non-Cash Benefits 0% 10% 5% 5% 5% 5% 5% 5% N/A N/A 0% 0% 0% 0%

3. Physical Disability 0% 10% 0% 5% 0% 5% 0% 5% 15% 10% 0% 0% 0% 0%

4. Develop-mental Disability 0% 10% 0% 5% 0% 5% 0% 10% 15% 10% 0% 0% 0% 0%

5. Chronic Health Condition 0% 10% 0% 5% 0% 5% 0% 10% 15% 10% 0% 0% 0% 0%

6. HIV/AIDS 0% 10% 0% 10% 0% 5% 0% 10% 15% 10% 0% 0% 0% 0%

7. Mental Health 0% 10% 0% 5% 0% 5% 0% 5% 15% 10% 0% 0% 0% 0%

8. Substance Abuse 0% 10% 0% 5% 0% 5% 0% 5% 15% 10% 0% 0% 0% 0%

9. Domestic Violence 0% 10% 5% 5% 5% 5% 5% 5% N/A N/A N/A N/A N/A N/A

10. Destination on Leaving 0% 10% 0% 5% 0% 5% 0% 5% N/A N/A 0% 0% 0% 0%

11. Date of Contact N/A N/A N/A N/A N/A N/A N/A N/A 0% 0% 0% 0% 0% 0%

12. Date of Engagement N/A N/A N/A N/A N/A N/A N/A N/A 0% 0% 0% 0% 0% 0%

13. Financial Assistance Provided N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 0% 0% 0% 0%

14. Housing Relocation and Stabilization Services Provided

N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 0% 0% 0% 0%

9


d. Data Integrity Recommendations and Support: To ensure high quality data and

ease in the generation of reports and analysis, the following data integrity

expectations and supports are encouraged:

i. All data for a given month should be completed by the sixth day of the

following month;

ii. HMIS Security Officer should provide a draft report to their CHO on the

seventh day, detailing Data Element Completion, Entry/Exit Record

Completion, Clients Served and Services Provided in the previous month;

iii. HMIS Project Manager will provide support to HMIS Security Officer as-

needed for corrections of the previous month’s data, and CHOs are

expected to make any corrections by the thirteenth day of the month; and

iv. HMIS Security Officer will provide a second report to their CHO (and

HMIS Project Manager if applicable) on the fourteenth day with updated

figures

V. Data Retrieval

a. CHOs: CHOs will have access to retrieve any client-level data entered by their

programs, other data as governed by the data sharing policies and procedures in

this manual, and by the signed Consent to Be Enrolled in HMIS.

b. Technology Director: The HMIS Project Manager will have access to retrieve all

data in the Broward County HMIS. The HMIS Project Manager will not access

individual client data for purposes other than maintenance, troubleshooting,

providing reports, and checking for data integrity.

c. HMIS Software Provider: The HMIS software provider will not access the system

except for purposes of software maintenance, troubleshooting, and data

conversion.

d. Client: Any client will have access to view, or keep a printed copy of, his or her

own records contained in the Broward County HMIS within a reasonable period

of time. The client will also have access to a logged audit trail of changes to those

records. No client shall have access to another client’s records in the Broward

County HMIS. e. Continuum of Care: The HMIS Data Committee and HMIS Project Manager will

provide de-identified and aggregate reports to the Continuum of Care as-needed

in support of its mission to prevent, reduce, and eliminate homelessness.

f. Public: Broward County HMIS, in consultation with the HMIS Data Committee,

will address all requests for data from entities other than CoC, CHOs or clients.

No client-level data will be provided to any party, even a client requesting their

own data, unless the CHO who entered the data is unable to satisfy the client’s

request. All requests from the public for HMIS reports must be made in writing

using the HMIS Report Request form7, which is provided on request. At the

request of the HIP Board the HMIS Project Manager will compile and publish

certain periodic reports for public consumption regarding homelessness and

7 Attachment VII – Report Request Form

10


housing issues in Broward County based on data available in HMIS. At no time

will published, publicly-available reports contain client-level or identifiable data.

g. Ethical Data Use: Data contained in the Broward County HMIS will only be used

to support the delivery of homeless and housing services in Broward County.

Each HMIS End User will affirm the principles of ethical data use and client

confidentiality contained in this Policies and Procedures Manual and the HMIS

CHO User Agreement.

h. Access to Core Database: No one will have direct access to the Broward County

HMIS database. Access is provided solely through the HMIS software. In contract

with Broward County HMIS the software provider will monitor access of the

database server and employ security methods to prevent unauthorized database

access.

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Attachment I

Memorandum of Understanding

between

Homeless Initiative Partnership

and

Covered Homeless Organization

This Memorandum of Understanding (MOU) is entered into this day of

, 2012 by and between the Broward County Homeless Initiative Partnership

(HIP) and , a Covered Homeless Organization (CHO).

I. Purpose This MOU addresses the joint responsibilities of HIP and the CHO for ongoing Homeless

Management Information Systems (HMIS) Activities. As the Broward County Continuum of

Care (CoC) HMIS Lead Agency, HIP is responsible for administering the HMIS on behalf of the

COC, including the implementation, project management, training, maintenance, help desk

support, and enhancement and upgrading of the software.

II. Background

The U. S. Department of Housing and Urban Development (HUD) requires all homeless

services grantees and sub-grantees to participate in a localized HMIS. The Broward County CoC

HMIS: a) provides a comprehensive system for collecting and disseminating information about

persons experiencing homelessness or at risk of homelessness; and b) is the homeless service

system in support of the CoC’s goal to prevent, reduce and ultimately eliminate homelessness.

This is accomplished by assisting homeless service providers in generating required reports, as

well as streamlining and consolidating the CoC’s HMIS data sharing, tracking and record-

keeping requirements.

III. HIP agrees to the following terms and conditions:

A. General

1. In consultation with the HMIS Data Committee, define the program, implement

its standards, promote awareness of the program to all interested parties, and

monitor the program’s successes and failures to validate its effectiveness.

2. HIP is the sole liaison with the software vendor; a CHO with questions

concerning software are to be directed to HMIS Project Manager only.

B. Network Operations

1. Develop, implement and maintain all components of operations of the web-based

system including the data security program.

2. Provide technical support to all CHOs.

3. Take all necessary precautions to prevent any destructive or malicious program

(virus) from being introduced to the system. Employ appropriate measures to

detect virus infection and employ all appropriate resources to efficiently remedy

any affected systems as quickly as possible.

4. HIP will notify CHOs of system failure, errors, or problems within a timely

manner.

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C. Security

1. Strictly safeguard all data including client-identifying information in accordance

with the latest technology as available and securely protect it to the maximum

extent possible.

2. Maintain and administer central and backup server operations including security

procedures and maintain backups of the system to prevent the loss of data.

3. Monitor access to all systems that could potentially reveal a violation of

information security protocols. Maintain and audit accurate logs of all changes

made to the information contained within the database.

4. Encrypt any client identifiable information stored on Broward County servers.

5. Issue all user IDs and passwords for HMIS users. User IDs and passwords will be

issued after the CHO HMIS end user has signed the CHO User Agreement form.

6. May deny access to HMIS for the purpose of investigating any suspicion of

breached confidentiality.

7. HIP will not release data to any person, agency, or organization that is not a CHO

without the client’s authorization, and following the CoC HMIS Policies and

Procedures Manual for the release of data.

D. Training

1. Provide and maintain ongoing training for new CHO users of the HMIS.

2. CHO understands that HIP will provide initial training and periodic updated

trainings to CHOs.

IV. The CHO agrees to the following terms and conditions:

A. General

1. Strictly adhere to all policies and procedures adopted in the HMIS Policies and

Procedures Manual.

2. Ensure that a CHO representative participates in HMIS Data Committee.

B. Confidentiality

1. Enforce network policies and procedures through agency level policies and

procedures.

2. Collect and maintain records of all required documentation in accordance with the

HMIS Policies and Procedures established by the HMIS Data Committee.

3. Abide by all modifications and amendments to the HMIS Policies and Procedures

Manual as decided upon by the HMIS Data Committee and approved by the CoC.

4. Abide by all federal and state laws, regulations, and with all HMIS Policies and

Procedures relating to the collection, storage, retrieval, dissemination of client

information, and in particular HUD HMIS Standards.

5. Abide by all HMIS sharing restrictions as defined by the client.

6. Not deny services to any clients solely because they decline to give authorization

for their information to be shared with other CHOs or entered into the integrated

HMIS database.

C. Network Operations

1. Maintain agency Internet connectivity and computer equipment in such a manner

as not to disrupt continuation of project participation.

13


2. Notify the HMIS Project Manager promptly of any difficulty with system

software, access to database or related problems; at no time will the CHO contact

the software vendor directly.

3. Take all necessary precautions to prevent any destructive or malicious program

(virus) from being introduced to the system. Employ appropriate measures to

detect virus infection and employ all appropriate resources to efficiently remedy

any affected systems as quickly as possible.

D. Data Entry

1. Collect all HUD mandatory data for consenting clients, and strive to collect

maximum data elements for all clients.

2. Enter data into the system as outlined in the HMIS Data Quality Standards.

3. Ensure the accuracy of information entered into the system. Any information

updates, errors, or inaccuracies that come to the attention of the CHO will be

corrected by the CHO. If necessary, HIP must be notified within five (5) business

days of any corrections that cannot be made by the CHO.

4. Develop program specific interview guidelines that are HMIS compliant, and

collect any additional elements the agency wishes to collect.

5. CHO Executive Director accepts responsibility for the validity of all records

entered by their agency. HIP reserves the right to deactivate all non-staff User IDs

if a non-staff member breaches confidentiality or security.

6. Ensure that CHO personnel do not knowingly enter erroneous information into

the HMIS.

7. Not include any profanity, offensive language, malicious information or

discriminatory comments based on race, ethnicity, religion, national origin,

disability, age, gender, or sexual orientation into the database.

8. Not transmit material in violation of any federal or state regulations, this includes

but is not limited to: copyrighted material, material legally judged to be

threatening or obscene, and material considered protected by trade secret.

E. Security

1. Limit HMIS access to authorized users and follow all protocols of monitoring

those users.

2. Provide HIP with the roles of all staff members who have access to HMIS. HIP

may deny access to the system for the purpose of investigation of any suspicion of

breached confidentiality.

3. CHO will ensure that all staff, and other persons issued a User ID and Password

to enter the system, sign and abide by CHO User Agreement.

4. Not transmit security information and network policies to non-members of the

HMIS in any manner.

5. Not release data to any person, agency, or organization that is not a CHO without

the client’s written authorization, and following procedures adopted by the HMIS

Data Committee referred to in the HMIS Policies and Procedures Manual for

release of data.

6. Develop an internal process for reporting to HIP the violation of any of the HMIS

information security protocols by all staff users.

7. Secure access to physical areas containing equipment, data, and software.

14


F. Training

1. Ensure all CHO HMIS users are properly trained in HMIS system, have received

confidentiality training, and are authorized to use the system in accordance with

the HMIS Policies and Procedures Manual.

2. Ensure that assigned CHO representative(s) regularly attend(s) HIP periodic

updated software and confidentiality trainings, and stay(s) current with the HMIS

Policies and Procedures Manual.

V. Term / Termination / Amendments

A. Term and Termination

This MOU is effective upon signature by both parties and shall remain in effect until

terminated. Each party shall have the right to terminate this agreement upon 45 days

prior written notice to the other party. Violation of any component will be handled

on a case by case basis.

B. Amendments

Amendments, including additions, deletions, or modifications to this MOU, may be

proposed in writing by either party for consideration of the HMIS Data Committee of

the Broward County CoC. If, after consultation with the HMIS Data Committee, both

parties agree to a revision, the HMIS Data Committee will amend this MOU, and

forward it to the CHO for signature.

C. Other

If this agreement is terminated, HMIS Data Committee and the remaining CHOs shall

retain their right to the use of all client data previously entered by the terminating

CHO. This use is subject to any restrictions requested by the client.

VI. Notices Any notices given under the provisions of this Agreement shall be in writing and shall be

hand-delivered, sent by Federal Express or other reputable overnight delivery service, or

sent by registered or certified mail, return receipt requested to the CHO’s authorized

signator and the HIP Administrator and/or HMIS Project Director. Notices shall be

deemed effective on the earliest date of receipt or five (5) working days after postmark.

Either party may designate from time to time an additional address for noticing purposes

under this provision by giving the other party ten (10) days written notice of same.

By signature below, both parties hereby agree with the terns and condition as set forth in

this MOU:

COVERED HOMELESS ORGANIZATION BROWARD COUNTY HOMELESS

(Name / Address) INITIATIVE PARTNERSHIP

115 South Andrews Avenue, Room A370

Fort Lauderdale, Florida 33301

Executive Director/CEO (Signature) / Date Administrator (Signature) / Date

_____________________________________ ____________________________________

Print Name Print Name

15


Attachment II



HMIS Covered Homeless Organization (CHO)

Security Officer Agreement

__________________________________ Broward County Continuum of Care

Agency Name Continuum of Care (CoC) Name

Each CHO will designate an HMIS Security Officer (“HMIS Security Officer”). This person

should be knowledgeable of all day-to-day case management operations and procedures and will

be responsible for ensuring compliance with applicable security standards. In addition to his or

her role as HMIS Security Officer, this person may have other assigned roles, such as case

manager, office manager, service coordinator or program director.

The HMSI Security Officer is the primary contact for all communication regarding the HMIS at

this agency. This person will be responsible for:

Ensuring compliance with applicable security standards.

Providing a point-of-communication between the end users and the HMIS Lead Agency

and staff regarding all HMIS-related issues.

Maintaining a reliable Internet connection for the HMIS and general communication with

other technical professionals.

Disseminating information regarding HMIS updates and providing the requisite training

to agency users.

Providing support on agency reports generated in HMIS.

Managing agency level HMIS user licenses.

Monitoring compliance with standards of client confidentiality and ethical data

collection, entry, and retrieval.

_______________________________________________________________

Designated HMIS Security Officer (PRINT full name) Date

______________________________________________________________

Email Address (PRINT clearly)

_______________________________________________________________

HMIS Security Officer Signature Date

________________________________________________________________

Executive Director/CEO Signature Date

16


Attachment III



Covered Homeless Organization (CHO) User Agreement

(Page 1 of 2)

CHO Agency Name_____________________________________________

Employee/User Name_______________________________________

HMIS is a collaborative project with participating homeless shelter and services providers in the

Broward County CoC. HMIS will enable homeless service providers to collect uniform client

information over time. This system is essential to efforts to streamline client services and inform

public policy. Analysis of information gathered through HMIS is critical to accurately calculate

the size, characteristics, and needs of the homeless population; these data are necessary to service

and systems planning.

The HMIS project recognizes the diverse needs and vulnerability of the homeless community.

HMIS’ goal is to improve the coordination of care for individuals and families in Broward

County. With this it is important that client confidentiality is vigilantly maintained treating the

personal data of our most vulnerable populations with respect and care.

As the holders of this personal data, Broward County CoC HMIS users have an ethical and legal

obligation to ensure that the data they collect is being collected, accessed and used appropriately.

It is also the responsibility of each user to ensure that client data is only used for the purposes as

outlined in the HMIS Policies and Procedures Manual.

The username and password provides you access to the HMIS system. Initial each item below to

indicate your understanding of the proper use of your username and password.

Then, sign where indicated.

Initial Only:

_______I have received training on how to use the HMIS.

_______I understand that my username and password are for my use only and must not be

shared with anyone. I must take all reasonable means to keep my password physically secure.

17


Attachment III



Covered Homeless Organization (CHO) User Agreement

(Page 2 of 2)

I understand that the only individuals who can view HMIS information are authorized users

and the clients to whom the information pertains.

I understand that I may only view, obtain, disclose, or use the database information that is

necessary to perform my job. If I am logged into the HMIS and must leave the work area

where the computer is located, I must log-off of the software before leaving the work area.

Failure to do so may result in a breach in client confidentiality and system security.

I understand that these rules apply to all users of HMIS, whatever their work role or position.

I understand that all HMIS information (hard copies and soft copies) must be kept secure and

confidential at all times and when no longer needed, they must be properly destroyed to

maintain confidentiality.

I understand that if I notice or suspect a security breach within the HMIS, I must immediately

notify my HMIS Security Officer.

I will not knowingly enter malicious or erroneous information into the HMIS.

Any questions or disputes about the data entered by another agency should be directed to the

Broward County CoC HMIS Project Manager.

I understand that my username and password will terminate should I move employment and

will not be passed on to a new staff member.

I agree to attend Broward County CoC HMIS End-User training or complete an on-line

training or equivalent user training.

I agree to maintain strict confidentiality of information obtained through the Broward County

CoC HMIS. This information will be used only for the legitimate client service and

administration of the agency. Any breach of confidentiality will result in immediate

termination of participation in HMIS.

I understand and agree to comply with all the statements listed above.

_________________________________ ____________

Employee/User Signature Date

_________________________________ ____________

CHO Administrator Signature Date

18


ATTACHMENT IV

BROWARD COUNTY CONTINUUM OF CARE (COC)

CLIENT ACKNOWLEDGEMENT FOR ELECTRONIC DATA COLLECTION

IN HOMELESS MANAGEMENT INFORMATION SYSTEM (HMIS)

_________________________________________

[AGENCY NAME]

When you sign this form, it shows that you understand the following:

We collect personal information about the people we serve in a computer system called the

ServicePoint (“SP”). SP is used by agencies which provide prevention, shelter and housing

related services in Broward County. Agencies using SP comply with all the requirements related

to keeping your personal information private and secure.

We use the personal information to run our programs and help us improve our services. Also,

we are required to collect some personal information by organizations that fund our program.

Your information will help us in getting the appropriate services for you through our program or

programs offered by other agencies.

You have a right to review the information that we have about you. If you find mistakes, you

can ask us to correct them. You have a right to file a complaint if you feel that your privacy

rights have been violated.

If you would like a copy of our privacy policy, our agency staff will provide one.

____________________________________________ _________

SIGNATURE OF CLIENT OR GUARDIAN DATE

____________________________________________ _________

SIGNATURE OF AGENCY WITNESS DATE

19

ATTACHMENT V MARCH 2010 HMIS DATA STANDARDS – QUICK VIEW

1

Universal Data Element RESPONSE CATEGORIES EXAMPLES ANSWERS / HELPFUL HINTS Page

3.1 Name First, Middle, Last, Suffix John David Doe, Jr. Complete with information reported 42

3.2 Social Security No. _ _ _ - _ _ - _ _ _ 123-45-6789

43

SSN Type Full SSN Reported 123-45-6789

2 = Partial SSN Reported 123-_ _ - _ _ _ _ If: 123 - _ 2 - 2 _ 2 _; only enter the 1st

3

8 = Don’t Know / Don’t have Applicable if the client does not know / does not have

9 = Refused Applicable if the client refuses to provide answer

3.3 Date of Birth _ _ / _ _ / _ _ _ _ 01/01/1950

44 DOB Type 1 = Full DOB Reported

2 = Approximate or Partial DOB Reported 8 = Don’t Know 9 = Refused

3.4 Race 1 = American Indian or Alaska Native 2 = Asian 3 = Black or African American 4 = Native Hawaiian or Other Pacific Islander 5 = White 8 = Don’t Know 9 = Refused

46

3.5 Ethnicity 0 = Non-Hispanic/Non-Latino 1 = Hispanic/Latino 8 = Don’t Know 9 = Refused

47

3.6 Gender 0 = Female 1 = Male 2 = Transgendered Male to Female 3 = Transgendered Female to Male 4 = Other 8 = Don’t Know 9 = Refused

48

3.7 Veteran Status >18 years of age ONLY

0 = No Individual has never served on active duty in the military OR served but was discharged with a status other than honorable

48-49 1 = Yes Individual served on active duty in the military including basic

training AND was discharged with honorable status 8 = Don’t Know Applicable if the client does not know 9 = Refused Applicable if the client refuses to provide answer

3.8 Disabling Condition 0 = No Answer “No” if the person does not meet any of the 5 “Yes” descriptions:

49-50

1 = Yes (1) a disability as defined in Section 223 of Social Security Act; OR

(2) a physical, mental, or emotional impairment which is (a) expected to be of long-continued & indefinite duration, AND (b) substantially impedes an individual’s ability to live

independently, AND (c) of such a nature that such ability could be improved by more

suitable housing conditions; OR

(3) a developmental disability as defined in Section 102 of the Developmental Disabilities Assistance and Bill of Rights Act; OR

(4) the disease of acquired immunodeficiency syndrome or any conditions arising from the etiological agency for acquired immunodeficiency syndrome; OR

(5) a diagnosable substance abuse disorder.

8 = Don’t Know Applicable if the client does not know


20

ATTACHMENT V MARCH 2010 HMIS DATA STANDARDS – QUICK VIEW

2

Universal Data Element RESPONSE CATEGORIES EXAMPLES ANSWERS / HELPFUL HINTS Page 3.9 Residence prior to

Program Entry 1 = Emergency shelter, including hotel or

motel paid for with ES voucher 15 = Foster care home/ foster group home 6 = Hospital (non-psychiatric) 14 = Hotel/motel paid for without ES voucher 7 = Jail, prison or juvenile detention facility 17 = Other 23 = Owned by client, no ongoing subsidy 21 = Owned by client, with ongoing subsidy 3 = Permanent housing for formerly hmls 16 = Place not meant for habitation 4 = Psychiatric hospital/other psych facility 22 = Rental by client, no ongoing subsidy 20 = Rental by client, with non-VASH) subsidy 19 = Rental by client, with VASH subsidy 5 = SA treatment facility or detox center 18 = Safe Haven 12 = Staying or living with family member 13 = Staying or living with friend 2 = Transitional housing for homeless 8 = Don’t Know 9 = Refused

Choose the location where the person spent the night before even if it was for more than one night. NOTE: If a person spent the night in a provider’s overnight / crisis bed, choose 16 = Place not meant for habitation

51-52

Length of stay in previous place

1 = One week or less 2 = More than one week, but less than one

month 3 = One to three months 4 = More than three months, but less than

one year 5 = One year or longer 8 = Don’t Know 9 = Refused

51-52

3.10 Zip Code of Last Permanent Address

_ _ _ _ _ 12345

53 Zip Code Type 1 = Full or Partial Zip Code Reported 8 = Don’t Know 9 = Refused

3.11 Housing Status 1 = Literally homeless Places not designed for or ordinarily used as a regular sleeping accommodation for human beings;

A supervised publicly or privately operated shelter designated to provide temporary living arrangements;

A hospital or other institution, if the person was sleeping in an emergency shelter or other place not meant for human habitation immediately prior to entry into the hospital or institution;

Fleeing a domestic violence situation.

54-56

2 = Imminently losing their housing Are currently housed and not literally homeless, per above definition; Are imminently losing their housing, whether permanent or temporary; Have no subsequent housing options identified; and Lack the resources or support networks needed to retain current housing or obtain temporary or permanent housing.

3 = Unstably housed and at-risk of losing their housing

Are currently housed and not literally homeless or imminently losing their housing, per above definitions; Are experiencing housing instability, but may have one or more other temporary housing options; and Lack the resources or support networks to retain or obtain permanent housing.

4 = Stably housed Persons who are stably housed are in a stable housing situation and not at risk of losing this housing (i.e., do not meet the criteria for any of the other housing response categories, per above definitions).

8 = Don’t Know Applicable if the client does not know


3.12 Program Entry Date _ _ / _ _ / _ _ _ _ (Month) (Day) (Year)

01/01/2011 First day of service or program entry 58

3.13 Program Exit Date _ _ / _ _ / _ _ _ _ (Month) (Day) (Year)

03/01/2011 The last day of continuous residence in the program’s housing before the client transfers to another program or otherwise stops residing in the shelter or housing program

59

3.14 Personal Identification Number

Auto generated 61

3.15 Household Identification Number

Auto generated 62

21

ATTACHMENT VI - MARCH 2010 HMIS DATA STANDARDS – QUICK VIEW (PROGRAM SPECIFIC)

1

Universal Data Element RESPONSE CATEGORIES ANSWERS / HELPFUL HINTS / EXAMPLES Page 4.1 Income & Source

Financial Resources Income received from any source in past 30 days? THIS IS CASH OR CHECKS ONLY

66-69

0 = No Only if the person does not receive any of the listed choices:

1 = Yes Enter the dollar value for EACH source chosen: 16 = Alimony or other spousal support 15 = Child support 1 = Earned Income (i.e., employment income) 11 = General Assistance (GA) 17 = Other source (EXPLAIN IN SPACE PROVIDED) 14 = Pension from a former job 6 = Private disability insurance 12 = Retirement income from Social Security 4 = Social Security Disability Income (SSDI) 3 = Supplemental Security Income (SSI) 10 = Temporary Assistance for Needy Families (TANF) 2 = Unemployment Insurance 5 = Veteran’s disability 13 = Veteran’s pension 7 = Worker’s compensation REMEMBER TO ENTER THE TOTAL OF ALL SOURCES

8 = Don’t Know Applicable if the client does not know 9 = Refused Applicable if the client refuses to provide answer

4.2 Non-Cash Benefits Non-cash benefit received from any source in past 30 days?

69-72

0 = No Only if the person does not receive any of the listed choices: 1 = Yes Enter the dollar value for EACH source chosen:

2 = MEDICAID 3 = MEDICARE 11 = Other TANF-funded services 13 = Other source (EXPLAIN IN SPACE PROVIDED) 12 = Section 8 / other ongoing rental assistance 1 = SNAP (Food Stamps) 5 = Special Supplemental Nutrition Program - WIC 4 = State Children’s Health Insurance Program 7 = TANF Child Care services 10 = TANF transportation services 14 = Temporary rental assistance 6 = Veteran’s Administration (VA) Medical Services


4.3 Physical Disability 0 = No Only if the person does not meet ALL of the “Yes” criteria:

72-74

1 = Yes If YES, complete “Currently Receiving Treatment” 0 = No / 1 = Yes / 8 = Don’t Know / 9 = Refused

A physical disability = physical impairment which: (a) is expected to be of long-continued & indefinite duration, AND (b) substantially impedes an individual’s ability to live independently, AND (c) of such a nature that such ability could be improved by more suitable housing conditions.


4.4 Developmental Disability

0 = No Only if the person does not meet the “Yes” criteria:

74-76


A developmental disability = a severe, chronic disability that is attributed to a mental or physical impairment (or combination of physical and mental impairments) that occurred before 22 years of age and limits the capacity for independent living and economic self-sufficiency.


4.5 Chronic Health Condition


76-77


A chronic health condition = a diagnosed condition that is more than 3 months in duration and is either not curable or has residual effects that limit daily living and require adaptation in function or special assistance.


4.6 HIV / AIDS 0 = No Only if the person does not meet the “Yes” criteria:

78-79


If a person has been diagnosed with AIDS or has tested positive for HIV


4.7 Mental Health Problem


79-81


A mental health problem may include serious depression, serious anxiety, hallucinations, violent behavior or thoughts of suicide. If Yes, answer “Expected to be of long-continued and indefinite duration and substantially impairs ability to live independently” with 0 = No / 1 = Yes / 8 = Don’t Know / 9 = Refused; then “currently receiving treatment.”


22

ATTACHMENT VI - MARCH 2010 HMIS DATA STANDARDS – QUICK VIEW (PROGRAM SPECIFIC)

2

Universal Data Element RESPONSE CATEGORIES ANSWERS / HELPFUL HINTS / EXAMPLES Page 4.8 Substance Abuse 0 = No Only if the person is not determined with any “Yes” criteria:

81-82

1 = Alcohol abuse 2 = Drug abuse 3 = Both alcohol and drug abuse

Then complete “Currently Receiving Treatment” 0 = No / 1 = Yes / 8 = Don’t Know / 9 = Refused

For each item chosen, answer “Expected to be of long-continued and indefinite duration and substantially impairs ability to live independently” with 0 = No / 1 = Yes / 8 = Don’t Know / 9 = Refused; then “currently receiving treatment.”


4.9 Domestic Violence 0 = No If the person has never experienced domestic violence

82-83

1 = Yes If Yes, MUST choose timeline: 1 = Within the past 3 months 2 = 3 to 6 months ago 3 = From 6 to 12 months ago

4 = More than a year ago 8 = Don’t Know 9 = Refused


4.10 Destination 24 = Deceased 1 = Emergency shelter 15 = Foster care home / foster care group home 6 = Hospital (non-psychiatric) 14 = Hotel or motel paid for without voucher 7 = Jail, prison or juvenile detention facility 17 = Other 11 = Owned by client, no ongoing subsidy 21 = Owned by client, with ongoing subsidy 3 = PSH (SHP, S+C, or SRO Mod Rehab) 16 = Place not meant for habitation 4 = Psychiatric hospital / other psychiatric facility

10 = Rental by client, no ongoing housing subsidy 19 = Rental by client, VASH Subsidy 20 = Rental by client, other (non-VASH) subsidy 18 = Safe Haven 12 = Staying/living w/ family, temporary 13 = Staying/living w/ friends, temporary 22 = Staying/living w/ family, permanent tenure 23 = Staying/living w/ friends, permanent tenure 5 = Substance abuse Tx facility / detox center 2 = Transitional housing for homeless persons 8 = Don’t Know 9 = Refused

84-86

4.15A Employment 0 = No

94-95

1 = Yes If currently working, enter # of hours worked in the past week 8 = Don’t Know Applicable if the client does not know 9 = Refused Applicable if the client refuses to provide answer Employment Tenure 1 = Permanent

2 = Temporary 3 = Seasonal

8 = Don’t Know 9 = Refused

[If unemployed] Is the client looking for work? [If employed] Is the client looking for additional employment or increased hours at current job?

0 = No 1 = Yes


4.15B Education Currently in school or working on any degree or certificate

0 = No 1 = Yes


95-96

Received vocational training or apprenticeship certificates

0 = No 1 = Yes


Highest level of school completed 0 = No schooling completed 1 = Nursery to 4th grade 2 = 5th grade or 6th grade 3 = 7th grade or 8th grade 4 = 9th grade 5 = 10th grade 6 = 11th grade

7 = 12th grade, No diploma 10 = High school diploma 11 = GED 12 = Post-secondary school 8 = Don’t Know 9 = Refused

If client has received a high school diploma, GED or enrolled in post-secondary education, what degree(s) has the client earned

0 = None 1 = Associates Degree 2 = Bachelors Degree 3 = Masters Degree 4 = Doctorate Degree

5 = Other grad/prof. degree 6 = Certificate of advanced training or skilled artisan 8 = Don’t Know 9 = Refused

4.15G Reason for Leaving 1 = Left for a housing opportunity before completing program 2 = Completed program 3 = Non-payment of rent/occupancy charge 4 = Non-compliance with program 5 = Criminal activity/destruction of property/violence 6 = Reached maximum time allowed by program

7 = Needs could not be met by program 8 = Disagreement with rules/persons 9 = Death 10 = Unknown/disappeared 11 = Other

103

4.15H Services Provided Date of Service __ __/__ __/__ __ __ __ (Month) (Day) (Year)

104

1 = Food Emergency food programs and food pantries 2 = Housing placement Housing search 3 = Material goods Clothing and personal hygiene items 4 = Temporary housing and other financial aid Rent payment or deposit assistance 5 = Transportation Bus passes and mass transit tokens 6 = Consumer assistance and protection Money management counseling and acquiring ID/SSN 7 = Criminal justice/legal services Legal counseling and immigration services 10 = Education GED instruction, bilingual education, and literacy programs 11 = HIV/AIDS-related services HIV testing, AIDS Tx, AIDS/HIV prevention and counseling 12 = Mental health care/counseling Telephone crisis hotlines and psychiatric programs 13 = Other health care Disability screening, health referrals and education (excluding

HIV/AIDS-related services, MH care/counseling, & SA services) 14 = Substance abuse services Detoxification and alcohol/drug abuse counseling 15 = Employment Job development and job finding assistance 16 = Case/care management Development of plans for the evaluation, Tx/care of persons

needing assistance in planning or arranging for services 17 = Day care Child care centers and infant care centers 18 = Personal enrichment Life skills, social skills, stress management 19 = Referral to other service(s) Street outreach referral, intra agency, other agencies

23

ATTACHMENT VII


Homeless Management Information System (HMIS) Report Request Form

Please type or print

Agency: Program:

Requestor Name: Phone: E-mail:

Today’s Date: Requested completion date:

Brief Description of the report:

Purpose of the report:

Time Period: from (MM/DD/YY) to (MM/DD/YY)

What data elements should be included report? (Ex: Gender, Ethnicity, Race, Age, Employment Status, Income)

What programs or program types should be included in the report?

Would you like unduplicated data or all records collected? Unduplicated All records

What format would you like the report? Custom ad hoc (program staff only) Excel PDF

If possible please attach an example of how you would like the report to look.

Only CHO SO can request/receive client level data for their program. Requests for aggregate data will be reviewed by

HMIS Data Committee.

**HMIS Project Manager Use Only**

Date received: _____ / _____ / _____ Approved? Yes No Date: _____ / _____ / _____

Completed by: Date completed: _____ / _____ / _____

Name of file/report created: Location:

E-mail this form to [email protected] – or – Fax to (954) 357-5521 (Attn: HMIS Project Manager)

24

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