Modesto, CA

HMIS Program Set-up

HMIS Housing Program/Grant Setup
Instructions: Fill out this form to add/modify HMIS Program Information. Please ensure that you complete one for each federally and private funded Programs/Projects. All sections – Agency, Program, Funding, Program Type, Population, and Inventory need to be completely filled out. If you have any questions, please contact HMIS Support .
Verification*
1. Upon submission of this form, I verify that the information provided in this set-up form is correct and has been approved by my organization's Director.
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Program Name*
Grant Name
Project Name*
Please list the Official project name
Program Start and End Date*
Program Start and End Date Start Date
—
Program Start and End Date End Date
Continuum Project*
1. Yes
2. No
Program Capacity
This options should only be selected if you want the HMIS system to limit enrollment to a specific number.
HUD Project ID or Grant number
Project Site Address*
If multiple sites please use the main agency address.
City
State
Zip Code
Program Type*
Site Configuration*
Program Component
For the program selected please include the primary component.
HHS PATH*
HHS RHY*
HUD VASH*
HUD CoC*
VA Grant Per Diem*
HUD Rural Housing Stability Assistance Program*
VA: Health Care for Homeless*
VA Supportive Services for Veteran Families*
Private*
Emergency Solutions Grant (ESG)*
Check all sources that supply your ESG funding*
1. City
2. County
3. State
HOPWA TYPE*
CDBG Funding City or County*
Describe the activity performed for this funding.
Target Population
A population is considered a "target population" if the program is designed to serve that population ans at least three-fourths (75%) of the clients served by the program fit the target group descriptor.
Target Population A*
Target Population B*
Target Population C*
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Total Participating HMIS Beds*
What is the total number of beds for each funding source?*
Please list all the funding sources for the bed/unit types below. Example: Total of 5 beds: 2 Private and 3 ESG and Private.
Dedicated Bed Inventory*
1. Veteran Bed Only
2. Youth Bed Only
1. Chronically Homeless Bed Only
2. Not Applicable
Bed Type*
Bed Availability*
Housing Type*
Seasonal Bed Availability*
Seasonal Bed Availability Start Date
—
Seasonal Bed Availability End Date
Bed Count
Please Note: Flex Beds are beds that can be used for either individuals or families.
Unit
Family*
Individual*
Flex Beds*
Bed
Family*
Individual*
Flex Beds*
Voucher
Family*
Individual*
Flex Beds*
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Reporting Requirements
Please check all the reporting types required from the HMIS system. If you would like specialized reporting please list the title and details under Other.
Required Reporting Type
Select all reports that this project will require during the reporting year
1. CAPER
2. APR
3. CSV
1. HOPWA
2. VA SSVF
3. PATH Annual Report
1. RHY Report
2. Other
APR Date Range*
APR Date Range Start Date
—
APR Date Range End Date
Other:
Please list in detail any desired reports no listed above.
CAPER Date Range*
CAPER Date Range Start Date
—
CAPER Date Range End Date
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