"But For" INITIAL CERTIFICATION Assessment for Homeless Prevention & Rapid Re-Housing

"BUT FOR" INITIAL CERTIFICATION Assessment for HP & RRH
Participant Name: First Name* Last Name* Date: Date

Participant must lack the financial resources and support networks to resolve their housing crisis and this should be documented at initial certification and at program re-certification (every 3 months). This form is designed to certify that without HP/RRH assistance, the household would not be able to obtain immediate housing or remain in current housing.
Does the household have resources to obtain/remain in housing?
Does the household have friends or family that can help obtain/remain in housing?
Does the household have friends or family that they can say with until they are able to obtain housing?
PREVENTION ONLY: Does the household's gross monthly income exceed 30% of the Area Median Income?
Is the household enrolled in any other program or organization that can help them remain in housing?
If the answer to any of these questions is "Yes" the household does not meet the "But for" criteria is not eligible for the Homeless Prevention or Rapid Re-Housing Program .
Participant Signature: Signature* Date: Date*
Intake Staff Signature:_______________________ Date:______________
Should be Empty:

"BUT FOR" INITIAL CERTIFICATION Assessment for HP & RRH