COHMIS Program Set Up Form
*Please note the project set up turnaround is within 7 business days of form submission*
Today's Date
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Month
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Day
Year
Date
Agency Name
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Agency Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Program Name
Program Description
When does the program begin?
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Month
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Day
Year
Date
Are you currently serving clients in this program?
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Yes
No
When do you anticipate serving clients in this program?
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Clients cannot be entered in HMIS before the project start date. Alternatively, there must not be a gap between the project start date and when the first client is enrolled.
When does the program end (if applicable)?
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Month
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Day
Year
Date
What is the grant start date?
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Month
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Day
Year
Date
Grant Amount
In what county is the program located?
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Program Address (specific address where the site is located)
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Who should we contact if there are questions about this program?
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Program Contact Name
Email
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Program Contact Email
Program Type
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Please Select
Day Shelter
Emergency Shelter - Entry-Exit (Note - RHY-funded shelters MUST be Entry/Exit)
Emergency Shelter - Night by Night (requires a bed night service each night the client stays)
Homelessness Prevention
PSH - Permanent Supportive Housing (disability required)
PH - Rapid Re-Housing (Housing with or without services)
PH - Rapid Re-Housing (Services Only - RRH with no inventory)
PH - Housing with Services (no disability required)
PH - Housing Only
Safe Haven
Services Only
Street Outreach
Transitional Housing
Does this program provide vouchers for people to stay in a motel or hotel?
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Yes
No
Is this a seasonal program that only offers beds or vouchers during certain months of the year?
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Yes
No
Does this program consist of ONLY overflow beds?
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Yes
No
N/A
If this Services Only project is affiliated with a housing project, please enter the name(s) of the housing project(s)
Will this program receive referrals from Coordinated Entry/OneHome?
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Yes
No
Program Site Type
Please Select
Non-residential: services only
Residential: special needs and non-special needs
Residential: special needs only
Housing Type
Please Select
Site-based – Single Site
Site-based – Clustered / Multiple Sites
Tenant-based – Scattered Site
FUNDING SOURCES -PLEASE READ
Funding source (grant start) dates MUST correspond with the project operating start date. There should not be a gap between when the project begins operation and when the funding begins. You must explain any gaps in the comment section below. One example of when this is acceptable is if a program has been funded since its operating start date, and you are now adding another funding source.
Funding Type (Federal)
HUD:CoC – Permanent Supportive Housing
HUD:CoC – Rapid Re-Housing
HUD:CoC – Supportive Services Only
HUD:CoC – Transitional Housing
HUD:CoC – Safe Haven
HUD:CoC - Youth Homeless Demonstration Program (YHDP)
HUD:ESG – Emergency Shelter (operating and/or essential services)
HUD:ESG – Homelessness Prevention
HUD:ESG – Rapid Rehousing
HUD:ESG – Street Outreach
HUD:HUD/VASH
HHS:PATH – Street Outreach & Supportive Services Only
HHS:RHY – Basic Center Program (prevention and shelter)
HHS:RHY – Maternity Group Home for Pregnant and Parenting Youth
HHS:RHY – Transitional Living Program
HHS:RHY – Street Outreach Project
HHS:RHY – Demonstration Project
VA: CRS Contract Residential Services
VA:Grant Per Diem – Bridge Housing
VA:Grant Per Diem – Low Demand
VA:Grant Per Diem – Hospital to Housing
VA:Grant Per Diem – Clinical Treatment
VA:Grant Per Diem – Service Intensive Transitional Housing
VA:Grant Per Diem – Transition in Place
VA:Community Contract Safe Haven Program
VA:Compensated Work Therapy Transitional Residence
VA:Supportive Services for Veteran Families
*Other Federal Funding Source
*Other Federal Funding Source
Is this program funded by any of the following Colorado entities?
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HOST
HOST - Rapid Resolution Initiative
DOLA
City of Aurora
*Other local funding source
None of these
Which DOLA Funding type?
DOLA: COR3
DOLA: ESG CDBG-CV
DOLA: ESG HSP
DOLA: ESG: Prop 123
DOLA: HPAP
DOLA: NAV CTR
DOLA: SHV
DOLA: THR
DOLA: TSS
*Other Local Funding Source
If this program has multiple funding sources, will 100% of clients be served under all funding sources? If not, MDHI will reach out to you for more information.
Yes, all clients funded by all funding sources
No, clients funded by different funding sources
Unsure
Is this program part of the Mayor's "All In Mile High/AIMH" initiative in conjunction with HOST? If "yes," this program will be set up under HOST's Encampment Response Collaborative Agency in HMIS. Please contact the MDHI HelpDesk if you have questions.
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Yes
No
Is this program part of the Navigation Campus Initiative?
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Yes
No
Do you want to add auto exits? Auto exits are based on the last service received/last activity
Yes
No
Please specify auto exit timeframe
1 Day
15 Days
30 Days
45 Days
60 Days
90 Days
120 Days
180 Days
360 Days
540 Days
Would you like to add services to this program? If "Yes," please click on the link to the Request for HMIS Services Form that appears after submitting this form
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Yes
No
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THIS SECTION IS
REQUIRED
FOR EMERGENCY SHELTER OR ANY HOUSING PROGRAMS
COHMIS Housing Project Inventory Setup Form
This form serves two purposes—confirming adequate setup of projects in HMIS, which will then be used to generate the Housing Inventory Count (HIC) which is submitted to the U.S. Department of Housing and Urban Development (HUD). This form must be filled out for Emergency Shelters, Permanent (Supportive) Housing, Transitional Housing, and Rapid-Rehousing programs.
Housing Inventory Start Date *THIS DATE MUST BE ON OR AFTER THE PROJECT START DATE*
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Month
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Day
Year
Date
Housing Inventory End Date (if applicable)
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Month
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Day
Year
Date
Bed Type
Please Select
Facility-based (Beds including cots or mats located in a residential homeless assistance facility dedicated for use by persons who are homeless)
Voucher (Beds located in a hotel or motel and made available by the homeless assistance project through vouchers or other forms of payment)
Other (located in a church or other facility not dedicated for use by persons experiencing homelessness
Bed Availability
Please Select
Year-round
Seasonal
Overflow
Do you have beds/vouchers dedicated to Youth or Veterans?
Yes
No
Number of BEDS/VOUCHERS dedicated to youth who are Veterans (if applicable)
Number of BEDS/VOUCHERS dedicated to any other youth (if applicable)
Number of BEDS/VOUCHERS dedicated to any other Veterans (if applicable)
Number of non-dedicated BEDS/VOUCHERS (beds for any type of client)
Total BED/VOUCHER inventory
Total UNIT inventory (for Housing Programs)
Of the total number of beds/vouchers for all clients (you must choose at least one):
Total number of beds/vouchers for households with only children (if applicable)
Total number of beds/vouchers for households with at least one child (if applicable)
Total number of beds/vouchers for households without children (if applicable)
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