HMIS Grievance Form
If you have data collected in the KS-507 and the KS-505 Homeless Management Information System (HMIS) and suspect your privacy rights have been violated by the Kansas Statewide Homeless Coalition (KSHC) or an HMIS partner agency, you have the right to file a grievance directly with KSHC.
It is against the law for KSHC or any partner agency to retaliate against you if you file a grievance. KSHC will attempt to respond to your filing within 30 days.
Your Name
Mailing Address
Email Address
example@example.com
Phone Number
Please enter a valid phone number.
Response Prference
Mail
Email
Phone
Name of the individual who violated your privacy rights (optional)
Name of the agency that violated your privacy rights (optional)
Summary of grievance or offense
You may upload documentation related to the grievance here
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