HMIS Agency Request

HMIS Agency Request
Welcome! Sacramento Steps Forward is the Homeless Managment Information System (HMIS) lead for Sacramento County. The use of an HMIS is mandated by Congress for any Continuums of Care (CoC) who receive federal funding to address homelessness in their communities.

Is your agency interested in joining HMIS, required to participate, or planning to close its current agency in the system? Use this form to request the addition of a new HMIS agency, update an existing one, or notify us if your agency is closing.
Date

MonthDayYear
Date
Hour MinutesAM/PM Option
Please select one:*

New AgencyExisting Agency UpdatesClosing Agency
Please select your CoC:*

CA-503 (Sacramento)CA-521 (Yolo)

HMIS Agency Request
Existing Agency Updates
Please detail any agency updates in this section below.

Note: If your agency is already participating in HMIS and you need to update an existing program/projects(s), please ensure that the Sacramento Program Form or the Yolo Program Form is completed.
Agency Name*
Agency E-mail*
example@example.com
Please select the Agency updates that need to be completed:*

Agency name changesChanges to agency leadershipChanges to site locationsChanges to agency fundingOther
Details about your agency change:*

HMIS Agency Request
Closing Agency Information

If your agency is closing or discontinuing its participation in HMIS, please notify us immediately via this form. We will guide you through the process of formally closing your HMIS agency and program/project(s).
Agency Name*
Agency E-mail*
example@example.com
Select the date your agency is closing:*

MonthDayYear
Date
Please provide the reason the agency is closing below:*

HMIS Agency Request
New Agency Information

Before gaining access to HMIS, the agency's CEO will need to review the documents below.
HMIS Privacy Security Plan

HMIS Data Quality Plan

HMIS Policies and Procedures Manual
Agency Name*
Agency E-mail*
example@example.com
Agency Phone Number*
Please enter a valid phone number.
Name of Agency CEO*

First NameLast Name
Agency CEO's Email Address*
example@example.com
Agency CEO's Phone Number*
Please enter a valid phone number.
Agency Website*
Sacramento Agency Geocode*
Yolo Agency Geocode*
Agency Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

HMIS Agency Request
Agency Partner Security Officer Information

Please see the HMIS Privacy & Security Plan for responsibilities for this role.
Name of Staff that will act as your Agency's Partner Agency Security Officer*

First NameLast Name
Partner Agency Security Officer's Phone Number*
Please enter a valid phone number.
Partner Agency Security Officer's Email Address*
example@example.com

HMIS Agency Request
Agency Lead HMIS Contact Person

This person will be a liaison between your agency and Sacramento Steps Forward's Data & Analytics Department for all Agency level HMIS reports, questions, and concerns.
Name of Staff that will act as your Agency's Lead HMIS Contact Person*

First NameLast Name
Lead HMIS Contact Person's Phone Number*
Please enter a valid phone number.
Lead HMIS Contact Person's Email Address*
example@example.com

HMIS Agency Request
Required New Agency Documents

These documents will give you a clear understanding of the responsibilities required of all participating agencies.
Please note for all new Agencies, the agency CEO will need to review the following:

HMIS Privacy Security Plan

HMIS Data Quality Plan

HMIS Policies and Procedures Manual
Have you and your agency staff read and agreed to abide by the standards outlined in the above documents?*

YesNo
Please describe the barriers preventing you from agreeing to the standards outlined in the documents above.*

HMIS Agency Request
Required New Sacramento Agency Documents

Your agency's CEO must complete and sign the following documents listed below.
HMIS Partner Agency Agreement Form

Inter Agency HMIS Data Sharing Agreement
Please upload the HMIS Partner Agency Agreement Form:*

Cancelof
Please upload the Inter Agency HMIS Data Sharing Agreement:*

Cancelof

HMIS Agency Request
Required New Yolo Agency Documents

Your agency's CEO must complete and sign the following documents listed below.
HMIS Partner Agency Agreement Form
Please upload the HMIS Partner Agency Agreement Form:*

Cancelof

HMIS Agency Request
Please submit the form below or save your submission to finish later! If submitted, hmis@sacstepsforward.org will be connecting with you further in 3 business days.
Should be Empty:

Existing Agency Updates