HMIS Program Requests

HMIS Program/Project Request
Date

MonthDayYear
Date
Hour MinutesAM/PM Option
Please fill out this form to request a new, update, or closure of an HMIS program/project. Upon receiving your submission, we will schedule a meeting to discuss your request.

For more information, please visit our Requesting HMIS Agencies, Programs, or Inventories webpage. If you have any questions, please email us at hmis@sacstepsforward.org or join our Open Office Hours.
Email of person completing this request:*
example@example.com
Please select the type of program/project request below:*

Program/project is new to HMIS.Program/project needs updates in HMIS.Program/project needs closure in HMIS.
Please select the CoC the program/project is associated with:*

Sacramento Continuum of Care (CoC)Yolo Continuum of Care (CoC)

HMIS Program/Project Request
New Sacramento Continuum of Care (CoC) Program/Project
Please select the Sacramento Agency for the Program/Project Build:*
Program/Project Name:*
Program/Project Phone Number:*
Please enter a valid phone number.
Program/Project Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please provide the geocode associated with the geographic location of the program/project principal service site.*

Sacramento (City) - 063144Sacramento County - 069067Citrus Heights - 060726Elk Grove - 061146Rancho Cordova - 062928
Note: For Scattered-site housing projects, please select the geocode where the majority of the beds are located.
If the program/project will be a collaboration between multiple agencies, please provide the names of your partnering agencies.
These would be agencies that would require their staff to access the program in HMIS.

HMIS Program/Project Request
New Yolo Continuum of Care (CoC) Program/Project
Please select the Yolo Agency for the program/project build:*
Program/Project Name:*
Program/Project Phone Number:*
Please enter a valid phone number.
Program/Project Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please provide the geocode associated with the geographic location of the program/project principal service site:*

Yolo County - 069113Davis - 060942West Sacramento - 064050Woodland - 064134
Note: For scattered-site housing program/projects, please select the geocode where the majority of the beds are located.
If the program/project will be a collaboration between multiple agencies, please provide the names of your partnering agencies. *
These would be agencies that would require their staff to access the program in HMIS.

HMIS Program/Project Request
Program/Project Manager

This is the person that can answer questions for program/project operations and management.
Name of Program/Project Manager*

First NameLast Name
Program/Project Manager Phone Number*
Please enter a valid phone number.
Program/Project Manager Email Address*
example@example.com

HMIS Program/Project Request
Program/Project Lead HMIS User

The Program/Project Lead HMIS User would be the person with HMIS access and have the ability to address data errors or questions. This may be the same person as the Program/Project Manager.
Name of Program/Project Lead HMIS User:*

First NameLast Name
Program/Project Lead HMIS User Phone Number:*
Please enter a valid phone number.
Program/Project Lead HMIS User Email Address:*
We do not accept free email addresses (e.g., Gmail)
Do you need a HMIS user license?*

Yes, I need to complete the required request, training, and quiz.No, I have an active Sacramento CoC HMIS license.

HMIS Program/Project Request
Program Demographics
Please provide a brief description of your project.*
How would you describe your project to a person outside your agency?
How do you plan on using the data to determine program/project outcomes?**
What is the program/project operating start date? *

MonthDayYear
Important Note: This is the date your project will begin (or has begun) enrolling clients into HMIS. Historical enrollments would require a Release of Information (ROI) from your client to enter the historical data.
The following definitions are provided to assist with you answer to who your program services. Please review below:
- Definition of Literally Homeless
- Definition of At Risk of Homelessness
Please select who your program serves:*

Persons who are literally homelessPersons who are at risk of becoming literally homelessBoth populations
Will/is 75% of the persons served by your program/project from one of these population subsets?*

HMIS Program Requests
Funding/Contract Information
Do you have a contract for the program you are operating? Does this contract require you to record data into HMIS?*
What are your reporting requirements?*
What funding source(s) does your program/project receive?*

HUD McKinney Vento SourceOther Federal Funding SourceCA AB 977 Funding SourceOther Local Project Funding SourceOther Funding Source
Provide all applicable Funding Source information below:

HUD McKinney Vento Funding Sources
Please provide HUD McKinney Vento Funding information:
Note: If you have an additional HUD McKinney Vento Funding Source, please click the above button "+ Add Another"

Other Federal Funding Sources
Please provide Other Federal Funding information:
Note: If you have an additional Federal Funding Funding Source, please click the above button "+ Add Another"

CA AB 977 Funding Sources
Please provide all CA AB 977 Funding information:
Note: If you have an additional CA AB 977 Funding Source, please click the above button "+ Add Another"
Contract Monitor Contact Information
Contract Monitor Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Overseeing Funder

Other Local Project Funding Sources
Please provide Other Local Funding information:
Note: If you have an additional Local Project Funding Source, please click the above button "+ Add Another"
Contract Monitor Contact Information
Contract Monitor Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Overseeing Funder

Other Funding Sources
Please provide any Other Funding Source information:
Note: If you have an additional Funding Source, please click the above button "+Add Another"

HMIS Program/Project Request
Housing Sites and Inventory
How is the project's housing site(s) configured?*

Site-based: Single Site (All clients are housed in a single project facility.)Site-based: Clustered / Multiple Sites (Clients are housed in more than one project facility in multiple locations.)Tenant-based: Scattered Site (Clients have leases or other occupancy agreements and are housed in residences that are not owned or managed by the project.)

HMIS Program/Project Request
Household Inventory
Does your project serve Households without children?*

YesNo
What is the Inventory Start Date?

MonthDayYear
Date

Emergency Shelters Only
What is the Bed Type?

Facility-based: Beds (including cots or mats) are located in a residential homeless assistance facility dedicated for use by persons who are homeless.Voucher: Beds are located in a hotel or motel and made available by the homeless assistance project through vouchers or other forms of payment.Other: Beds are located in a campground, church or other facility not dedicated for the use by persons who are homeless.
What is the Bed availability?

Year-roundSeasonal: Beds available on a planned basis with a set start and end date during periods of high demand.Overflow: Beds available during high demand that exceeds available inventory.
If Bed Availability is Seasonal, please enter the ending date.

MonthDayYear
Date

Households without children
Households composed exclusively of persons who are 18 years of age or older.

Please review the dedicated bed definitions below to provide the correct bed inventory information:
- Youth-Veterans Beds — The number of beds that are dedicated to house youth (persons up to age 24) Veterans experiencing homelessness and their household members.
- Any other Veteran Beds — The number of beds that are dedicated to house Veterans who are not youth and not experiencing chronic homelessness and their household members.
- Any Other Youth Beds — The number of beds that are dedicated to house youth (persons up to age 24) experiencing homelessness who are not Veterans and are not experiencing chronic homelessness, and their household members.
- Any Chronically Homeless Beds — Beds dedicated to non-youth, non-Veteran persons experiencing homelessness. This bed inventory information is only required for PSH & PH project types.
- Non-Dedicated Beds — All other (non-dedicated) beds not already accounted for in dedicated beds.
Please provide dedicated (if applicable) & non-dedicated beds for Households without children:
Total Beds
This is calculated from your numbers provided above

HMIS Program/Project Request
Bed and Unit Inventory
Does your project serve Households with at least 1 adult and 1 minor child?*

YesNo
What is the Inventory Start Date?

MonthDayYear
Date

Emergency Shelters Only
What is the Bed Type?

Facility-based: Beds (including cots or mats) are located in a residential homeless assistance facility dedicated for use by persons who are homeless.Voucher: Beds are located in a hotel or motel and made available by the homeless assistance project through vouchers or other forms of payment.Other: Beds are located in a campground, church or other facility not dedicated for the use by persons who are homeless.
What is the Bed availability?

Year-roundSeasonal: Beds available on a planned basis with a set start and end date during periods of high demand.Overflow: Beds available during high demand that exceeds available inventory.
If Bed Availability is Seasonal, please enter the ending date.

MonthDayYear
Date

Households with at least 1 adult and 1 minor child
Please review the dedicated bed definitions below to provide the correct bed inventory information:
- Youth-Veterans Beds — The number of beds that are dedicated to house youth (persons up to age 24) Veterans experiencing homelessness and their household members.
- Any other Veteran Beds — The number of beds that are dedicated to house Veterans who are not youth and not experiencing chronic homelessness and their household members.
- Any Other Youth Beds — The number of beds that are dedicated to house youth (persons up to age 24) experiencing homelessness who are not Veterans and are not experiencing chronic homelessness, and their household members.
- Any Chronically Homeless Beds — Beds dedicated to non-youth, non-Veteran persons experiencing homelessness. This bed inventory information is only required for PSH & PH project types.
- Non-Dedicated Beds — All other (non-dedicated) beds not already accounted for in dedicated beds.
Please provide dedicated (if applicable) & non-dedicated beds for Households with at least 1 adult and 1 minor child:
Total Beds
This is calculated from your numbers provided above
What is the total number of units for Households with at least 1 adult and 1 minor child?
Units = Households your project can provide housing for on a given night.

HMIS Program/Project Request
Does your project serve Households with only children?*

YesNo
What is the Inventory Start Date?

MonthDayYear
Date

Emergency Shelters Only
What is the Bed Type?

Facility-based: Beds (including cots or mats) are located in a residential homeless assistance facility dedicated for use by persons who are homeless.Voucher: Beds are located in a hotel or motel and made available by the homeless assistance project through vouchers or other forms of payment.Other: Beds are located in a campground, church or other facility not dedicated for the use by persons who are homeless.
What is the Bed availability?

Year-roundSeasonal: Beds available on a planned basis with a set start and end date during periods of high demand.Overflow: Beds available during high demand that exceeds available inventory.
If Bed Availability is Seasonal, please enter the ending date.

MonthDayYear
Date

Households with only children
Households composed exclusively of minors

Please review the dedicated bed definitions below to provide the correct bed inventory information:
- Youth-Veterans Beds — The number of beds that are dedicated to house youth (persons up to age 24) Veterans experiencing homelessness and their household members.
- Any Other Youth Beds — The number of beds that are dedicated to house youth (persons up to age 24) experiencing homelessness who are not Veterans and are not experiencing chronic homelessness, and their household members.
- Any Chronically Homeless Youth Beds — The number of beds that are dedicated to house youth (persons up to age 24) experiencing chronic homelessness and their household members. This bed inventory information is only required for PSH & PH project types.
- Non-Dedicated Beds — All other (non-dedicated) beds not already accounted for in dedicated beds.
Please provide dedicated (if applicable) & non-dedicated beds for Households with only children:
Total Beds
This is calculated from your numbers provided above

HMIS Program/Project Request
Rental Subsidies and Vouchers
What is your program/project's Annual budget for Rental Subsidies or Housing Vouchers?
Example: $120,000
Which household types do you serve?

Households without childrenHouseholds with at least 1 adult and 1 minor childHouseholds with only children
Provide all applicable Rental Subsidy & Voucher information below:

Households without children
What percentage of Households without children does your project serve?
Example: 69% out of 100%
If your project serves Households without children, what is the average fair market rate for a unit if your project was subsidizing the FULL rent?
Example: $950 for studio apartment

Households with at least 1 adult and 1 minor child
What percentage of Family Households (at least 1 Adult and 1 Minor child) does your project serve?
Example: 30% out of 100%
If your project serves Family Households, what is the average Family Household size?
Example: 3, 1 adult with 2 children
If your project serves Family Households, what is the average fair market rate for a unit if your project was subsidizing the FULL rent for the average Family Household?
Example: $1,400 for 2 bedroom apartment

Households with only children
What percentage of Households with Only Children does your project serve?
Example: 1% out of 100%
If your project serves Households with Only Children, what is the average fair market rate for a unit if your project was subsidizing the FULL rent?
Example: $600 for room for rent

HMIS Program/Project Request
Custom Services for the Program/Project
Please upload your file outlining custom services in the file upload section below to build for the HMIS program/project. This information will help us tailor our services to meet your specific needs effectively.
File Upload

Cancelof

HMIS Program/Project Request
Coordinated Access System
Will this program/project be receiving referrals from Sacramento Steps Forward's Coordinated Access (CAS) Team?*

YesNoI don't know

HMIS Program/Project Request
Coordinated Access System (CAS)
When do you want to start receiving referrals from the CAS Team?

MonthDayYear
Date
Will you want to utilize the intake appointment feature in HMIS?

YesNo
Please provided the days and appointment times you would like setup in HMIS.
For example: Mondays, Tuesdays, and Wednesdays at 1pm, 3pm, and 4pm
Please provide the names and contact information of your staff that will need to coordinate with the Sacramento Steps Forward CAS Team during the referral process.

HMIS Program/Project Request
Program/Project Update
Please select below the update for your HMIS program/project:*

Our program/project inventory has changed.Our program/project type has changed.Our program/project location has changed.Our program/project has new responsible staff (i.e. management, supervisors).Our program/project funding source(s) have changed.Other

Inventory Changes
Your inventory has changed? Please complete the HMIS Housing Inventory Request to update your program/project inventory.

Program/Project Type Change
Please provide the program/project type that needs to be updated on a current HMIS program/project, along with a detailed response to why this need to occur:
Date Program/Project Type Changed

MonthDayYear
Date

Program/Project Location Change
Please provide the address that the program/project need to be updated to:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Responsible Staff Changes
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.

Other Program/Project Change
Please provide a detailed explanation to the program/project update that you need completed:

HMIS Program Requests
Updating Funding Information

Please complete any funding information updates below
What funding source(s) does your program/project receive?*

HUD McKinney Vento SourceOther Federal Funding SourceCA AB 977 Funding SourceOther Local Project Funding SourceOther Funding Source
Provide All Funding Sources Below:

HUD McKinney Vento Funding Sources
Please provide HUD McKinney Vento Funding information:
Note: If you have an additional HUD McKinney Vento Funding Source, please click the above button "+ Add Another"

Other Federal Funding Sources
Please provide Other Federal Funding information:
Note: If you have an additional Federal Funding Funding Source, please click the above button "+ Add Another"

CA AB 977 Funding Sources
Please provide all CA AB 977 Funding information:
Note: If you have an additional CA AB 977 Funding Source, please click the above button "+ Add Another"
Contract Monitor Contact Information
Contract Monitor Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Overseeing Funder

Other Local Project Funding Sources
Please provide Other Local Funding information:
Note: If you have an additional Local Project Funding Source, please click the above button "+ Add Another"
Contract Monitor Contact Information
Contract Monitor Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Overseeing Funder

Other Funding Sources
Please provide any Other Funding Source information:
Note: If you have an additional Funding Source, please click the above button "+Add Another"

HMIS Program/Project Request
Program/Project Closure
Reminder: All clients must be exited from your program before or on the closure date.
Please provide the date that program/project operations will end:*

MonthDayYear
Date
Please provide a detailed explanation as to why this program/project is closing:*
Do we need to adjust agency user access in HMIS if this program involves a partnership with another agency? This includes scenarios where we may need to remove access from the partnering agency's staff.
Example: Your organization collaborates with Agency X on a program tracked in HMIS. Initially, Agency X had access to view and update client records. However, if the program ends or partnership terms change, you would revoke Agency X's HMIS access to protect data confidentiality.

HMIS Program/Project Request
Thank you for submitting your HMIS Program/Project Request! If you need to save and come back to this form later, please select "Save" below.

For any further requests, please explore our other webpages or reach out to us at hmis@sacstepsforward.org for assistance.
Should be Empty:

HMIS Program/Project Request

HMIS Program/Project Request

New Sacramento Continuum of Care (CoC) Program/Project

HMIS Program/Project Request

New Yolo Continuum of Care (CoC) Program/Project

HMIS Program/Project Request

Program/Project Manager

HMIS Program/Project Request

Program/Project Lead HMIS User

HMIS Program/Project Request

Program Demographics

HMIS Program Requests

Funding/Contract Information

Provide all applicable Funding Source information below:

Contract Monitor Contact Information

Contract Monitor Contact Information

HMIS Program/Project Request

Program/Project Types

HMIS Program/Project Request

Housing Sites and Inventory

HMIS Program/Project Request

Household Inventory

HMIS Program/Project Request

Bed and Unit Inventory

HMIS Program/Project Request

HMIS Program/Project Request

Rental Subsidies and Vouchers

Provide all applicable Rental Subsidy & Voucher information below:

HMIS Program/Project Request

Default & Optional Services for All Program/Projects

HMIS Program/Project Request

Custom Services for the Program/Project

HMIS Program/Project Request

Coordinated Access System

HMIS Program/Project Request

Coordinated Access System (CAS)

HMIS Program/Project Request

Program/Project Update

HMIS Program Requests

Updating Funding Information

Provide All Funding Sources Below:

Contract Monitor Contact Information

Contract Monitor Contact Information

HMIS Program/Project Request

Program/Project Closure

HMIS Program/Project Request