• New HMIS Program Request

    New HMIS Program Request

  • Date
     - -
    2 digit month, 2 digit day, 4 digit year

  • Please fill out this form to request a new HMIS program. Upon receiving your submission, we will schedule a meeting to discuss your request.

    If you need more information about becoming an HMIS Participating Agency, please visit our Participate in HMIS webpage. If you have any questions, please email HMIS.

  • Please note - this form is for requesting a new program be built in HMIS.  If you need to update your program or notify us that a program is closing, please use our HMIS Program Update or Closure request form.

  • Program Details

    Program Details

    Name, Start Date, Descriptions, Populations Served, etc
  • Please select the Continuum of Care (CoC) your organization is associated with:*
  • Format: (000) 000-0000.
  • Please provide the geocode associated with the program's address.
  • Please provide the geocode associated with the program's address.
  • Is this program a partnership between multiple agencies?*
  • Does this program have a County or City contract monitor who oversees its funding (e.g., BHBH or BHSA)?*
  • When will or when did this program begin serving clients? *
     - -
    2 digit month, 2 digit day, 4 digit year
  • What population(s) does your program serve? Please use the definitions below if needed to answer this question.*
    • HUD Definition of Literally Homelessness
    • HUD Definition of At Risk of Homelessness
  • Will this program be receiving referrals from Sacramento Steps Forward's Coordinated Entry Team?
  • Coordinated Entry System

    Coordinated Entry System

    CES or CAS

  • This page is designed to gather information from Sacramento CoC based programs that will be receiving referrals from the SSF Coordinated Entry System.  If your program is NOT receiving referrals, please use the back button below to go back to the previous page and correct your answer to the question about receiving Coordinated Entry referrals.

  • When do you want to start receiving referrals from the Coordinated Entry Team? *
     - -
    2 digit month, 2 digit day, 4 digit year
  • Will you want to utilize the intake appointment feature in HMIS?*

  • Coordinated Entry System Program Eligibility Requirements

  • Household Types Served (check all that apply)
  • Housing Status at Entry Requirement (per HUD Definitions) (check all that apply
  • Age Requirements for Head of Household
  • Gender Requirements (HoH)
  • Vulnerable Populations (HoH)
  • Household Size Requirements (leave blank if not applicable)*
    Rows
  • Income Requirements: Maximum Allowed AMI (by Percentage)

  • HEALTH RESTRICTIONS OR REQUIREMENTS

    This section will cover any eligibility limitations restrictions for your program.
  • Can your program accommodate clients with mobility impairments?
  • Can your program accommodate clients who use medical devices, equipment, and/or supplies?
  • Can your program accommodate clients who require assistance with medical or personal care needs?
  • Restrictions Related to 290 Status
  • Restrictions Related to Violent Crime Convictions
  • Restrictions Related to Arson Convictions

  • Responsible Staff for Coordinated Entry Referrals

    Enter the contact information for at least one staff member to collaborate on referrals
  • Responsible Staff for Referrals
  • Program Responsible Staff

    Program Responsible Staff

  • SSF requires that all programs identify at least two individuals who can act as Responsible Staff for this particular program. Responsible Staff should be well versed in the program and able to respond to any questions about program utilization and data quality that arise. Responsible Staff are also tasked with keeping HMIS updated with program information and updates to HMIS access needs for HMIS end users working in this program.

  • Responsible Staff Member

  • All Responsible Staff members must be active HMIS users.  If the staff member is not yet an active HMIS user, please submit a request for access on their behalf.

  • Leadership Without HMIS Access

    While all Responsible Staff must be active HMIS users, there are often times when there is a Program Manager or other leadership role who is responsible for the performance and accuracy of a program but does not need HMIS access.  Please use the space below to provide their contact information.

  • Program Manager or other Leader with no HMIS Access
  • HMIS Program Types

    HMIS Program Types

  • The following program type definitions are aligned with the Sacramento CoC Community Standards & HUD Guidance. For more information on the below program types, please review the Sacramento Community Standards and HUD Exchange Project Components Overview.

  • Please select the MOST appropriate Program Type:*
  • What is your Method of Tracking for Emergency Shelter?
  • Is your SSO or RRH-SO program affiliated with a residential program (i.e. PSH program)?

  • HOUSING SITE CONFIGURATION

    When documenting the housing inventory, HMIS needs to understand how your housing site is configured.  Please answer the questions below to help us understand what kind of housing support your program is offering.

  • How is the program's housing site(s) configured?
  • For your tenant-based housing sites, how does your program provide rental support?
  • Housing Inventory

    Housing Inventory

    Physical Beds and Housing Vouchers

  • If you are unfamiliar with any of the concepts in this list, please review our Housing Inventory Training Resource before filling out your program's housing inventory information.

    • Difference between Bed and Unit Definitions per HUD
    • Household Types: Households without Children, Households with Children, Households with Children Only*
    • Dedicated vs. Non-Dedicated Beds: Identifying any beds specifically dedicated to youth, veterans, and clients experiencing chronic homelessness
    • Rapid Re-Housing Inventory: Calculating bed and unit inventory in housing programs without physical bed spaces.
    • Rental Vouchers: Calculating bed and unit inventory in housing programs without physical bed spaces.

    * Only a very small number of programs - like runaway youth programs - will serve Households with Children Only.  Programs that serve minors without accompanying adults are the only programs that will choose this household type.

    VOUCHERS
    If your program has a set number of housing vouchers that you provide to clients, please use the number of vouchers you have available as the number of households that you expect to serve.

  • Household Types

  • What types of households will your program serve? Please choose all that apply.*

  • Adult Only Households (All Clients 18 Years or Older)

  • AO: What is the Inventory Start Date?
     - -
    2 digit month, 2 digit day, 4 digit year
  • AO: Do you have any beds that are dedicated (only used for) for TAY, Chronically Homeless, or Veteran clients? Click all that apply.

  • Households with Children (Adult Clients and Clients under 18 Years Old)

  • HwC: What is the Inventory Start Date?
     - -
    2 digit month, 2 digit day, 4 digit year
  • HwC: Do you have any beds that are dedicated (only used for) for TAY, Chronically Homeless, or Veteran clients? Click all that apply.

  • Children Only Households (All Clients under 18 Years Old)

  • CO: What is the Inventory Start Date?
     - -
    2 digit month, 2 digit day, 4 digit year
  • CO: Do you have any beds that are DEDICATED (only used for) for veterans?
  • Housing Inventory Continued

    Housing Inventory Continued

  • This page is designed to gather housing inventory information for programs who have an annual budget for rental subsidies and vouchers.

    If you have physical beds or have a set number of vouchers for your program, please use the back button below to go back to the previous page and correct your answer to the question about housing site configuration.

  • Which household types do you serve?
  • Please input the approximate percentage of each household type you anticipate serving. For any household types you are not serving, please leave the slider at 0%. When you are done, your total percentage of clients should equal 100%
  • Program Data Needs

    Program Data Needs

    Services, Funding Sources, Outcome Reporting

  • When creating your program in HMIS, you need to consider the data you need to manage your program and provide whatever federal, state, or funding based reporting you need. HMIS needs to configure your program correctly when we build it so your organization has the data it needs to successfully measure your program outcomes.

    For this reason, the HMIS teams needs information about your program funding sources and direction about which services you will need to be tracking in the system.  The page below is broken down into three parts:

    1. An open ended question about your expectation for program outcome reporting
    2. Lists of default services that will help you see what will already be present in your program.  We request that you review the document(s) and consider any additional services you'd like to add so we can discuss this during our meeting after the program is built
    3. A selection where we will be asking for detailed information about your funding including grant identifiers

  • 1. Open Ended Question

  • 2. Lists of Default Program Services

  • There are many different types of program in our HMIS.  To support these programs, we have created templates with default program services customized for different funding sources and program types.  Please review the Default Services Lists below that pertain to your program type and funding source.  At your program review, please be prepared to lust us know if there are any additional services you want included in your program or default services you would like to exclude.  

    SPECIAL FUNDING TYPES

    • CalAIM-ECM Funding Default Services List
    • CalAIM-CS Funding Default Services List
    • SSVF Rapid Re-Housing Default Services List
    • SSVF Homeless Prevention Default Services List

    HMIS DEFAULT SERVICES BY PROGRAM TYPE

    • Emergency Shelter Entry/Exit (ES E/E)
    • Emergency Shelter Night by Night (ES NbN)
    • Homeless Prevention (HP)
    • Permanent Housing (PH)
    • Permanent Supportive Housing (PSH)
    • Rapid Re-Housing (RRH)
    • Rapid Re-Housing Services Only (RRH-SO)
    • Street Outreach (SO)
    • Supportive Services Only (SSO)
    • Transitional Housing (TH)

  • 3. Funding and Contract Information

  • *

  • Thank you for providing us information about your new program.  To send this information to HMIS, please hit the submit button below.  If you have questions or need assistance, please email HMIS.

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