Update HMIS Program Request

Update HMIS Program Request

For requesting updates to your program or notifying HMIS that your program has closed
Date

MonthDayYear
Date
Hour MinutesAM/PM Option
Please fill out this form to request an update to your existing program or to notify us that you need to close your program. Upon receiving your submission, we will reach out to you to discuss your request.
Name of Person Completing this Request*
Email of Person Completing this Request:*
Work Email Address Only
Please select the CoC the program is associated with:*

Sacramento Continuum of Care (CoC)Yolo Continuum of Care (CoC)
Please select your HMIS Participating Agency (Sac CoC):
Please select your HMIS Participating Agency (Yolo CoC):
HMIS Program Name*
Please input the name exactly as it appears in HMIS
Please select the type of program request below:*

Program needs updates in HMISProgram needs to be closed in HMIS
Please note - this form is for requesting updates to an existing program. If you need to request a new program be built in HMIS, please use our HMIS New Program Request form. If you have any questions, please email HMIS.

Requesting a Program Update

Name, Start Date, Descriptions, Populations Served, etc
Do you need to update your program's name, contact information, or Responsible Staff?*

Yes, we need to update our program's name and/or contact informationYes, we need to update our program's Responsible StaffNo, we do not need to make these kinds of updates.
Program Name:
Program Phone Number:
Please enter a valid phone number.
Program Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is this request connected to any larger changes with your 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

Coordinated Access System (CAS)

Programs Receiving Referrals from Sacramento CoC CAS
Do you want to make changes to your program's CAS Referral Participation Status?*

Yes, we'd like to start receiving referrals from SSF's Coordinated Access System.Yes, we'd like to stop receiving referrals from SSF's Coordinated Access System.No, we have no changes to the program's CAS participation status
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?

YesNoI don't know
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 a list of your eligibility criteria:
Common criteria include housing status, age, income threshold, specific populations, criminal history, etc.
Responsible Staff for CAS Referrals

Enter the contact information for at least one staff member to collaborate on CAS referrals
Please provide additional information about your request to begin accepting CAS referrals. Have you been in contact with anyone from the CAS team?
When do you want to stop receiving referrals from the CAS Team?

MonthDayYear
Date
Please provide additional information about your request to no longer accept CAS referrals. Have you talked to anyone from the CAS team about this change?

Program Services

Recording the Right Data to Provide Program Insight
Do you want to make changes to your program's available services?*

Yes, we'd like to add new services to this program.Yes, we'd like to remove some services from this program.No, we have no changes to the program's available 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 so you let us know if there are any additional services you want included in your program.

HMIS Default Service Lists by Special Funding Type
HMIS Default Service Lists by Program Type
Which services would you like to add to your progam?
Which services would you like removed from your program?

Additional Program Information
Please use this space if your type of update was not covered in the sections above or you have additional information you'd like to provide to us.
Move to Final Page

YesNo

Program Closure Request
This page is designed to gather the information we need to close down your program in HMIS. HMIS cannot set a closure date in the future, so you will need to have exited all clients before you submit this form.

Data Quality Reminder: Please make sure that all client exits are either before or on the day of the program's closure.
Date

MonthDayYear
Date
Please explain why the program is closing and provide any other information that may be helpful to HMIS to process this request.
Will you need to build a new program to take the place of this one?

YesNo
Once you submit this program closure request, please go to our HMIS New Program Request form to submit information about the program you would like to build.

If you have any questions, please email HMIS.

Thank you for providing us information about your program. To send your closure or update request to HMIS, please hit the submit button below. If you have questions or need assistance, please email HMIS.
Should be Empty:

Update HMIS Program Request

Requesting a Program Update

Coordinated Access System (CAS)

Responsible Staff for CAS Referrals

HMIS Bed and Unit Inventory

Program Services

Program Funding Sources

Additional Program Information

Program Closure Request