Continuum of Care Homeless Assistance Grant Application

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Overview

1 - Emergency Shelter
2 - Transitional Housing
3 - Permanent Housing
4 - Safe Haven Housing
5 - Unmet Need
6 - PIT Data Entry
7 - Bed Utilization Rates

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Sheet 1: 1 - Emergency Shelter

Housing Inventory Chart: Emergency Shelters

Total Year-Round Beds - Individuals

KEY: Inventory type

1. Current Year-Round Individual Emergency Shelter (ES) Beds

0

#dv in hmis

C: Current Inventory

1A. Number of DV Year-Round Individual ES Beds

0

0.00

N: New Inventory

1B. Subtotal, non-DV Year-Round Individual ES Beds

0

U: Under development

2. New Year-Round Individual ES beds

0

# u in hmis

3. Under Development Year-Round Individual Beds

0

0

3. Total Year Round Individual ES Beds in HMIS

0

4. HMIS Bed Coverage: Individual ES Beds

KEY: Target Population A and B

Total Year-Round Beds - Families

SM: single males

YF: youth females

5. Current Year-Round Family Emergency Shelter (ES) Beds:

0

#dv in hmis

SF: single females

YMF: youth males and females

5A. Number of DV Year-Round Family ES Beds:

0

0

SMF: single males and females

SMH + HC: Single male and female plus households with children

5B. Subtotal, non-DV Year-Round Family ES Beds

0

CO: couples only, no children

5. New Year-Round Family ES Beds

0

# u in hmis

SMHC: single males and households with children

6. Under Development Year-Round Family ES Beds

0

0

SFHC: single females and households with children

DV - Domestic Violence victims only

7. Total Year-Round Family ES Beds in HMIS

0

HC: households with children

VET - Veterans only

8. HMIS Bed Coverage: Family ES Beds

YM: youth males

HIV - HIV/AIDS populations only

Error Messages

ERROR MSG: PROGRAM DETAILS

None

ERROR MSG: FAMILY BEDS/UNITS

None

ERROR MSG: DV HMIS COVERAGE

None

Program Information

Target Population

HUD Participation Information

All Year-Round Beds/Units

Year-Round Beds covered in HMIS

Seasonal Beds

O/V Beds

#

Provider

Facility Name

Geo Code

Inventory type

A

B

Does this facility receive McKinney-Vento funding?

Data submitted to AHAR?

Family Beds

Family Units

Individual Beds

Total Year-Round Beds

Year-Round Family beds covered in HMIS

Year-Round Individual Beds covered in HMIS

Percentage family beds covered in HMIS

Percentage individual beds covered in HMIS

Total Seasonal Beds

Number Available in HMIS

Availability Start Date

Availability End Date

O/V Beds

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SM

SF

SMF

CO

SMHC

SFHC

HC

YM

YF

YMF

SMF+HC

DV

VET

HIV

Yes

No

Oct-07

Nov-07

Dec-07

Jan-08

Feb-08

Mar-08

Apr-08

May-08

Jun-08

Jul-08

Aug-08

Sep-08

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Sheet 2: 2 - Transitional Housing

Housing Inventory Chart: Transitional Housing

Total Year-Round Beds - Individuals

KEY: Inventory type

1. Current Year-Round Individual Transitional Housing (TH) Beds

0

#dv in hmis

C: Current Inventory

1A. Number of DV Year-Round Individual TH Beds

0

0.00

N: New Inventory

1B. Subtotal, non-DV Year-Round Individual TH Beds

0

U: Under development

2. New Year-Round Individual TH beds

0

# u in hmis

3. Under Development Year-Round Individual Beds

0

0

4. Total Year Round Individual TH Beds in HMIS

0

5. HMISBed Coverage: Individual TH Beds

KEY: Target Population A and B

Total Year-Round Beds - Families

SM: single males

YF: youth females

6. Current Year-Round Family Transitional Housing (TH) Beds:

0

#dv in hmis

SF: single females

YMF: youth males and females

6A. Number of DV Year-Round Family TH Beds:

0

0

SMF: single males and females

SMH + HC: Single male and female plus households with children

6B. Subtotal, non-DV Year-Round Family TH Beds

0

CO: couples only, no children

7. New Year-Round Family TH Beds

0

# u in hmis

SMHC: single males and households with children

8. Under Development Year-Round Family TH Beds

0

0

SFHC: single females and households with children

DV - Domestic Violence victims only

9. Total Year-Round Family TH Beds in HMIS

0

HC: households with children

VET - Veterans only

10. HMIS Bed Coverage: Family TH Beds

YM: youth males

HIV - HIV/AIDS populations only

Error Messages

ERROR MSG: PROGRAM DETAILS

None

ERROR MSG: FAMILY BEDS/UNITS

None

ERROR MSG: DV HMIS COVERAGE

None

Program Information

Target Population

HUD Participation Information

All Year-Round Beds/Units

Year-Round Beds covered in HMIS

#

Provider

Facility Name

Geo Code

Inventory type

A

B

Does this facility receive McKinney-Vento funding?

Data submitted to AHAR?

Family Beds

Family Units

Individual Beds

Total Year-Round Beds

Year-Round Family beds covered in HMIS

Year-Round Individual Beds covered in HMIS

Percentage family beds covered in HMIS

Percentage individual beds covered in HMIS

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SM

SF

SMF

CO

SMHC

SFHC

HC

YM

YF

YMF

SMF+HC

DV

VET

HIV

Yes

No

Oct-07

Nov-07

Dec-07

Jan-08

Feb-08

Mar-08

Apr-08

May-08

Jun-08

Jul-08

Aug-08

Sep-08

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Sheet 3: 3 - Permanent Housing

Housing Inventory Chart: Permanent Supportive Housing

Total Year-Round Beds - Individuals

KEY: Inventory type

1. Current Year-Round Individual Permanent Housing (PH) Beds

0

#dv in hmis

C: Current Inventory

1A. Number of DV Year-Round Individual PH Beds

0

0.00

N: New Inventory

1B. Subtotal, non-DV Year-Round Individual PH Beds

0

U: Under development

2. New Year-Round Individual PH beds

0

# u in hmis

3. Under Development Year-Round Individual Beds

0

0

4. Total Year Round Individual PH Beds in HMIS

0

5. HMIS Bed Coverage: Individual PH Beds

KEY: Target Population A and B

Total Year-Round Beds - Families

SM: single males

YF: youth females

6. Current Year-Round Family Permanent Housing (PH) Beds:

0

#dv in hmis

SF: single females

YMF: youth males and females

6A. Number of DV Year-Round Family PH Beds:

0

0

SMF: single males and females

SMH + HC: Single male and female plus households with children

6B. Subtotal, non-DV Year-Round Family PH Beds

0

CO: couples only, no children

7. New Year-Round Family PH Beds

0

# u in hmis

SMHC: single males and households with children

8. Under Development Year-Round Family PH Beds

0

0

SFHC: single females and households with children

DV - Domestic Violence victims only

9. Total Year-Round Family PH Beds in HMIS

0

HC: households with children

VET - Veterans only

10. HMIS Bed Coverage: Family PH Beds

YM: youth males

HIV - HIV/AIDS populations only

Error Messages

ERROR MSG: PROGRAM DETAILS

None

ERROR MSG: FAMILY BEDS/UNITS

None

ERROR MSG: DV HMIS COVERAGE

None

Program Information

Target Population

HUD Participation Information

All Year-Round Beds/Units

Year-Round Beds covered in HMIS

#

Provider

Facility Name

Geo Code

Inventory type

A

B

Does this facility receive McKinney-Vento funding?

Data submitted to AHAR?

Family Beds

Family Units

Individual Beds

Total Year-Round Beds

Year-Round Family beds covered in HMIS

Year-Round Individual Beds covered in HMIS

Percentage family beds covered in HMIS

Percentage individual beds covered in HMIS

CH Beds

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SM

SF

SMF

CO

SMHC

SFHC

HC

YM

YF

YMF

SMF+HC

DV

VET

HIV

Yes

No

Oct-07

Nov-07

Dec-07

Jan-08

Feb-08

Mar-08

Apr-08

May-08

Jun-08

Jul-08

Aug-08

Sep-08

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Sheet 4: 4 - Safe Haven Housing

Housing Inventory Chart: Safe Havens

Total Year-Round Beds - Individuals

KEY: Inventory type

1. Current Year-Round Individual Safe Haven (SH) Beds

0

#dv in hmis

C: Current Inventory

1A. Number of DV Year-Round Individual SH Beds

0

0.00

N: New Inventory

1B. Subtotal, non-DV Year-Round Individual SH Beds

0

U: Under development

2. New Year-Round Individual SH beds

0

# u in hmis

3. Under Development Year-Round Individual Beds

0

0

4. Total Year Round Individual SH Beds in HMIS

0

5. HMIS Bed Coverage: Individual SH Beds

KEY: Target Population A and B

Total Year-Round Beds - Families

SM: single males

YF: youth females

6. Current Year-Round Family Save Haven (SH) Beds:

0

#dv in hmis

SF: single females

YMF: youth males and females

6A. Number of DV Year-Round Family SH Beds:

0

0

SMF: single males and females

SMH + HC: Single male and female plus households with children

6B. Subtotal, non-DV Year-Round Family SH Beds

0

CO: couples only, no children

7. New Year-Round Family SH Beds

0

# u in hmis

SMHC: single males and households with children

8. Under Development Year-Round Family SH Beds

0

0

SFHC: single females and households with children

DV - Domestic Violence victims only

9. Total Year-Round Family SH Beds in HMIS

0

HC: households with children

VET - Veterans only

10. HMIS Bed Coverage: Family SH Beds

YM: youth males

HIV - HIV/AIDS populations only

Error Messages

ERROR MSG: PROGRAM DETAILS

None

ERROR MSG: FAMILY BEDS/UNITS

None

ERROR MSG: DV HMIS COVERAGE

None

Program Information

Target Population

HUD Participation Information

All Year-Round Beds/Units

Year-Round Beds covered in HMIS

#

Provider

Facility Name

Geo Code

Inventory type

A

B

Does this facility receive McKinney-Vento funding?

Data submitted to AHAR?

Family Beds

Family Units

Individual Beds

Total Year-Round Beds

Year-Round Family beds covered in HMIS

Year-Round Individual Beds covered in HMIS

Percentage family beds covered in HMIS

Percentage individual beds covered in HMIS

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SM

SF

SMF

CO

SMHC

SFHC

HC

YM

YF

YMF

SMF+HC

DV

VET

HIV

Yes

No

Oct-07

Nov-07

Dec-07

Jan-08

Feb-08

Mar-08

Apr-08

May-08

Jun-08

Jul-08

Aug-08

Sep-08

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Sheet 5: 5 - Unmet Need

Housing Inventory Chart: Unmet Need Totals
All Year-Round Beds/Units				Seasonal Beds	Overflow Beds
Family Beds	Family Units	Individual Beds	Total Year-Round Beds	Total Seasonal Beds	Overflow Beds
Emergency Shelters
Transitional Housing
Permanent Supportive Housing
Safe Havens

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Sheet 6: 6 - PIT Data Entry

Sheltered Population Point-in-Time (PIT) Data Entry Worksheet
Provider	Facility Name	January PIT (Required)
		HMIS	Other Methods
		# of sheltered persons on a	# of sheltered persons on a
		night in Jan. 22 - Jan. 31, 2008	night in Jan. 22 - Jan. 31, 2008

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Sheet 7: 7 - Bed Utilization Rates

Provider	Facility Name	Bed Utilization Rates			Program Type	Average Bed Utilization Rates
		HMIS-Based Rate	Other Methods Rate			HMIS-Based Rate	Other Methods Rate
					Emergency Shelters
					Transitional Housing
					Permanent Supportive Housing
					Safe Havens