Table 1A Homeless and Special Needs Populations

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Table 1A
Homeless and Special Needs Populations

Continuum of Care:  Housing Gap Analysis Chart


Current Inventory 
Under Development  
Unmet Need/
Gap

Individuals

Example

Emergency Shelter

100

40

26

Emergency Shelter



Beds
Transitional Housing




Permanent Supportive Housing




Total




Persons in Families With Children

Emergency Shelter



Beds
Transitional Housing




Permanent Supportive Housing




Total





Continuum of Care:  Homeless Population and Subpopulations Chart


Part 1: Homeless Population
Sheltered
Unsheltered
Total

Emergency
Transitional


Number of Families with Children (Family Households):




1. Number of Persons in Families with Children




2. Number of Single Individuals and Persons in Households without children




(Add Lines Numbered 1 & 2 Total Persons)




Part 2: Homeless Subpopulations

Sheltered

Unsheltered

Total
a.  Chronically Homeless



b.  Seriously Mentally Ill


c.  Chronic Substance Abuse


d.  Veterans


e.  Persons with HIV/AIDS


f.  Victims of Domestic Violence


g.  Unaccompanied Youth (Under 18)









Optional Continuum of Care Homeless Housing Activity Chart:


Optional Continuum of Care Homeless Housing Activity Chart Instructions

Column Name 
Provider Name:  Self-explanatory.
Facility Name:  Self-explanatory. 
HMIS: Enter one of the following three codes for each project concerning its participation in the Continuum of Care’s HMIS. 
C=Currently entering client data into the HMIS; P-Month/year (P-4/04) = Planned month/year that the program will begin entering client data into the HMIS; and N=the program currently does not plan to participate in the HMIS.  

Geo Code: Indicate the Geographic Area Code (Geo Code) for the project.  Where there is only one geographic code for the Continuum, check the box and indicate that code in the first project only.  If the project is located in multiple jurisdictions, select the jurisdiction where the majority of the provider’s inventory is located.  

Target Population A:  Select the code that best represents your project: SM= only Single Males (18 years and older); SF= only Single Females (18 years and older); SMF= only Single Males and Females (18 years and older with no children); FC= only Families with Children; YM= only unaccompanied Young Males (under 18 years); YF= only unaccompanied Young Females (under 18 years); YMF= only unaccompanied Young Males and Females (under 18 years); M= mixed populations.   Only one code should be used per facility.  If more than one group is served use the M=mixed populations code   

Target Population B:  Indicate whether the project serves these additional characteristics: DV= only Domestic Violence victims; VET= only Veterans, and AIDS= only persons with HIV/AIDS.

2010 Year-Round Units/Beds: 
     Family Units: Enter the number of units that the project set-aside for serving families. 
     Family Beds: Enter the number of beds that are contained in family units. 
     Individual Beds: Enter the number of beds serving individuals. 

2010 All Beds (Emergency Shelters Only) 
Emergency shelters are usually structures with year-round beds, but there are structures with seasonal beds that are made available to homeless persons during particularly high-demand seasons of the year, usually wintertime.  In addition, projects may have overflow capacity that includes cots or mats in addition to permanent bed capacity that is not ordinarily available but can be marshaled when demand is especially great, for example, on the coldest nights of the year. Vouchers are to be identified under overflow beds.  The total number of year-round, seasonal and overflow beds would provide a point-in-time snapshot of the housing inventory for homeless people at its highest point in  the year. 
Year-Round Beds: The number of family beds in (column “Family Beds”) plus the number of beds for individuals (column “Individual Beds”). 
Seasonal Beds: The number of beds made available to individuals and families on a seasonal basis. 
Overflow Beds: The number of beds, mats or spaces or vouchers that are made available on a very temporary basis. 
Current Inventory: List all facilities and voucher programs that are currently operating.
Under Development: List all the projects that are fully funded but are not yet serving homeless people. 	


Optional Continuum of Care Homeless Service Activity Chart:

Using the format below, describe the fundamental service components of your Continuum of Care system currently in place, and any additional services being planned.  

Fundamental Components in Continuum of Care System -- Service Activity Chart

Component:  Prevention
Services in place:  Please arrange by category (e.g., rental/mortgage assistance), being sure to identify the service provider.
Services planned:
How persons access/receive assistance:


Component:  Outreach
Outreach in place:  (1) Please describe the outreach activities for homeless persons who are living on the streets in your Continuum of Care area and how they are connected to services and housing.
(2) Describe the outreach activities that occur for other homeless persons. 
Outreach planned:  Describe any planned outreach activities for (1) persons living on the streets; and (2) for other homeless persons.


Component:  Supportive Services
Services in place:  Please describe how each of the following services are provided in your community (as applicable): case management, life skills, alcohol and drug abuse treatment, mental health treatment, AIDS-related treatment, education, employment assistance, child care, transportation, and other.
Services planned:
How homeless persons access/receive assistance:



Table 1B
SPECIAL NEEDS SUBPOPULATIONS
Priority Need Level 
High, Medium, Low,
No Such Need 

Unmet 
Need
Dollars to Address
Unmet Need

Multi-Year
Goals

Annual Goals
Elderly





Frail Elderly





Severe Mental Illness





Developmentally Disabled





Physically Disabled





Persons w/ Alcohol/Other Drug Addictions





Persons w/HIV/AIDS





Victims of Domestic Violence





Other











TOTAL






Table 1C   Summary of Specific Objectives

Grantee Name:					

Decent Housing with Purpose of New or Improved Availability/Accessibility  (DH-1)
Specific Objective
Source of Funds
Year
Performance
Indicators
Expected
Number
Actual Number
Percent Completed
DH1.1


2010
2011
2012
2013
2014







   %
   %
   %
   %
   %



MULTI-YEAR GOAL


   %
Decent Housing with Purpose of New or Improved Affordability  (DH-2)
DH2.1


2010
2011
2012
2013
2014







   %
   %
   %
   %
   %



MULTI-YEAR GOAL


   %
Decent Housing with Purpose of New or Improved Sustainability  (DH-3)
DH3.1


2010
2011
2012
2013
2014






   %
   %
   %
   %
   %



MULTI-YEAR GOAL


   %
Suitable Living Environment with Purpose of New or Improved Suitable Living Environment  (SL-1)
SL1.1


2010
2011
2012
2013
2014







   %
   %
   %
   %
   %



MULTI-YEAR GOAL


   %
Suitable Living Environment with Purpose of New or Improved Affordability  (SL-2)
SL2.1


2010
2011
2012
2013
2014











   %
   %
   %
   %
   %



MULTI-YEAR GOAL


   %
Suitable Living Environment with Purpose of New or Improved Sustainability  (SL-3)
SL3.1


2010
2011
2012
2013
2014







   %
   %
   %
   %
   %



MULTI-YEAR GOAL


   %

Table 1C  Summary of Specific Objectives

Grantee Name:					

Economic Opportunity with Purpose of New or Improved Availability/Accessibility  (EO-1)
Specific Objective
Source of Funds
Year
Performance
Indicators
Expected
Number
Actual Number
Percent Completed
EO1.1


2010
2011
2012
2013
2014







   %
   %
   %
   %
   %



MULTI-YEAR GOAL


   %
Economic Opportunity with Purpose of New or Improved Affordability  (EO-2)
EO2.1


2010
2011
2012
2013
2014







   %
   %
   %
   %
   %



MULTI-YEAR GOAL


   %
Economic Opportunity with Purpose of New or Improved Sustainability  (EO-3)
EO3.1


2010
2011
2012
2013
2014






   %
   %
   %
   %
   %



MULTI-YEAR GOAL


   %
Neighborhood Revitalization  (NR-1)
NR1.1


2010
2011
2012
2013
2014







   %
   %
   %
   %
   %



MULTI-YEAR GOAL


   %
Other  (O-1)
O
1.1


2010
2011
2012
2013
2014











   %
   %
   %
   %
   %



MULTI-YEAR GOAL


   %
Other (O-2)
O
2.1


2010
2011
2012
2013
2014







   %
   %
   %
   %
   %



MULTI-YEAR GOAL


   %


Table 2A
Priority Housing Needs/Investment Plan Table

PRIORITY HOUSING NEEDS
(households)
Priority 

Unmet Need



0-30%



Small Related
31-50%




51-80%




0-30%



Large Related
31-50%




51-80%


Renter

0-30%



Elderly
31-50%




51-80%




0-30%



All Other
31-50%




51-80%




0-30%



Small Related
31-50%




Owner


51-80%




0-30%



Large Related
31-50%


Owner

51-80%




0-30%



Elderly
31-50%




51-80%




0-30%



All Other
31-50%




51-80%





Non-Homeless
Special Needs
  
Elderly
0-80%



Frail Elderly
0-80%



Severe Mental Illness
0-80%



Physical Disability
0-80%



Developmental Disability
0-80%



Alcohol/Drug Abuse
0-80%



HIV/AIDS
0-80%



Victims of Domestic Violence
0-80%





Table 2A
Priority Housing Needs/Investment Plan Goals 

Priority Need 
5-Yr.
Goal
Plan/Act
Yr. 1
Goal
Plan/Act
Yr. 2
Goal
Plan/Act
Yr. 3
Goal
Plan/Act
Yr. 4
Goal
Plan/Act
Yr. 5
Goal
Plan/Act
Renters






   0 - 30 of MFI






  31 - 50% of MFI






  51 - 80% of MFI






Owners






   0 - 30 of MFI






  31 - 50 of MFI






  51 - 80% of MFI






Homeless*






  Individuals






  Families






Non-Homeless Special Needs 






  Elderly






  Frail Elderly






  Severe Mental Illness






  Physical Disability






  Developmental Disability






  Alcohol/Drug Abuse






  HIV/AIDS






  Victims of Domestic Violence






Total






Total Section 215






  212 Renter






  215 Owner






* Homeless individuals and families assisted with transitional and permanent housing
Table 2A
         Priority Housing Activities

Priority Need 
5-Yr.
Goal
Plan/Act
Yr. 1
Goal
Plan/Act
Yr. 2
Goal
Plan/Act
Yr. 3
Goal
Plan/Act
Yr. 4
Goal
Plan/Act
Yr. 5
Goal
Plan/Act
CDBG






Acquisition of existing rental units






Production of new rental units 






Rehabilitation of existing rental units






Rental assistance






Acquisition of existing owner units






Production of new owner units






Rehabilitation of existing owner units






Homeownership assistance






HOME






Acquisition of existing rental units






Production of new rental units 






Rehabilitation of existing rental units






Rental assistance






Acquisition of existing owner units






Production of new owner units






Rehabilitation of existing owner units






Homeownership assistance






HOPWA






Rental assistance






Short term rent/mortgage utility payments






Facility based housing development






Facility based housing operations 






Supportive services 






Other





























Table 2C   Summary of Specific Objectives 
Grantee Name:					

Decent Housing with Purpose of New or Improved Availability/Accessibility  (DH-1)
Specific Objective
Source of Funds
Year
Performance
Indicators
Expected
Number
Actual Number
Percent Completed
DH1.1


2010
2011
2012
2013
2014







   %
   %
   %
   %
   %



MULTI-YEAR GOAL


   %
Decent Housing with Purpose of New or Improved Affordability  (DH-2)
DH2.1


2010
2011
2012
2013
2014







   %
   %
   %
   %
   %



MULTI-YEAR GOAL


   %
Decent Housing with Purpose of New or Improved Sustainability  (DH-3)
DH3.1


2010
2011
2012
2013
2014






   %
   %
   %
   %
   %



MULTI-YEAR GOAL


   %
Suitable Living Environment with Purpose of New or Improved Availability/Accessibility  (SL-1)
SL1.1


2010
2011
2012
2013
2014







   %
   %
   %
   %
   %



MULTI-YEAR GOAL


   %
Suitable Living Environment with Purpose of New or Improved Affordability  (SL-2)
SL2.1


2010
2011
2012
2013
2014











   %
   %
   %
   %
   %



MULTI-YEAR GOAL


   %
Suitable Living Environment with Purpose of New or Improved Sustainability  (SL-3)
SL3.1


2010
2011
2012
2013
2014







   %
   %
   %
   %
   %



MULTI-YEAR GOAL


   %


Grantee Name:					

Economic Opportunity with Purpose of New or Improved Availability/Accessibility  (EO-1)
Specific Objective
Source of Funds
Year
Performance
Indicators
Expected
Number
Actual Number
Percent Completed
EO1.1


2010
2011
2012
2013
2014







   %
   %
   %
   %
   %



MULTI-YEAR GOAL


   %
Economic Opportunity with Purpose of New or Improved Affordability  (EO-2)
EO2.1


2010
2011
2012
2013
2014







   %
   %
   %
   %
   %



MULTI-YEAR GOAL


   %
Economic Opportunity with Purpose of New or Improved Sustainability  (EO-3)
EO3.1


2010
2011
2012
2013
2014






   %
   %
   %
   %
   %



MULTI-YEAR GOAL


   %
Neighborhood Revitalization  (NR-1)
NR1.1


2010
2011
2012
2013
2014







   %
   %
   %
   %
   %



MULTI-YEAR GOAL


   %
Other  (O-1)
O
1.1


2010
2011
2012
2013
2014











   %
   %
   %
   %
   %



MULTI-YEAR GOAL


   %
Other (O-2)
O
2.1


2010
2011
2012
2013
2014







   %
   %
   %
   %
   %



MULTI-YEAR GOAL


   %

Table 3A  Summary of Specific Annual Objectives

Grantee Name:					

Decent Housing with Purpose of New or Improved Availability/Accessibility (DH-1)
Specific Annual Objective
Source of Funds
Year
Performance
Indicators
Expected
Number
Actual Number
Percent Completed
DH1.1


2010
2011
2012
2013
2014







   %
   %
   %
   %
   %



MULTI-YEAR GOAL


   %
Decent Housing with Purpose of New or Improved Affordability  (DH-2)
DH2.1


2010
2011
2012
2013
2014







   %
   %
   %
   %
   %



MULTI-YEAR GOAL


   %
Decent Housing with Purpose of New or Improved Sustainability  (DH-3)
DH3.1


2010
2011
2012
2013
2014






   %
   %
   %
   %
   %



MULTI-YEAR GOAL


   %
Suitable Living Environment with Purpose of New or Improved Availability/Accessibility  (SL-1)
SL1.1


2010
2011
2012
2013
2014







   %
   %
   %
   %
   %



MULTI-YEAR GOAL


   %
Suitable Living Environment with Purpose of New or Improved Affordability  (SL-2)
SL2.1


2010
2011
2012
2013
2014











   %
   %
   %
   %
   %



MULTI-YEAR GOAL


   %
Suitable Living Environment with Purpose of New or Improved Sustainability  (SL-3)
SL3.1


2010
2011
2012
2013
2014







   %
   %
   %
   %
   %



MULTI-YEAR GOAL


   %

Table 3A  Summary of Specific Annual Objectives

Grantee Name:					

Economic Opportunity with Purpose of New or Improved Availability/Accessibility  (EO-1)
Specific Annual Objective
Source of Funds
Year
Performance
Indicators
Expected
Number
Actual Number
Percent Completed
EO1.1


2010
2011
2012
2013
2014







   %
   %
   %
   %
   %



MULTI-YEAR GOAL


   %
Economic Opportunity with Purpose of New or Improved Affordability  (EO-2)
EO2.1


2010
2011
2012
2013
2014







   %
   %
   %
   %
   %



MULTI-YEAR GOAL


   %
Economic Opportunity with Purpose of New or Improved Sustainability  (EO-3)
EO3.1


2010
2011
2012
2013
2014






   %
   %
   %
   %
   %



MULTI-YEAR GOAL


   %
Neighborhood Revitalization  (NR-1)
NR1.1


2010
2011
2012
2013
2014







   %
   %
   %
   %
   %



MULTI-YEAR GOAL


   %
Other  (O-1)
O
1.1


2010
2011
2012
2013
2014











   %
   %
   %
   %
   %



MULTI-YEAR GOAL


   %
Other (O-2)
O
2.1


2010
2011
2012
2013
2014







   %
   %
   %
   %
   %



MULTI-YEAR GOAL


   %


Table 3B
Annual Housing Completion Goals
Grantee Name:

Program Year:
Expected Annual Number of Units
To Be Completed 
Actual Annual 
Number of Units
Completed
Resources used during the period 




CDBG

HOME

ESG

HOPWA
BENEFICIARY GOALS 
(Sec. 215 Only)






   Homeless households






   Non-homeless households






   Special needs households






Total Sec. 215 Beneficiaries*






RENTAL GOALS 
(Sec. 215 Only)






   Acquisition of existing units






   Production of new units






   Rehabilitation of existing units






   Rental Assistance






Total Sec. 215 Affordable Rental






HOME OWNER GOALS  
(Sec. 215 Only) 






   Acquisition of existing units






   Production of new units






   Rehabilitation of existing units






   Homebuyer Assistance






Total Sec. 215 Affordable Owner






COMBINED RENTAL AND OWNER GOALS  (Sec. 215 Only) 






   Acquisition of existing units






   Production of new units






   Rehabilitation of existing units






   Rental Assistance






   Homebuyer Assistance






Combined Total Sec. 215 Goals*






OVERALL HOUSING GOALS
(Sec. 215 + Other Affordable Housing)






   Annual Rental Housing Goal






   Annual Owner Housing Goal






Total Overall Housing Goal







Table 4
Priority Public Housing Needs
Local Jurisdiction 

Public Housing Need Category

PHA Priority Need Level
High, Medium, Low, No Such Need

Estimated Dollars To Address 
Restoration and Revitalization


Capital Improvements


Modernization


Rehabilitation


Other (Specify)











Management and Operations











Improved Living Environment


Neighborhood Revitalization (non-capital)


Capital Improvements


Safety/Crime Prevention/Drug Elimination


Other (Specify)








Economic Opportunity


Resident Services/ Family Self Sufficiency


Other (Specify)

















Total