| The Paperwork Reduction Act Statement: This collection of information is voluntary and will be used to evaluate the effectiveness of the Family Unification Program.[3] Public reporting burden for this collection of information is estimated to average 10 minutes per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB number and expiration date for this collection are OMB #: 0970-XXXX, Exp: XX/XX/XXXX. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to Michael Pergamit at [email protected]. | |||||||
| Instructions: | |||||||
| This information is being collected to inform the evaluation of the Family Unification Program (FUP) being conducted by a research team at the Urban Institute, Chapin Hall at the University of Chicago and Child Trends. This information will be used to inform the US Department of Health and Human Services Administration for Children and Families (HHS ACF) and the US Department of Housing and Urban Development to improve the administration of the FUP program. All the information you provide will be kept private to the extent permitted by law. |
| OMB Control # 0970 – XXXX and Expiration Date: XX/XX/XXXX. | ||||||||||||||||||||||||
| ID | Date certified | Eligible (yes/no) | Ineligible Reason | RA Date | Treatment Status | Date referred | Referring Agency | Case Management Provider | Date of Application Submission | Date of Housing Orientation | Attended Housing Orientation | Date of Voucher Issuance | Date of Voucher Denial | If Denied, Denial Reason | Date of Lease Up | Voucher type | FSS Start Date | FSS End Date | Date of Housing Exit | Housing Exit Reason | Date of re-entry to housing | Date of Voucher Loss | Voucher Loss Reason | Date Ported Out |
| Project ID | Date child welfare eligibility certified | Yes if eligible, no if ineligible | Reason found ineligible, e.g. sex offender in household | Date randomized | Treatment or control | Date referral sent to housing authority | Agency or organization that referred the family to FUP | Agency or organization providing on-going case management services | Date application was submitted to the housing authority | Date of voucher orientation | Yes if FUP family attended no if did not attend | Date of Voucher Issuance | Date denied a voucher | Voucher denial reason, e.g. sex offender in the household | Date of first lease up in housing with voucher | Tenant-based or project-based | Start date if participating in Family Self Sufficiency Program | End date if participating in Family Self Sufficiency Program | Date exited first housing | Reason exited, e.g. evicted | Date re-entered housing after a housing exit | Date lost voucher | Reason for voucher loss, e.g. over income | Date ported voucher out to a different jurisdiction |
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |