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pdfOMB Approval Number: 2501-0034
Expiration Date: XX/XX/XXXX
HUD Standards for Success
Participant Record-Level Information
Key for Applicable HUD Programs: Family Self-Sufficiency Program (FSS); Jobs Plus Program (Jobs+), Juvenile Reentry Assistance Program (JRAP), Housing Counseling Program (HC), Housing Opportunities for Persons with AIDS
Program (HOPWA), Lead Based Paint Hazard Control Program (LBPHC), Lead Hazard Reduction Demo Program
(LHRD), Multifamily Housing Service Coordinator Program (MFH), Resident Opportunity and Self-Sufficiency Service
Coordinator Program (ROSS).
Fixed
ID
i.
Indicator
Number1
N/A
Data Element Name
Data Element Description
Response Options
Grant Number
The unique number identifying the
grants as listed in award document.
The unique number identifying
the grant.
ii.
N/A
Grantee DUNS
Number
iii.
N/A
Grant Appropriation
Fiscal Year
The unique, non-indicative identifier
issued by D&B and used by sam.gov
to verify business entity.
The year of appropriation for the
Federal funds awarded.
The 9-digit DUNS number
assigned to the grantee's
business. Omit dashes (-).
The year of appropriation in a
YYYY format.
iv.
N/A
Budget-Based
Funding Type
If the property pays for the service
coordinator via the property budget
rather than a grant, indicate the
source of funding.
v.
N/A
The 5-digit CFDA number for the
grant award.
vi.
N/A
Catalog of Federal
Domestic Assistance
Number
Reporting Period
Beginning Date
1 = PRAC
2 = Section 8
3 = Residual Receipts
4 = Section 236
5 = Debt Service Savings
The CFDA number in a XXXXX
format. Omit the period (.).
vii.
N/A
Reporting Period End
Date
The end date for the reporting
period.
viii.
N/A
ix.
N/A
202 Property
Designation
Resident Population
The property primarily designated
for elderly residents.
The populations the property
serves.
x.
N/A
Number of Units
The number of units that are on the
property.
1
2
The begin date for the reporting
period.
The beginning date for the
reporting period in YYYY-MMDD format.
The ending date for the
reporting period in a YYYY-MMDD format.
1 = Yes
2 = No
1 = Elderly
2 = Disabled
3 = Families
Whole number
Applicable HUD
Programs2
FSS, Jobs+, JRAP, HC,
HOPWA, LBPHC,
LHRD, MFH, ROSS
FSS, Jobs+, JRAP, HC,
HOPWA, LBPHC,
LHRD, MFH, ROSS
FSS, Jobs+, JRAP, HC,
HOPWA, LBPHC,
LHRD, MFH, ROSS
MFH
FSS, Jobs+, JRAP, HC,
HOPWA, LBPHC,
LHRD, MFH, ROSS
FSS, Jobs+, JRAP, HC,
HOPWA, LBPHC,
LHRD, MFH, ROSS
FSS, Jobs+, JRAP, HC,
HOPWA, LBPHC,
LHRD, MFH, ROSS
MFH
MFH
MFH
N/A includes demographic and other descriptive attributes of interest.
Bold font indicates program currently utilizes HUD-PRL for reporting.
HUD Standards for Success
Participant Record-Level Information
Page 1 of 25
HUD-PRL - Approved XX/XX/XXXX
OMB Approval Number: 2501-0034
Expiration Date: XX/XX/XXXX
Fixed
ID
xi.
Indicator
Number
N/A
Data Element Name
Data Element Description
Response Options
Number of
Subsidized Units
Number of Service
Coordinators Worked
Number of Service
Coordinator Hours
Worked
Wage of Service
Coordinators
Additional Funding
The number of subsidized units that
are on the property.
The number of service coordinators
that work on the property.
The number of hours worked per
service coordinator.
Whole number
Applicable HUD
Programs
MFH
xii.
N/A
Whole number
MFH
xiii.
N/A
Whole number with fraction
MFH
xiv.
N/A
The average wage (USD/hour) of
service coordinators
The property receives any of the
following outside funding to help
with the service coordination
program.
MFH
N/A
Property Ownership
Entity
IREMS Number
Nine-digit number beginning
with the number 8.
MFH
N/A
FHA Number
Enter the owner entity name for the
property.
This (property ID) is a HUD number
that every property has, which
remains unchanged even if the
property changes ownership.
Federal Housing Administration
Number.
Whole number with two
decimal places.
1 = Tax Credit
2 = Building Operations
(non Section 8)
3 = Non HUD Grant
4 = Private Funding
5 = Foundation
6 = Other
Text, up to 200 characters
xv.
N/A
xvi.
N/A
xvii.
xviii.
Whole number
MFH
HUD Standards for Success
Participant Record-Level Information
MFH
MFH
Page 2 of 25
HUD-PRL - Approved XX/XX/XXXX
OMB Approval Number: 2501-0034
Expiration Date: XX/XX/XXXX
Fixed
ID
1.
Indicator
Number
N/A
2.
N/A
3.
N/A
4.
N/A
5.
N/A
6.
N/A
7.
N/A
Data Element Name
Data Element Description
Person Identifier
Response Options
Applicable HUD
Programs
FSS, Jobs+, JRAP, HC,
HOPWA, LBPHC,
LHRD, MFH, ROSS
The unique record identification
Grantee assigned alpha-numeric
code for the individual person
identifier. Do not use SSNs or a
(participant) assigned by the
combination of personally
grantee.
identifying characters.
Household Identifier
The unique record identification
The alpha-numeric identifier
FSS, Jobs+, JRAP, HC,
code for the individual's
assigned to the individual's
HOPWA, LBPHC,
household assigned by the
household by the grantee.
LHRD, MFH, ROSS
grantee.
A household includes all the people who occupy a housing unit. (People not living in households are classified as living in
group quarters.) A housing unit is a house, an apartment, a mobile home, a group of rooms, or a single room that is
occupied (or if vacant, is intended for occupancy) as separate living quarters. Separate living quarters are those in which
the occupants live separately from any other people in the building and which have direct access from the outside of the
building or through a common hall. The occupants may be a single family, one person living alone, two or more families
living together, or any other group of related or unrelated people who share living arrangements.
Participant Status
This will identify if the resident
1 = Participant
FSS, Jobs+, JRAP, HC,
Code
does or does not participate in
2 = Non-Participant – Resident
HOPWA, LBPHC,
the service coordination program
Opted Out
LHRD, MFH, ROSS
– responses below are not
3 = Non-Participant – Resident
required if the resident is a nonNon-Responsive
participant. Responses can be
filled out if known.
Service Start Date /
The date the individual enrolled
Service start, move-in, or initiation
FSS, Jobs+, JRAP, HC,
Intake Date
in the program, moved into a
date in YYYY-MM-DD format.
HOPWA, LBPHC,
service coordinator residential
LHRD, MFH, ROSS
property, or first received services
or benefits, defined as the start or
initiation of services. Provide the
earliest date.
Age
The age in years of the individual
Whole number
FSS, Jobs+, JRAP, HC,
at the time of data collection.
HOPWA, LBPHC,
LHRD, MFH, ROSS
Gender Code
The gender for the participant.
1 = Male
FSS, Jobs+, JRAP, HC,
2 = Female
HOPWA, LBPHC,
3 = Transgendered Male to Female
LHRD, MFH, ROSS
4 = Transgendered Female to Male
5 = Other
77 = Information not collected
88 = Individual refused.
99 = Individual does not know
Ethnicity Code
The self-identified ethnicity of the 1 = Hispanic/Latino
FSS, Jobs+, JRAP, HC,
participant.
2 = Not Hispanic/Latino
HOPWA, LBPHC,
77 = Information not collected
LHRD, MFH, ROSS
88 = Individual refused
99 = Individual does not know
HUD Standards for Success
Participant Record-Level Information
Page 3 of 25
HUD-PRL - Approved XX/XX/XXXX
OMB Approval Number: 2501-0034
Expiration Date: XX/XX/XXXX
Fixed
ID
8.
Indicator
Number
N/A
9.
N/A
10.
N/A
11.
N/A
12.
N/A
Data Element Name
Data Element Description
Race Code
The self-identified race of the
participant. Multiple choices may
be selected.
Response Options
Applicable HUD
Programs
FSS, Jobs+, JRAP, HC,
HOPWA, LBPHC,
LHRD, MFH, ROSS
1 = American Indian or Alaska
Native
2 = Asian
3 = Black or African American
4 = Native Hawaiian or other
Pacific Islander
5 = White
6 = Mixed
77 = Information not collected
88 = Individual refused
99 = Individual does not know
American Indian or Alaska Native = person having origins in any of the original peoples of North America and South
America (including Central America), and who maintains cultural identification through tribal affiliation or community
recognition.
Asian = person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent
(e.g., India, Pakistan, Bangladesh, Sri Lanka, Nepal, Sikkim, and Bhutan).
Black or African American = person having origins in any of the black racial groups of Africa.
Native Hawaiian or Other Pacific Islander = person having origins in any of the original peoples of Hawaii, Guam, Samoa, or
other Pacific Islands. It includes people who indicate their race as “Native Hawaiian,” “Guamanian or Chamorro,”
“Samoan,” and “Other Pacific Islander” or provide other detailed Pacific Islander responses.
White = person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
Head of Household
The individual is an adult who is
1 = Yes
FSS, Jobs+, JRAP, HC,
Code
considered the head of household 2 = No
HOPWA, LBPHC,
for purposes of determining
77 = Information not collected
LHRD, MFH, ROSS
income eligibility and rent.
88 = Individual refused
99 = Individual does not know
The head of household is responsible for ensuring that the household fulfills all its responsibilities under the program,
alone or in conjunction with a co-head or spouse. The household may designate any qualified household member as the
head of household. The head of household must have the legal capacity to enter a lease under state and local law. A
minor who is emancipated under state law may be designated as head of household.
Residence Census
The 11-digit census tract number
The 11-digit code for the census
FSS, Jobs+, JRAP, HC,
Tract
for the residence of the
tract for the individual's residence.
HOPWA, LBPHC,
individual.
LHRD, MFH, ROSS
The Census Bureau has developed an online tool for converting physical addresses to census tract numbers
(http://factfinder2.census.gov/faces/nav/jsf/pages/searchresults.xhtml?ref=addr&refresh=t#none). Homeless individuals
may designate a fixed location as their residence for identification purposes. This location may be a homeless shelter, or
other location where a homeless individual may spend time or return to for sleep.
Veteran Status Code
The individual who initiated
1 = Yes
FSS, Jobs+, JRAP, HC,
services under this grant is a
2 = No
HOPWA, MFH, ROSS
person who served on active duty 77 = Information not collected
in the armed forces and was
88 = Individual refused
discharged or released from such
99 = Individual does not know
service under conditions other
than dishonorable.
Time in Subsidized
Total number of years individual
Whole number (in years);
FSS, Jobs+, JRAP,
Housing Number
has lived in publicly or privately
Whole number (in months
HOPWA, MFH, ROSS
subsidized housing. Count all time
even if not consecutive.
HUD Standards for Success
Participant Record-Level Information
Page 4 of 25
HUD-PRL - Approved XX/XX/XXXX
OMB Approval Number: 2501-0034
Expiration Date: XX/XX/XXXX
Fixed
ID
13.
Indicator
Number
N/A
14.
N/A
15.
N/A
16.
N/A
Data Element Name
Data Element Description
Disability Status
Code
The disability status of the
individual.
Response Options
1 = Yes, individual indicates a
disability as defined in ADA
2 = No, individual indicates no
disability as defined by ADA
66 = N/A
77 = Information not collected
88 = Individual refused
99 = Individual does not know
ADA = Section 3(2) (a) of the Americans with Disabilities Act of 1990 (42 U.S.C. 12102).
Disability Category
The category of disability for the
1 = Impairment is primarily
Code
individual.
physical, including mobility and
sensory impairments
2 = Impairment is primarily mental,
including cognitive and learning
impairments
3 = Impairment is both physical
and mental
66 = N/A
77 = Information not collected
88 = Individual refused
99 = Individual does not know
Disability Requires
The individual with a disability
1 = The disabled individual requires
Assistance Code
who received services funded
services to manage home activities
under the grant demonstrated a
2 = The disabled individual does
need for assistance with activities not require services for home
of daily living, including eating,
management
bathing, grooming, and dressing
3 = The disabled individual was not
and home management activities. assessed for these criteria
66 = N/A
77 = Information not collected
88 = Individual refused
99 = Individual does not know
Hard to House Code
The household is at high risk of
1 = Head of household has lived in
losing housing. Choose all that
public housing for more than 10
apply.
years
2 = Head of household does not
have a high-school diploma or GED
3 = Three or more minors in the
household
4 = One or more household
members has a criminal record
5 = The head of household is not
disabled, but one or more other
household members is disabled
6 = The head of household is a
single, elderly adult who is the
primary caregiver for one or more
children
66 = N/A
77 = Information not collected
88 = Individual refused
99 = Individual does not know
HUD Standards for Success
Participant Record-Level Information
Applicable HUD
Programs
FSS, Jobs+, JRAP,
MFH, ROSS
MFH, ROSS
MFH, ROSS
HOPWA
Page 5 of 25
HUD-PRL - Approved XX/XX/XXXX
OMB Approval Number: 2501-0034
Expiration Date: XX/XX/XXXX
Fixed
ID
17.
Indicator
Number
N/A
18.
N/A
19.
N/A
20.
N/A
21.
N/A
22.
N/A
Data Element Name
Data Element Description
Returning
Citizen/Ex-Offender
Code
The individual is currently an
offender with an active criminal
record in the justice system, or
has committed or been charged
with committing criminal acts in
the previous 12 months.
Response Options
Applicable HUD
Programs
FSS, Jobs+, JRAP,
ROSS
1 =Individual is currently a subject
involved in the CJS
2 = The individual is not currently
subject to any phase of the CJS, but
has been in the previous 12
months
3 = The individual is not currently
(CJS = criminal justice system)
subject to any phase of the CJS,
and has not been in the previous
12 months
66 = N/A
77 = Information not collected
88 = Individual refused
99 = Individual does not know
Supplemental
The individual received SNAP
1 = Yes
FSS, Jobs+, JRAP,
Nutrition Assistance
benefits at the time of data
2 = No
HOPWA, MFH, ROSS
Program (SNAP)
collection.
66 = N/A
Code
77 = Information not collected
88 = Individual refused
99 = Individual does not know
Temporary
The individual received cash or
1 =Yes
FSS, Jobs+, JRAP,
Assistance to Needy
other support services under
2 = No
HOPWA, MFH, ROSS
Families (TANF)
TANF at the time of data
66 = N/A
Code
collection.
77 = Information not collected
88 = Individual refused
99 = Individual does not know
TANF is federally funded but is administrated by each state. TANF is a financial assistance program for low income families
that have children and for pregnant women in their last three months of pregnancy.
Supplemental
The individual received SSI at the
1 =Yes
FSS, Jobs+, JRAP,
Security Income
time of data collection.
2 = No
HOPWA, MFH, ROSS
(SSI) Code
66 = N/A
77 = Information not collected
88 = Individual refused
99 = Individual does not know
SSI is a Federal income supplement program funded by general tax revenues (not Social Security taxes). It is designed to
help aged, blind, and disabled people who meet income and asset thresholds.
Social Security
The individual received SSDI at
1 =Yes
FSS, Jobs+, JRAP,
Disability Insurance
the time of data collection.
2 = No
HOPWA, MFH, ROSS
(SSDI) Code
66 = N/A
77 = Information not collected
88 = Individual refused
99 = Individual does not know
Acquired Immune
The individual was diagnosed by a 1 = The individual identified as
HOPWA
Deficiency
medical professional as being
being infected with HIV/AIDS
Syndrome
infected with AIDS/HIV. AIDS is an 2 = The individual identified as not
(AIDS)/Human
infectious disease caused by the
being infected with HIV/AIDS
Immunodeficiency
human immunodeficiency virus or 66 = N/A
Virus (HIV) Status
HIV. Both variants of the HIV
77 = Information not collected
Code
virus, HIV-1 and HIV-2, cause
88 = Individual refused
AIDS.
99 = Individual does not know
HUD Standards for Success
Participant Record-Level Information
Page 6 of 25
HUD-PRL - Approved XX/XX/XXXX
OMB Approval Number: 2501-0034
Expiration Date: XX/XX/XXXX
Fixed
ID
23.
Indicator
Number
4
24.
11
25.
12,13,14
26.
12,13,14
27.
12,13,14
28.
N/A
Data Element Name
Data Element Description
Response Options
HIV/AIDS Service
Code
The individual received HIV/AIDS
health and counseling services.
Services include
1 = Yes
66 = N/A
77 = Information not collected
Applicable HUD
Programs
HOPWA, MFH
If Yes, input number of times, as
whole number.
Human immunodeficiency virus infection/acquired immunodeficiency syndrome (HIV/AIDS) health and counseling services
include access to treatment, financial assistance to pay for medication and medical tests, and assistance in securing
housing.
Opportunity Area
The census tract is identified as
1 = Yes
FSS, Jobs+, JRAP, HC,
Census Tract
an area of opportunity in the
2 = No
HOPWA, LBPHC,
community’s Regional Fair
66 = N/A
LHRD
Housing Equity Assessment
77 = Information not collected
(FHEA).
Primary Health Care
The individual has a personal
1 = Yes
FSS, Jobs+, JRAP,
Provider Code
primary health care provider (a
2 = No
HOPWA, MFH, ROSS
general doctor, a specialist
66 = N/A
doctor, nurse practitioner or
77 = Information not collected
physician’s assistant).
88 = Individual refused
99 = Individual does not know
Health Coverage
The individual was covered by a
1 = Yes, covered through employer FSS, Jobs+, JRAP,
Code
private or public health insurance or union (current or former)
HOPWA, MFH, ROSS
plan. Please note that a person
2 = Yes, purchased insurance from
having only a private plan that
insurance company
paid for one type of service, such
3 = Medicare
as accidents or dental care, is
4 = Medicaid/Medical Assistance
considered uninsured.
5 = TRICARE or other military
health care
Insurance coverage may be held
6 = VA health care
or purchased by this individual or
7 = Indian Health Service
any family member.
8 = Other health insurance or
health coverage plan
9= No coverage
66 = N/A
77 = Information not collected
88 = Individual refused
99 = Individual does not know
Medical
The individual received a routine
1 = Yes
FSS, Jobs+, JRAP,
Examination Status
medical examination within the
2 = No
HOPWA, MFH, ROSS
Code
last 12 months. This includes
66 = N/A
well-baby visit, well-child visit,
77 = Information not collected
well-woman visit, physical exam
88 = Individual refused
performed by a health care
99 = Individual does not know
provider and annual wellness visit
covered through Medicare.
Dentist Service
The individual has a dentist or
1 = Yes
MFH, ROSS
Code
dental clinic.
2 = No
66 = N/A
77 = Information not collected
88 = Individual refused
99 = Individual does not know
HUD Standards for Success
Participant Record-Level Information
Page 7 of 25
HUD-PRL - Approved XX/XX/XXXX
OMB Approval Number: 2501-0034
Expiration Date: XX/XX/XXXX
Fixed
ID
29.
Indicator
Number
N/A
Data Element Name
Data Element Description
Response Options
Dental Visit Service
Code
The individual received a dental
cleaning within the last 12
months.
30.
15
Asthma Condition
Code
The individual has been
diagnosed with asthma by a
medical professional.
31.
N/A
32.
15
Chronic Medical
Conditions Code
Emergency Room /
Hospital Visit Code
Number of Chronic Medical
Conditions resident has
The individual was treated in the
emergency department or
hospitalized within the last 12
months.
1 = Yes
2 = No
66 = N/A
77 = Information not collected
88 = Individual refused
99 = Individual does not know
1 = Yes
2 = No
66 = N/A
77 = Information not collected
88 = Individual refused
99 = Individual does not know
Whole number
33.
34.
N/A
N/A
Emergency Room/
Hospital Visit Follow
Up Service Code
Resident Falls
If responded “1” to the prior
question for ER or hospital visits,
report the number of service
interactions linked to those visits.
The individual had a major fall
during the reporting period.
1 = Yes
2 = No
66 = N/A
77 = Information not collected
88 = Individual refused
99 = Individual does not know
If Yes, input number of times, as
whole number. And input number
of times, as a whole number, that
were asthma related.
1 = Yes
66 = N/A
77 = Information not collected
If Yes, input number of times, as
whole number.
1 = Yes
66 = N/A
77 = Information not collected
Applicable HUD
Programs
MFH, ROSS
LBPHC, LHRD
MFH, ROSS
LBPHC, LHRD, MFH,
ROSS
MFH, ROSS
MFH, ROSS
If Yes, input number of times, as
whole number.
HUD Standards for Success
Participant Record-Level Information
Page 8 of 25
HUD-PRL - Approved XX/XX/XXXX
OMB Approval Number: 2501-0034
Expiration Date: XX/XX/XXXX
Fixed
ID
35.
36.
Indicator
Number
N/A
N/A
Data Element Name
Data Element Description
Response Options
Activities of Daily
Living (ADL) Count
If assessed, individual
demonstrated need for assistance
in completing one or more ADLs.
Record ADLs individual could not
complete at time of initial
assessment.
ADLs that the individual is unable
to perform. Select all that apply.
Applicable HUD
Programs
HOPWA, MFH, ROSS
1 = Toileting hygiene
2 = Feeding or eating
3 = Dressing upper body
4 = Dressing lower body
5 = Grooming
6 = Bathing
7 = Toilet transferring
8 = Transferring
9 = Ambulation/locomotion
Activities of Daily Living (ADLs) are basic activities of daily life and include tasks that are required to live independently.
Check any of the below items a resident may need assistance with:
(1) Toileting hygiene – using the toilet appropriately and/or cleaning oneself
(2) Feeding or eating – getting food from the plate to one’s mouth
(3) Dressing upper body – selecting clothes, putting them on, and adequately managing one’s personal appearance for the
upper body
(4) Dressing lower body – selecting clothes, putting them on, and adequately managing one’s personal appearance for the
lower body
(5) Grooming – combing hair, shaving, brushing teeth, and other personal appearance tasks
(6) Bathing – washing one’s face and body in the bath or shower
(7) Toilet transferring – getting to and from toilet
(8) Transferring – being able to move from one body position to another. This includes being able to move from a bed to a
chair, or into a wheelchair. This can also include the ability to stand up from a bed or chair in order to grasp a walker or
other assistive device
(9) Ambulation/Locomotion – being able to walk around and/or get from place to place
Instrumental
If assessed, individual
IADLs that the individual is unable
HOPWA, MFH, ROSS
Activities of Daily
demonstrated need for assistance to perform. Select all that apply.
Living (IADL) Count
in completing one or more IADLs.
Record number of IADLs
1 = Telephone
individual could not complete at
2 = Traveling
time of initial assessment.
3 = Shopping
4 = Preparing meals
5 = Housework
6 = Medications
7 = Money management
Instrumental Activities of Daily Living (IADLs) are more complex activities of daily life than ADLs and include tasks that may
be required to live independently. Check any of the below items a resident may need assistance with:
(1) Telephone/Communications – being able to use basic communication devises like the phone and mail sorting
(2) Transportation/Traveling – managing transportation such as driving or organizing and obtaining other means of
transportation
(3) Shopping – shopping required for basic items like groceries, toiletries, et cetera
(4) Preparing meals – task required to get a meal on the table, such as cutting, heating, cooking food items
(5) Housework – cleaning kitchen after eating, keeping one’s living space reasonably clean and tidy, and keeping up with
home maintenance
(6) Managing medications – obtaining medication and taking them as directed
(7) Money management – Managing finances, such as paying bills and managing financial assets
HUD Standards for Success
Participant Record-Level Information
Page 9 of 25
HUD-PRL - Approved XX/XX/XXXX
OMB Approval Number: 2501-0034
Expiration Date: XX/XX/XXXX
Fixed
ID
37.
Indicator
Number
N/A
Data Element Name
Data Element Description
Adult Personal
Assistance Service
Code
Response Options
Applicable HUD
Programs
HOPWA, MFH, ROSS
A chronically ill or disabled
Select each ADL and IADL for which
individual, needing help with daily the individual is receiving Adult
living, received assistance with
Personal Assistance Service.
activities of daily living (ADLs)
and/or instrumental activities of
daily living (IADLs).
Includes adult day care center services and services provided to frail elderly and disabled individuals who are unable to
live independently and perform ADLs and/or IADLs without assistance. An adult day care center, also commonly known as
adult day services, is a non-residential facility that supports the health, nutritional, social support, and daily living needs of
adults in professionally staffed, group settings.
If the resident has been identified as having any of the below ADLs or IADLs, please indicate if they are receiving adult
personal assistance services for them:
Activities of Daily Living (ADLs)
(1) Toileting hygiene – using the toilet appropriately and/or cleaning oneself
(2) Feeding or eating – getting food from the plate to one’s mouth
(3) Dressing upper body – selecting clothes, putting them on, and adequately managing one’s personal appearance for the
upper body
(4) Dressing lower body – selecting clothes, putting them on, and adequately managing one’s personal appearance for the
lower body
(5) Grooming – combing hair, shaving, brushing teeth, and other personal appearance tasks
(6) Bathing – washing one’s face and body in the bath or shower
(7) Toilet transferring – getting to and from toilet
(8) Transferring – being able to move from one body position to another. This includes being able to move from a bed to a
chair, or into a wheelchair. This can also include the ability to stand up from a bed or chair in order to grasp a walker or
other assistive device
(9) Ambulation/Locomotion – being able to walk around and/or get from place to place
38.
N/A
39.
16
Instrumental Activities of Daily Living (IADLs)
(1) Telephone/Communications – being able to use basic communication devises like the phone and mail sorting
(2) Transportation/Traveling – managing transportation such as driving or organizing and obtaining other means of
transportation
(3) Shopping – shopping required for basic items like groceries, toiletries, et cetera
(4) Preparing meals – task required to get a meal on the table, such as cutting, heating, cooking food items
(5) Housework – cleaning kitchen after eating, keeping one’s living space reasonably clean and tidy, and keeping up with
home maintenance
(6) Managing medications – obtaining medication and taking them as directed
(7) Money management – Managing finances, such as paying bills and managing financial assets
Adult Personal
Identify funding source for each
Select the funding source for each
HOPWA, MFH, ROSS
Assistance Service
Adult Personal Assistance Service
rendered Adult Personal Assistance
Funding Code
Service:
1 = Government resource
2 = Private pay
3 = No-cost informal network:
family member / friend
4 = Medicaid
Blood-Lead Test
A blood level test was performed
1 = Yes
LBPHC, LHRD
Code
for a child under age 6 in the
2 = No
household in last 12 months.
66 = N/A
77 = Information not collected
88 = Individual refused
99 = Individual does not know
HUD Standards for Success
Participant Record-Level Information
Page 10 of 25
HUD-PRL - Approved XX/XX/XXXX
OMB Approval Number: 2501-0034
Expiration Date: XX/XX/XXXX
Fixed
ID
40.
Indicator
Number
16
Data Element Name
Data Element Description
Response Options
Blood-Lead Test
Result
Blood level test result was
elevated (>= 5 μg/dL).
41.
4,12,13,
14
Medical Care
Service Code
The individual is referred for and
receives medical or health care
services to optimize and maintain
physical health.
1 = Yes
2 = No
66 = N/A
77 = Information not collected
1 = Yes
66 = N/A
77 = Information not collected
42.
43.
44.
4,12,13,
14
4,12,13,
14
N/A
Applicable HUD
Programs
LBPHC, LHRD
FSS, Jobs+, JRAP,
HOPWA, MFH, ROSS
If Yes, input number of times, as
whole number.
The medical or health care services are provided by a physician, medical professional, credentialed nutritionist. Medical
services also include dental services, home health services, receiving durable medical equipment and other adaptive
equipment, prescription medication and medication management, dietary support, and lifeline programs.
Mental Health
The individual is referred for and
1 = Yes
FSS, Jobs+, JRAP,
Service Code
receives mental health services.
66 = N/A
HOPWA, MFH, ROSS
77 = Information not collected
If Yes, input number of times, as
whole number.
These services include being treated by credentialed psychiatrists, psychologists, therapists, and mental health counselors.
Mental health services may be delivered in a one-on-one setting or in a group setting through therapeutic support groups.
Prescription medication and medication management for mental health concerns are also considered mental health
services.
Substance Abuse
The individual received substance 1 = Yes
FSS, Jobs+, JRAP,
Service Code
abuse services during
66 = N/A
HOPWA, MFH, ROSS
participation in grant activities.
77 = Information not collected
If Yes, input number of times, as
whole number.
These services include treatment for use of addictive substances such as tobacco, alcohol, drugs (prescription and street).
Examples of treatment providers are the American Lung Association or other smoking cessation programs, physicians,
mental health workers, alcohol and drug treatment facilities, and Alcoholics Anonymous (AA).
Substance Abuse
The individual is being treated by
1 = The individual is being treated
HOPWA, MFH, ROSS
Treatment Code
a medical professional or a
for substance abuse or
treatment facility for substance
dependence
abuse or dependence. Substance
2 = The individual is not being
abuse is defined as a maladaptive treated for substance abuse or
(i.e., harmful to a person's life)
dependence, but did receive
pattern of substance use marked
treatment in past 12 months
by recurrent and significant
3 = The individual was not treated
negative consequences related to for substance abuse or
the repeated use of substances.
dependence in past 12 months, but
These substances may be legal,
did receive such treatment over a
such as alcohol, or an illicit drug
year ago
such as hashish, cocaine
4 = The individual never received
hallucinogens, heroin, or
treatment for substance abuse or
prescription–type drug used nondependence
medically.
66 = N/A
77 = Information not collected
88 = Individual refused
99 = Individual does not know
HUD Standards for Success
Participant Record-Level Information
Page 11 of 25
HUD-PRL - Approved XX/XX/XXXX
OMB Approval Number: 2501-0034
Expiration Date: XX/XX/XXXX
Fixed
ID
45.
46.
47.
48.
Indicator
Number
N/A
N/A
N/A
N/A
Data Element Name
Data Element Description
Response Options
Isolation
Intervention Service
Code
The individual received isolation
intervention services during
participation in grant activities.
1 = Yes
66 = N/A
77 = Information not collected
Applicable HUD
Programs
MFH, ROSS
If Yes, input number of times, as
whole number.
This service includes helping a resident to increase or improve their socialization through identifying recreational or other
activities in the community. Encouraging resident-to-resident networking. Encouraging residents to participate in
property/community activities.
Home Management
The individual received home
1 = Yes
MFH, ROSS
Service Code
management during participation 66 = N/A
in grant activities.
77 = Information not collected
If Yes, input number of times, as
whole number.
This service includes referrals to services or supports to assist resident with keeping, managing, and maintaining all
aspects of their home. Activities in this area can include assisting resident with simple money management, budgeting, bill
paying, reading mail, organization of personal records, or utility/cable company issues.
Benefits /
The individual received benefits
1 = Yes
MFH, ROSS
Entitlement Service
services during participation in
66 = N/A
Code
grant activities.
77 = Information not collected
If Yes, input number of times, as
whole number.
This service includes assistance in applying for any government entitlement, veteran’s benefits or social services “safety
net” programs (federal, state, local) and/or any other public benefit program. Explaining or otherwise assisting in
maintaining/re-determining benefits. Assistance with accessing various other private insurance or benefits matters as
requested (i.e. supplemental health insurance, life insurance, pension, burial policy, prescription assistance, home
heating/cooling assistance, immigration/naturalization, et cetera).
Monitor Services
The individual received
1 = Yes
MFH, ROSS
Service Code
monitoring services during
66 = N/A
participation in grant activities.
77 = Information not collected
If Yes, input number of times, as
whole number.
This service includes follow-up on service outcomes or verification of services that have been received with the resident
and/or service providers, to determine whether the services are meeting needs and when new or additional resources
might be needed. Following up on Resident Service Plan items. Following up on hospital and ER visits. Conduct resident
satisfaction surveys.
HUD Standards for Success
Participant Record-Level Information
Page 12 of 25
HUD-PRL - Approved XX/XX/XXXX
OMB Approval Number: 2501-0034
Expiration Date: XX/XX/XXXX
Fixed
ID
49.
Indicator
Number
N/A
Data Element Name
Data Element Description
Response Options
Crisis Intervention/
Support Counseling/
Family Support Service
Code
The individual received Crisis
Intervention/ Support
Counseling/ Family Support
services during participation in
grant activities.
1 = Yes
66 = N/A
77 = Information not collected
Applicable HUD
Programs
FSS, Jobs+, JRAP,
HOPWA, MFH, ROSS
If Yes, input number of times, as
whole number.
This service includes crisis which is either an internal experience of emotional change/distress or a disastrous event.
Intervening in a situation that could result in serious consequences to the resident’s health, safety and/or well-being.
Helping or supporting residents who are in distress to promote effective coping that can lead to positive growth and
change. Activities can include self-esteem counseling; bereavement counseling; referral for psychiatric intervention; et
cetera. Assistance in obtaining Crisis Intervention/Support through a community provider (e.g. 911, mobile crisis unit,
suicide prevention hotline, Adult Protective Services). Serve as a “neutral sounding board” for resident to express their
feelings around personal issues (e.g. loss or change), as appropriate. Provide empathy for and support of resident’s
concerns, suggest possible coping methods and/or referral to professional counseling.
50.
8,9,10
51.
N/A
“Family” is defined as those individuals chosen by the resident as primary providers of support, whether actually related
or not (only with resident’s signed consent). Activities in this area can include assisting resident’s family in finding supports
for themselves on issues such as caring for an elderly parent/loved one and grief and loss; contact with resident’s family
regarding available services for the resident; contact with resident’s family members regarding resident’s functioning or
changes in functioning; counseling/education/information related to transition/move-out to higher level of care or
alternative living arrangements.
Highest Education
The highest degree or level of
0 = No schooling completed,
FSS, Jobs+, JRAP,
Level Code
education completed by the
Nursery school, or Kindergarten.
HOPWA, MFH, ROSS
individual.
1 - 11 = Grade 1 through 11.
12 = 12th grade, no diploma.
13 = High school diploma.
14 = GED or alternative credential.
15 = Less than 1 year of college
credit.
16 = 1 or more years of college
credit, no degree.
17 = Associate's degree
18 = Bachelor's degree
19 = Master's degree).
20 = Professional degree
(e.g., MD, DDS, DVM, LLB, JD).
21 = Doctorate degree
66 = N/A
77 = Information not collected
88 = Individual refused
99 = Individual does not know
Functionally Literate
The resident can read and write.
1 = Yes
MFH, ROSS
2 = No
66 = N/A
77 = Information not collected
88 = Individual refused
99 = Individual does not know
HUD Standards for Success
Participant Record-Level Information
Page 13 of 25
HUD-PRL - Approved XX/XX/XXXX
OMB Approval Number: 2501-0034
Expiration Date: XX/XX/XXXX
Fixed
ID
52.
Indicator
Number
8,9,10
53.
8,9,10
54.
8,9,10
55.
1,2
56.
1,2
Data Element Name
Data Element Description
Enrollment in
Educational or
Vocational Program
Individual’s current enrollment in
educational or vocational
training.
Response Options
Applicable HUD
Programs
FSS, Jobs+, JRAP,
HOPWA, ROSS
1 =Individual is enrolled in
educational training.
2 = Individual is enrolled in
vocational training.
3 = Not enrolled in educational or
vocational training.
66 = N/A
77 = Information not collected
88 = Individual refused
99 = Individual does not know
License or
Individual’s attainment of a
1 = Occupational skills license
FSS, Jobs+, JRAP,
Certificate
vocational/occupational license
2 = Occupational skills certificate
HOPWA, ROSS
Attainment Code
or certificate while receiving
3 = Other license or certificate
grant-funded services. The
recognized by state
license or certificate must have
4 = Individual did not attain a
been attained between the start
license or certificate
and the completion or
66 = N/A
termination of grant-funded
77 = Information not collected
services.
88 = Individual refused
99 = Individual does not know
Degree Attainment
Individual’s attainment of a
1 = High school diploma/ GED
FSS, Jobs+, JRAP,
Code
degree while receiving grant2 = AA or AS diploma
HOPWA, ROSS
funded services. The degree must 3 = BA or BS diploma.
have been attained between the
4 = Other degree.
start and the completion or
5 = No degree attained
termination of grant-funded
66 = N/A
services.
77 = Information not collected
88 = Individual refused
99 = Individual does not know
Employment Status
Individual’s employment status
1 = Employed
FSS, Jobs+, JRAP,
Code
during the prior month, including, 2 = Not employed at any time in
HOPWA, MFH, ROSS
the date of collection. An
the last month and actively seeking
individual is considered
work.
"employed" if he or she did any
3 = Not employed at any time in
work for pay during the last
the last month and not actively
month even for just for a few
seeking work.
hours)
66 = N/A
77 = Information not collected
88 = Individual refused
99 = Individual does not know
Employment Type
The type of employment,
1 = Full-time worker employed in
FSS, Jobs+, JRAP,
Status Code
classified as full-time or part-time. the last month.
HOPWA, ROSS
2 = Part-time worker employed in
the last month.
66 = N/A
77 = Information not collected
88 = Individual refused
99 = Individual does not know
Full-time includes people at least 16 years old who worked or who were scheduled to work 35 hours or more per week.
Part-time includes people at least 16 years old who worked or who were scheduled to work less than 35 hours per week.
HUD Standards for Success
Participant Record-Level Information
Page 14 of 25
HUD-PRL - Approved XX/XX/XXXX
OMB Approval Number: 2501-0034
Expiration Date: XX/XX/XXXX
Fixed
ID
57.
Indicator
Number
1,2
Data Element Name
Data Element Description
Response Options
Entered
Employment Date
The date entered employment in
YYYY-MM-DD format.
58.
1,2
Occupation Code
The date the individual entered
employment. When multiple
instances of entering
employment exist, use the
current or most recent job.
The SOC Based Occupation Group
that best describes the
individual's occupation.
The individual's gross earnings
from all employment for the prior
4 weeks leading up to, and
including, the collection date.
The household's self-reported
annual gross income.
Applicable HUD
Programs
FSS, Jobs+, JRAP,
HOPWA, ROSS
1 = Management Occupations
2 = Business and Financial
Operations Occupations
3 = Computer, Engineering, and
Science Occupations
4 = Education, Legal, Community
Service, Arts, and Media
Occupations
5 = Healthcare Practitioners and
Technical Occupations
6 = Healthcare Support
Occupations
7 = Protective Service Occupations
8 = Food Preparation and Serving
Related Occupations
9 = Building and Grounds Cleaning
and Maintenance Occupations
10 = Personal Care and Service
Occupations
11 = Sales and Related Occupations
12 = Office and Administrative
Support Occupations
13 = Farming, Fishing, and Forestry
Occupations
14 = Construction and Extraction
Occupations
15 = Installation, Maintenance, and
Repair Occupations
16 = Production Occupations
17 = Transportation and Material
Moving Occupations
66 = N/A
77 = Information not collected
88 = Individual refused
99 = Individual does not know
For additional instructions and
examples, see supplement.
Reported gross monthly earnings
in whole (rounded U.S. dollars.
FSS, Jobs+, JRAP,
HOPWA, ROSS
59.
1,2
Monthly Paid
Earnings Amount
60.
17
Household Annual
Estimated annual income in whole
FSS, Jobs+, JRAP,
Gross Income
(rounded) U.S. dollars.
HOPWA, MFH
Amount
For the purposes of determining included and excluded income in the calculation of household income, please refer to
definition of "adjusted gross income" as used in the Internal Revenue Service's 1040 long form. Go to
http://portal.hud.gov/hudportal/HUD?src=/program_offices/comm_planning/affordablehousing/training/web/calculator/
definitions/irs#inclusions for sources of income to be included and excluded in this calculation.
HUD Standards for Success
Participant Record-Level Information
FSS, Jobs+, JRAP,
HOPWA, ROSS
Page 15 of 25
HUD-PRL - Approved XX/XX/XXXX
OMB Approval Number: 2501-0034
Expiration Date: XX/XX/XXXX
Fixed
ID
61.
Indicator
Number
4,5,6
62.
4,5,6
63.
4,5,6
Data Element Name
Data Element Description
Homeless Status
Code
The individual's homeless or
runaway status.
Response Options
Applicable HUD
Programs
HOPWA
1 = Homeless
2 = Runaway youth
3 = Neither homeless nor a
runaway youth
66 = N/A
77 = Information not collected
88 = Individual refused
99 = Individual does not know
A "homeless" person lacks a fixed, regular, adequate nighttime residence. This definition includes any individual who has
a primary night time residence that is a publicly or privately operated shelter for temporary accommodation; an institution
providing temporary residence for individuals intended to be institutionalized; or a public or private place not designated
for or ordinarily used as a regular sleeping accommodation for human beings; or a person under 18 years of age who
absents himself or herself from home or place of legal residence without the permission of his or her family (i.e., runaway
youth). This definition does not include an individual imprisoned or detained under an Act of Congress or State law. An
individual who may be sleeping in a temporary accommodation while away from home should not, as a result of that
alone, be recorded as homeless.
Weeks Homeless
The number of weeks the
The number of weeks homeless.
HOPWA
Count
homeless person lacked a fixed,
regular, adequate nighttime
residence in the past 12 month or
52-week period. The weeks do
not have to be consecutive to
count.
Chronically
The individual meets definition of 1 = Yes
HOPWA
Homeless Status
chronically homeless person.
2 = No
Code
3 = Individual was not assessed for
this condition
66 = N/A
77 = Information not collected
88 = Individual refused
99 = Individual does not know
HUD defines a chronically homeless person as an unaccompanied homeless individual with a disabling condition who has
either been continuously homeless for a year or more, or has had at least four episodes of homelessness in the past three
years, where each homeless occasion was at least 15 days. To be considered chronically homeless, persons must have
been sleeping in a place not meant for human habitation (e.g., living on the streets) and/or in an emergency homeless
shelter during that time. Disabling conditions include substance use disorder, serious mental illness, developmental
disability (as defined in section 102 of the Developmental Disabilities Assistance Bill of Rights Act of 2000 (42 U.S.C.
15002)), post-traumatic stress disorder, cognitive impairments resulting from brain injury, or chronic physical illness or
disability. An individual who has been residing in an institutional care facility, including a jail, substance abuse or mental
health treatment facility, hospital, or other similar facility, for fewer than 90 days and met all the criteria in the above
paragraph before entering that facility is considered chronically homeless. A family with an adult head of household (or if
there is no adult in the family, a minor head of household) who meets all of the criteria in the above paragraph of this
definition, including a family whose composition has fluctuated while the head of household has been homeless.
HUD Standards for Success
Participant Record-Level Information
Page 16 of 25
HUD-PRL - Approved XX/XX/XXXX
OMB Approval Number: 2501-0034
Expiration Date: XX/XX/XXXX
Fixed
ID
64.
Indicator
Number
4,5,6
Data Element Name
Data Element Description
Response Options
Prior Night
Residence Code
For homeless individuals, indicate
the type of living arrangement
the night before the individual
received services funded by the
grant. If the individual was
residing in an institution (hospital,
jail, et cetera) for less than 30
days, then select where he or she
was staying before the entering
the institution.
65.
18
Housing Status Code
The current housing status of the
individual.
1 = Emergency shelter including
hotel/ motel voucher
2 = Foster care home or foster care
group home
3 = Hospital or other residential
non-psychiatric medical facility
4 = Hotel or motel paid for without
emergency shelter voucher
5 = Jail, prison or juvenile
detention facility
6 = Long-term care facility or
nursing home
7 = Owned by individual, no
ongoing housing subsidy
8 = Owned by individual, with
ongoing housing subsidy
9 = Permanent housing for
formerly homeless persons
10 =Place not meant for habitation
11 =Psychiatric hospital or other
psychiatric facility
12 =Rental by individual, no
ongoing housing subsidy
13 =Rental by individual, with
ongoing housing subsidy
14 =Safe Haven
15 =Staying or living in a family
member's room, apartment or
house
16 =Staying or living in a friend's
room, apartment or house
17 =Substance abuse treatment
facility or detox center
18 =Transitional housing for
homeless persons (including
homeless youth)
66 = N/A
77 = Information not collected
88 = Individual refused
99 = Individual does not know
1 = Identifies as a public housing
resident
2 = Receives a tenant-based rental
voucher
3 = Receives a project based rental
voucher
4 = Privately subsidized housing
5 = Unsubsidized (market rate)
housing
6 = Owns a home
7 = Homeless
66 = N/A
77 = Information not collected
88 = Individual refused
99 = Individual does not know
HUD Standards for Success
Participant Record-Level Information
Applicable HUD
Programs
HOPWA
FSS, Jobs+, JRAP,
HOPWA, ROSS
Page 17 of 25
HUD-PRL - Approved XX/XX/XXXX
OMB Approval Number: 2501-0034
Expiration Date: XX/XX/XXXX
Fixed
ID
66.
Indicator
Number
18
Data Element Name
Data Element Description
Response Options
Intermediate
Housing Status Code
The intermediate housing
outcome achieved by the
individual.
67.
N/A
Eviction Service
Code
68.
17
Household Housing
Cost Amount
69.
17
Household
Transportation Cost
Amount
70.
N/A
Adequate
Transportation
Code
If responded “1” to the prior
question, the resident avoided
eviction from rental property,
how many service interactions
were linked to the eviction
prevention.
Monthly household housing costs
including rent, mortgage, utilities,
fees and property taxes.
Monthly transportation costs
including car payments, vehicle
insurance and public
transportation cost. Exclude
vacations and other rare
instances of travel.
The resident has adequate
transportation.
1 = Avoided eviction from rental
property
2 = Obtained a Home Equity
Conversion Mortgage (HECM)
3 = Prevented or resolved a
mortgage default
66 = N/A
77 = Information not collected
88 = Individual refused
99 = Individual does not know
Whole number
71.
4,8,9,10
Adult Basic
Education Service
Code
72.
4
The individual received training
(e.g. uses textbooks and
handouts) to improve his/her
literacy and numeracy skills.
Applicable HUD
Programs
HC, FSS, Jobs+, JRAP,
HOPWA
MFH, ROSS
The household’s average monthly
housing costs in whole (rounded)
U.S. dollars.
The household’s average monthly
transportation costs in whole
(rounded) U.S. dollars.
FSS, Jobs+, JRAP,
HOPWA, ROSS
1 = Yes
2 = No
66 = N/A
77 = Information not collected
88 = Individual refused
99 = Individual does not know
1 = Yes
66 = N/A
77 = Information Not Collected
MFH, ROSS
FSS, Jobs+, JRAP,
HOPWA, ROSS
FSS, Jobs+, JRAP,
HOPWA, ROSS
If Yes, input number of times, as
whole number.
Literacy skills training develops critical reading, writing, listening, speaking, and viewing skills and knowledge necessary to
function productively in school, the workplace or society in general. This may take the form of classes or one-on-one
tutoring. Examples include basic reading, writing, literacy, math skills, pre-admission college prep courses and other adult
continuing education classes (non-credit). This does not include ESL, GED prep, enrollment in post-secondary education,
occupational skills training, or work readiness classes.
ESL Class Service
Individual with limited English
1 = Yes
FSS, Jobs+, JRAP,
Code
proficient individual (LEP) (e.g.
66 = N/A
HOPWA, MFH, ROSS
non-native English speaker)
77 = Information not collected
received English as a second
language (ESL) instruction.
If Yes, input number of times, as
whole number.
English as a Second Language is the use of English by speakers with different native languages. The individual participated
in one or more programs and activities designed to help the individual learn English. ESL instruction reduces language
barriers that can preclude meaningful access by LEP persons to important government programs, services, and
employment. This may take the form of classes or one-on-one tutoring.
HUD Standards for Success
Participant Record-Level Information
Page 18 of 25
HUD-PRL - Approved XX/XX/XXXX
OMB Approval Number: 2501-0034
Expiration Date: XX/XX/XXXX
Fixed
ID
73.
74.
75.
Indicator
Number
1,2,4
1,2,4
1,2,4
76.
1,2,4
77.
1,2,4
78.
1,2,4
Data Element Name
Data Element Description
Response Options
Career Guidance
Service Code
The individual received career
guidance services.
1 = Yes
66 = N/A
77 = Information not collected
Applicable HUD
Programs
FSS, Jobs+, JRAP,
HOPWA, ROSS
If Yes, input number of times, as
whole number.
Career guidance services include the provision of information, materials, suggestions, or advice which are intended to
assist the job seeker in making occupation or career decisions.
Self-Directed Job
The individual received job search 1 = Yes
FSS, Jobs+, JRAP,
Search Assistance
activities.
66 = N/A
HOPWA, ROSS
Service Code
77 = Information not collected
If Yes, input number of times, as
whole number.
Job search activities help an individual plan and carry out a successful self-directed job-hunting strategy and include
resume preparation, application preparation, interviewing skills, job lead development, job finding clubs, and
development of a job search plan.
Work Readiness
The individual received work
1 = Yes
FSS, Jobs+, JRAP,
Assistance Service
readiness assistance.
66 = N/A
HOPWA, ROSS
Code
77 = Information not collected
If Yes, input number of times, as
whole number.
Work readiness includes specific work-related skills that young people and adults need in order to be successful as entrylevel workers in any formal sector business or industry or in any informal sector livelihood. These skills are generally
thought of as life skills with a strong work focus, and include work-related health and safety at work, work habits and
conduct, personal leadership at work, communicating with others at work, team work and collaboration at work, rights
and responsibilities of workers and employers, and customer service. This may include business communications,
computer literacy, financial literacy, employment counseling.
Occupational Skills
The individual received
1 = Yes
FSS, Jobs+, JRAP,
Training (OST)
occupational skills training (OST).
66 = N/A
HOPWA, ROSS
Service Code
OST may be conducted in the
77 = Information not collected
classroom or on-the-job in the
workplace or a combination of
If Yes, input number of times, as
approaches.
whole number.
The OST curriculum is designed to meet the technical needs of the workplace. OST provides participants with the
technical skills necessary to perform a specific job or group of jobs. The duration of OST activities varies based on many
factors. This could be to retain an existing job, for a new job, for advancement in a current field, or for employment in a
new/different field. This could be training provided by an employer.
Job Development
The individual received job
1 = Yes
FSS, Jobs+, JRAP,
Service Code
development services. Job
66 = N/A
HOPWA, ROSS
development is contacting an
77 = Information not collected
employer directly for the purpose
of obtaining possible employment If Yes, input number of times, as
for a specific individual.
whole number.
Job Retention
The individual received job
1 = Yes
FSS, Jobs+, JRAP,
Service Code
retention services.
66 = N/A
ROSS
77 = Information not collected
If Yes, input number of times, as
whole number.
Job retention services include a Job coach works with participant on managing challenges in the workplace or works with
employer to create a remediation plan for employee, et cetera. Occupational skills training (OST), employer sponsored “inservice training” and certifications needed to maintain employment are excluded.
HUD Standards for Success
Participant Record-Level Information
Page 19 of 25
HUD-PRL - Approved XX/XX/XXXX
OMB Approval Number: 2501-0034
Expiration Date: XX/XX/XXXX
Fixed
ID
79.
80.
Indicator
Number
4
4
81.
N/A
82.
N/A
83.
4
Data Element Name
Data Element Description
Response Options
Fair Housing and
Civil Rights
Assistance Service
Code
The individual received services
or participated in programs that
promotes racially, ethnically, and
economically diverse
communities and integrated living
patterns and avoid patterns
where persons are forced to live
in high poverty areas, or in areas
suffering from a lack of accessible
services, or a lack of integration in
terms of income, race, or
ethnicity, or disability status.
The individual received tax
preparation services while
participating in grant-funded
activities.
1 = Yes
66 = N/A
77 = Information not collected
Tax Preparation
Service Code
Applicable HUD
Programs
HC, HOPWA, MFH
If Yes, input number of times, as
whole number.
1 = Yes
66 = N/A
77 = Information not collected
FSS, Jobs+, JRAP,
MFH, ROSS
If Yes, input number of times, as
whole number.
Tax preparation services include assistance with obtaining information about low- or no-cost tax preparation services;
arranging no-cost tax preparation services at the property; assistance with organizing tax documents, paperwork, and
other supporting materials for individuals; and assistance with preparing and/or filing of senior/disabled age/incomebased specific tax rebates including property tax rebate programs and/or food sales tax rebate programs. These services
may be provided by an IRS Volunteer Income Tax Assistance (VITA) center or a reputable (not refund-anticipation loantype) private service. This does not include the use of tax software by individuals unless facilitated by the PHA or a partner.
Earned Income Tax
The individual received the
1 =Individual reported receipt of
FSS, Jobs+, JRAP,
Credit Recipient
Earned Income Tax Credit (EITC)
the EITC in most recent tax year
ROSS
Code
for the most recent tax year.
2 = Individual reported no receipt
of the EITC in most recent tax year
66 = N/A
77 = Information not collected
88 = Individual refused
99 = Individual does not know
The Earned Income Tax Credit, EITC or EIC, is a benefit for working people with low to moderate income. To qualify,
persons must meet certain requirements and file a tax return, even if no taxes are owed or the person is not required to
file. EITC reduces the amount of tax a person owes and may provide a refund to the person.
Financial Account
The individual has a checking,
1 = Individual has a checking or
FSS, Jobs+, JRAP,
Creation Code
savings, Individual Development
savings account
ROSS
Account (IDA), or escrow account. 2 = Individual has an IDA
3 = The individual has an FSS
escrow account
66 = N/A
77 = Information not collected
88 = Individual refused
99 = Individual does not know
Financial Account
The individual was assisted with
1 = Yes
FSS, Jobs+, JRAP,
Creation Service
credit activities or to create a
66 = N/A
ROSS
Code
financial account
77 = Information not collected
(checking/savings), an Individual
Development Account (IDA), or
If Yes, input number of times, as
an escrow account.
whole number.
The Individual Development Account (IDA) is created through an Assets for Independence Program, an alternative
program at the housing authority or another IDA through a partner. IDAs are matched savings accounts that help people
with modest means to save towards the purchase of a lifelong asset, such as a home.
HUD Standards for Success
Participant Record-Level Information
Page 20 of 25
HUD-PRL - Approved XX/XX/XXXX
OMB Approval Number: 2501-0034
Expiration Date: XX/XX/XXXX
Fixed
ID
84.
Indicator
Number
4
85.
4
86.
4
87.
4, 18
88.
4, 18
Data Element Name
Data Element Description
Response Options
Legal Assistance
Service Code
The individual received legal
assistance in civil or criminal
matters during participation in
the grant-funded activities.
1 = Yes
66 = N/A
77 = Information not collected
Applicable HUD
Programs
FSS, Jobs+, JRAP,
HOPWA, MFH, ROSS
If Yes, input number of times, as
whole number.
Legal assistance includes receiving legal aid or counsel as well as participating in community legal clinics. Counsel includes
providing basic information on services such as end of life decision making, advanced directives, or wills.
Legal Assistance
The type of legal assistance
1 = Will preparation, advanced
FSS, Jobs+, JRAP,
Type Service Code
received during participation in
directives, end of life decisions
HOPWA, MFH, ROSS
the grant-funded activities.
2 = ID theft and credit Issues
3 = Foreclosure prevention
4 = Eviction prevention
5 = Custody, divorce and child
support
6= Fair housing assistance
7 = Assistance to victims of
domestic violence
8 = Expunging criminal records
9 = Other
66 = N/A
77 = Information not collected
Financial Education
The individual participated in
1 = Yes
FSS, Jobs+, JRAP,
Service Code
financial literacy, budgeting or
66 = N/A
HOPWA, MFH, ROSS
credit education activities.
77 = Information not collected
If Yes, input number of times, as
whole number.
This financial management assistance is designed to help low-income families increase income, build savings, and gain
assets to improve financial stability. It provides adults practical tips to manage debt, avoid quick fixes, and plan to resolve
financial trouble. It also helps homebuyers understand the basics of handling new homeowner expenses.
Pre-Housing
Prior to purchase or rental, the
1 = Yes
FSS, Jobs+, JRAP, HC,
Counseling Service
individual was counseled and/or
66 = N/A
HOPWA, MFH, ROSS
Code
received service related to buying 77 = Information not collected
a home or renting.
If Yes, input number of times, as
whole number.
Bank-sponsored mortgage seminars open to the general public or simply going to a bank and being guided through the
process are excluded. Sweat-equity programs that offer homeownership counseling, such as Habitat for Humanity, are
also excluded.
Post-Housing
After purchase or rental, the
1 = Yes
FSS, Jobs+, JRAP, HC,
Counseling Service
individual was counseled and/or
66 = N/A
HOPWA, MFH, ROSS
Code
received service related to
77 = Information not collected
renting, default, foreclosure
avoidance, credit issues or
If Yes, input number of times, as
reverse mortgages.
whole number.
HUD Standards for Success
Participant Record-Level Information
Page 21 of 25
HUD-PRL - Approved XX/XX/XXXX
OMB Approval Number: 2501-0034
Expiration Date: XX/XX/XXXX
Fixed
ID
89.
90.
Indicator
Number
4
4
91.
N/A
92.
4
93.
4
94.
4
Data Element Name
Data Element Description
Response Options
Food and Nutrition
Service Code
The individual received food and
nutrition services to prevent
and/or end a period of hunger or
a period of malnutrition.
1 = Yes
66 = N/A
77 = Information not collected
Applicable HUD
Programs
HOPWA, MFH, ROSS
If Yes, input number of times, as
whole number.
These services include participation the Women, Infant and children (WIC) nutrition program, in congregate meal sites
such as Meals on Wheels programs, using emergency food programs and food banks, grocery shopping or cooking services
or other means of access including family, friends, and individuals within the community, and receiving donated food
items from community-based sources. The Supplemental Nutrition Assistance Program (SNAP) is not included.
Conflict Resolution
The individual received
1 = Yes
HOPWA, MFH, ROSS
Service Code
counseling and/or other services
66 = N/A
related to conflict resolution.
77 = Information not collected
If Yes, input number of times, as
whole number.
Conflict resolution services include assistance to resolve conflict by helping to clarify, educate, mediate, and propose
compromises or alternative solutions to parties who are contesting some mutual objectives. Conflict may be between
individuals or between individuals and property management, service providers, or other parties. This includes court
ordered participation.
Translator
The resident needs a translator.
1 = Yes
MFH, ROSS
66 = N/A
77 = Information not collected
Translation/
Individual with no or limited
1 = Yes
FSS, Jobs+, JRAP, HC,
Interpretation
English-speaking ability or with
66 = N/A
HOPWA, MFH, ROSS
Service Code
hearing or visual impairments
77 = Information not collected
received translation or
interpretation services to
If Yes, input number of times, as
participate in the program.
whole number.
Housing Retention
The individual received housing
1 = Yes
HOPWA, MFH, ROSS
Service Code
retention assistance.
66 = N/A
77 = Information not collected
If Yes, input number of times, as
whole number.
This assistance includes Informing individuals of lease provisions and/or of behaviors/problems that could lead to lease
violations, such as noise, odors, unsanitary or unsafe conditions in apartments (hoarding and clutter) or common areas.
Activities can include assistance with eviction prevention; assistance with preparing, organizing and understanding
documents for lease recertification; and assistance with apartment inspection compliance. Includes linking individuals
with a member of the property management team for assistance with understanding their lease and house rules. Working
with property management staff to provide reasonable accommodation as defined by 1973 Rehabilitation Act when an
individual's mental, physical, or social disability is impeding compliance with the lease.
Household
The individual participated in a
1 = Yes
MFH, ROSS
Skills/Life Skills
course or training regarding
66 = N/A
Service Code
household or life skills.
77 = Information not collected
If Yes, input number of times, as
whole number.
Household or life skills services may include Good Neighbor trainings, household management, food prep, civic
engagement, navigating community resources, citizenship classes, driver’s education, et cetera.
HUD Standards for Success
Participant Record-Level Information
Page 22 of 25
HUD-PRL - Approved XX/XX/XXXX
OMB Approval Number: 2501-0034
Expiration Date: XX/XX/XXXX
Fixed
ID
95.
96.
97.
98.
99.
Indicator
Number
4
3,4
4,7
4,7
4,8,9,10
Data Element Name
Data Element Description
Response Options
Needs Assessment
Service Code
The individual received a
documented assessment or
Individual Services and Training
Plan (ITSP) that identifies housing
and supportive service needs.
1 = Yes
66 = N/A
77 = Information not collected
Applicable HUD
Programs
FSS, Jobs+, JRAP,
HOPWA, MFH, ROSS
If Yes, input number of times, as
whole number.
Assessment is the process that reveals the past and current details of a service seeker’s strengths, and needs, in order to
match the client to appropriate housing and supportive services. The results of the assessment are documented in the
individual's case record and are typically used in providing counseling services, making referrals and in developing an
individual service plan. Assessment can occur either at primary screening or at entry to a housing program.
Service
The individual received service
1 = Yes
FSS, Jobs+, JRAP,
Coordination
coordination assistance.
66 = N/A
HOPWA, MFH, ROSS
Service Code
77 = Information not collected
If Yes, input number of times, as
whole number.
Service coordination includes establishing linkages with appropriate agencies and service providers in the general
community in order to tailor the needed services to the program participant; linking program participants to providers of
services that the participant needs; and educating participants on issues, including, but not limited to, supportive service
availability, application procedures and client rights.
Parenting Skills
The individual received parenting
1 = Yes
FSS, Jobs+, JRAP,
Service Code
training.
66 = N/A
HOPWA, ROSS
77 = Information not collected
If Yes, input number of times, as
whole number.
Parenting skills includes training in child development, family budgeting, health and nutrition, and other skills to promote
their long-term economic independence and the well-being of their children.
3 to 5 Years
The individual received assistance 1 = Yes
FSS, Jobs+, JRAP,
Childhood
obtaining early childhood
2 = Household has children
HOPWA, ROSS
Education Service
education for children between
aged 3-5 years and did not receive
Code
the ages of 3 and 5 (or the age
childcare services
prior to the commencement of
66 = N/A
compulsory education at primary
77 = Information not collected
school).
Record for head of household
only; not recorded for children.
The early childhood program is childcare combined with a developmentally appropriate educational component. This
includes Head Start and Pre-K. Do NOT record as a service to the child); record as a service to the head of household.
High School/GED
The individual participated in an
1 = Yes
FSS, Jobs+, JRAP,
Preparation Service
organized program of study or a
66 = N/A
ROSS
Code
GED preparation class to attain
77 = Information not collected
secondary school diploma or
equivalent. This may take the
If Yes, input number of times, as
form of classes or one-on-one
whole number.
tutoring.
HUD Standards for Success
Participant Record-Level Information
Page 23 of 25
HUD-PRL - Approved XX/XX/XXXX
OMB Approval Number: 2501-0034
Expiration Date: XX/XX/XXXX
Fixed
ID
100.
101.
Indicator
Number
4,8,9,10
4
102.
4
103.
N/A
Data Element Name
Data Element Description
Response Options
PostSecondary/College
Education Service
Code
The individual is attending a postsecondary school or program,
including college (either full or
part-time) and assistance is
provided to enable the individual
to enroll and/or remain in the
organized program of study to
attain a post-secondary school
diploma or a certificate.
The disabled or frail elderly
individual received assistance in
obtaining services to enable him
or her to remain in their own
home.
1 = Yes
66 = N/A
77 = Information not collected
Independent Living
Service Code
Applicable HUD
Programs
FSS, Jobs+, JRAP,
HOPWA, ROSS
If Yes, input number of times, as
whole number.
1 = Yes
66 = N/A
77 = Information not collected
FSS, Jobs+, JRAP,
HOPWA, MFH, ROSS
If Yes, input number of times, as
whole number.
Services include apartment cleaning, laundry, shopping, and cooking, and referrals to services or supports to assist
individual with keeping, managing and maintaining all aspects of their home other than homemaking. Activities can
include assisting individual with simple money management budgeting, bill paying, reading mail, organization of personal
records, or utility company issues.
Transportation
The individual received
1 = Yes
FSS, Jobs+, JRAP,
Assistance Service
transportation services to
66 = N/A
HOPWA, MFH, ROSS
Code
participate in medical or other
77 = Information not collected
personal appointments, religious,
social, or recreational activities.
If Yes, input number of times, as
whole number.
This may include bus passes/tokens, rides in a service provider-owned van, arranging carpools, connecting to city/county
special transportation opportunities, assistance with personal auto repair, et cetera.
Outreach Service Code The individual received Outreach
1 = Yes
FSS, Jobs+, JRAP,
services during participation in
66 = N/A
HOPWA, MFH, ROSS
grant activities.
77 = Information not collected
If Yes, input number of times, as
whole number.
This service includes encouraging residents currently not using the services/assistance of the service coordinator to do so.
Efforts to encourage residents to attend programs. New resident contact. Overall outreach to non-property community
residents. This does not include distributing flyers, calendars, newsletters, et cetera.
104.
N/A
Do not count this in the service coordination service code of total service interactions. Outreach is not a service
interaction.
General Information
The individual received General
1 = Yes
FSS, Jobs+, JRAP,
and Referral Service
Information and Referral services
66 = N/A
HOPWA, MFH, ROSS
Code
during participation in grant
77 = Information not collected
activities.
If Yes, input number of times, as
whole number.
This service includes sharing “quality time” with a resident with no particular service rendered other than the resident’s
desire/need for conversation or sharing of general information. Handing out Resource Directories and other general
referral information.
Do not count this in the service coordination service code of total service interactions. Outreach is not a service
interaction.
HUD Standards for Success
Participant Record-Level Information
Page 24 of 25
HUD-PRL - Approved XX/XX/XXXX
OMB Approval Number: 2501-0034
Expiration Date: XX/XX/XXXX
Fixed
ID
105.
Indicator
Number
4,5,6
106.
4,5,6
107.
4,5,6
108.
4,5,6
Data Element Name
Data Element Description
Response Options
Shelter Placement
Service Code
The homeless individual was
placed in an emergency shelter.
1 = Yes
66 = N/A
77 = Information not collected
Applicable HUD
Programs
HOPWA
If Yes, input number of times, as
whole number.
A shelter is any facility whose primary purpose is to provide temporary housing. A shelter provides support, supervision,
and a safe place to live in a group home, cluster of apartments, or a network of homes that integrate housing and services
for low-income individuals and families.
Housing Placement
The housed individual was
1 = Yes
HOPWA, MFH, ROSS
Service Code
provided assistance for
66 = N/A
permanent and/or temporary or
77 = Information not collected
short-term transfer to another
property, a different unit within
If Yes, input number of times, as
the property, or to an alternative
whole number.
care facility.
Information and assistance were provided to the individual and/or family members regarding temporary housing options.
Includes assistance with an individual's transition back to their apartment from short-term care facility or hospital.
Permanent Housing
The individual is no longer on the
HOPWA, MFH, ROSS
1 = Moved Out: Purchased a
Placement /
property or in the program for
home
Turnover Reason
the following reason.
2 = Moved Out: Another
Code
apartment or rental property
3 = Moved Out: Higher Level of
Care
4 = Moved Out: With family
5 = Moved Out: Other
6 = Moved Out: Unknown
7 = Eviction
8 = Death
66 = N/A
77 = Information not collected
Service End Date /
The date services were completed Service end, completion, or
FSS, Jobs+, JRAP, HC,
Permanent Housing
or terminated, the date the
termination date in YYYY-MM-DD
HOPWA, LBPHC,
Placement Date /
individual moved out of a service
format.
LHRD, MFH, ROSS
Turnover Date
coordinator residential property
for any of the above reasons, or
the last date the individual
received service. Provide the
earliest date.
Public reporting burden for this collection of information is estimated to average 20 minutes per respondent, including the time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. This agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless that
collection displays a valid OMB control number. This information is collected in connection with HUD's respective program. The information is
considered sensitive and is protected by the Privacy Act which requires the records to be maintained with appropriate administrative, technical
and physical safeguards to ensure their security and confidentiality.
HUD Standards for Success
Participant Record-Level Information
Page 25 of 25
HUD-PRL - Approved XX/XX/XXXX
| File Type | application/pdf |
| File Title | Participant Record-Level Report Information |
| Author | Wincek, Thaddeus D |
| File Modified | 2019-07-25 |
| File Created | 2019-07-25 |