Vendor Relations and Changing Software, 2010 HMIS-HEARTH Conference



Similar documents
Use block letters for text and mark appropriate boxes with an X. Complete a separate form for each household member.

Data Quality Plan Louisiana Service Network Data Consortium

HMIS Annual Assessment Form

Public Health Management Corporation. Address: Street City Zip Code. Medical Case Manager /Housing Counselor.

A Quick Summary for Domestic Violence Advocates

ADHOC REPORTING 201 TRAINING MANUAL

HMIS Data Quality Plan

Data Quality Standards

HMIS Data Standards Manual

Homeless Management Information System (HMIS) Indiana Housing & Community Development Authority


U.S. Department of Housing and Urban Development Community Planning and Development

2016 Homeless Count Results Los Angeles County and LA Continuum of Care. Published by: Los Angeles Homeless Services Authority May 4,

New Hampshire HMIS Governance Model

VA DATA GUIDE - FY2015

Rhode Island Homeless Management Information System Data Quality Standards

Homeless Count and Characteristics Survey Results. West Texas Homeless Network. January 22, 2015

Quality Data Assures Quality Decisions. Acknowledgements: Symmetric Solutions, Inc. prepared this document under the direction of

ServicePoint Supportive Service Workflow for CoC SSO Projects

HPRP FREQUENTLY ASKED QUESTIONS (FAQS)

Length of stay numbers are approximate and were calculated using a weighted average over multiple programs. 97

Emergency Solutions Grants Program. Eligible Expense Guide

Homeless Management Information System (HMIS)

HMIS Policies and Procedures. San Antonio/Bexar County Continuum of Care (CoC) Homeless Management Information System (HMIS) Policies and Procedures

Senate Bill (SB) 855: Housing Support Program Orange County Application

State Guidelines Point in Time and Housing Inventory Count of Homeless Persons. January 2016

Homeless Count and Characteristics Survey Results. South Plains Homeless Consortium. January 22, 2015

Dear Community Kitchen Academy Applicant:

Table of Contents. Introduction Logging into ETO ETO HMIS Homepage Description ETO HMIS Homepage Tabs... 13

9. WILL THE INFORMATION I GIVE BE CHECKED? Yes and we may also ask you to send written proof.

Homelessness in Greater New Orleans: A Report on Progress toward Ending Homelessness May 2012

Health Coverage & Help Paying Costs Application for One Person

SAMPLE SUPPORTIVE HOUSING INTAKE/ASSESSMENT FORM

EMERGENCY SOLUTIONS GRANTS PROGRAM (ESG) ELIGIBLE EXPENSE GUIDE

HOW TO APPLY FOR FREE AND REDUCED PRICE SCHOOL MEALS

RENTAL APPLICATION Caldwell Housing Authority Farmway Road Caldwell, Idaho (208)

St. Louis County Project Homeless Connect. Summary of guests served on October 24, 2007

CASE MANAGEMENT INVENTORY OF SUPPORT SERVICES For Adults

HMIS System Admin Training

HARTLAND CONSOLIDATED SCHOOLS

2014 SAN DIEGO REGIONAL HOMELESS PROFILE

TIPS AND TRICKS FOR USING THE HRE VIRTUAL HELP DESK

MA Free and Reduced Price School Meal Application

A String Theory School

Homeless Operations Management and Evaluation System (HOMES) Homeless Services Assessment Form

CoC Debriefing Summary FY 2013

Apply for Free and Reduced Price Meals OR Prepay for Meals Online!

Trumbull Career and Technical Center 528 Educational Highway Warren, Ohio Toll Free

Supportive Housing Collaborations Miami Dade Examples

L E T T E R T O H O U S E H O L D

2015 HUD CoC Competition Evaluation Instrument

C A L H O U N COUNTY SCHOO LS

How To Answer A Test For A Welfare Check (For Seniors)

Case Management Homelessness Prevention and Rapid Re-housing

Understanding Unduplicated Count and Data Integration

ClientTrack User s Guide

NOTICE OF DIRECT CERTIFICATION

ECEC Application Revised

INSTRUCTIONS FOR COMPLETING THE APPLICATION FOR PARTICIPATION IN THE ADDP AND/OR HICP PROGRAM

Instructions for Completing a Medicare Savings Program (MSP) Application

Application for Health Coverage & Help Paying Costs

Pre-Application for Waiting List Section 8 Housing Choice Voucher (HCV) Program

Massachusetts Application for Health and Dental Coverage and Help Paying Costs

ASPIRA Management Information System OJJDP General Intake Information

The Five Year Plan to End Homelessness Among Veterans: Actions for FY Pete Dougherty Paul Smits

2014 SOUTHERN NEVADA CONTINUUM OF CARE (COC) LOCAL PROJECT APPLICATION INSTRUCTIONS. July 31, 2013

Application for Vocational Rehabilitation Services

BUCKS COUNTY, PENNSYLVANIA

Supportive Housing Program (SHP) Self-Monitoring Tools

Apply faster online at Compass.ga.gov.

Application for Health Coverage & Help Paying Costs

Important! How the Affordable Care Program works

TIPS AND TRICKS FOR USING THE HRE VIRTUAL HELP DESKS

Application for Health Coverage & Help Paying Costs

Sample Privacy Notice to Clients

Family-Related Medical Assistance Application

Changes in the HUD Definition of Homeless

12-month Enrollment Institution: State Fair Community College (179539) Overview screen

Veterans Health Administration Fact Sheet

Application for Health Coverage & Help Paying Costs

MILFORD EXEMPTED VILLAGE SCHOOL DISTRICT Nutrition Services 777 Garfield Avenue Milford, OH (513)

2015 AHAR Webinar Part 2-Steps to a Successful Data Submission Transcript

STUDENT PARTICIPATION AGREEMENT

24. How does your disability keep you from working, or cause problems in your ability to maintain work? phone: phone: phone: date(s) date(s) date(s)

Application for Health Coverage & Help Paying Costs

FORECLOSURE COUNSELING APPOINTMENT CHECKLIST. Completed Foreclosure Intake Forms Including Budget Sheet, Release of Information, & Privacy Statement

EMERGENCY SOLUTIONS GRANT PROGRAM

City / Town Report of Direct Assistance: ***Total Number of Households Served: 115

City / Town Report of Direct Assistance: ***Total Number of Households Served: 100

SOUTHERN NEVADA COC APPLICATION PROCESS

Medicaid and Long-Term Care Application for Medicaid and Insurance Affordability Programs (Financial Assistance)

CREDIT & BUDGET COUNSELING CHECKLIST. Completed Housing Intake Forms Including Budget Sheet, Release of Information, & Privacy Statement

Improving Service Delivery Through Administrative Data Integration and Analytics

Before Starting the Project Application

Enrollment Forms Packet (EFP)

Using an Integrated Data Systems to Better Serve People Experiencing Homelessness

REGISTRATION FORM. How would you like to receive health information? Electronic Paper In Person. Daytime Phone Preferred.

Date of Referral. Race: Black/African American/Caribbean White/Caucasian Asian Other Marital Status: Single Divorced Widowed Married

Application for Health Coverage and Help Paying Costs

Supportive Services for Veteran Families (SSVF)

Transcription:

Vendor Relations and Changing Software, 2010 HMIS-HEARTH Conference Worksheet for HMIS Software Capacity Evaluation Introduction This tool is designed to help CoC and HMIS staff assess if a HMIS meets the community's data collection and usage needs. This tool can identify areas for needed change or support the development of functional requirements for a Request for Proposals (RFP) for HMIS vendors. Contents: This workbook contains four worksheets: Basic Assessment PDDE worksheet contains the Program Descriptor Data Element UDE worksheet contains the Universal Data Elements PDE worksheet contains the Program-Specific Data Elements How to Use the Tool: The Basic Assessment worksheet allows for the examination of specific software functionality within HMIS. Review each item and indicate if it is available in the HMIS. Within the Basic Assessment, three items refer to the March 2010 HUD HMIS Data Standards. Each item has an individual worksheet to allow for the assessment of individual data elements by descriptor and response categories. Sponsored by the U.S. Department of Housing and Urban Development

Software Selection Check Sheet Description Yes No Notes Client Data Collection 1 Client intake 2 Needs assessments 3 History of services provided Resources directory to provide information and make 4 referral, an I&R application 5 Client financial worksheets 6 Case management (needs assessment) 7 Program entry and exit history 8 Referral management (referral type, follow up, status) 9 Client follow-up 10 Capacity to record family and household relationships 11 Collection of socio-demographic information 12 Assessments for determining client self-sufficiency Does the software collect all of the HUD Program Descriptor Data Elements (see worksheet labeled PDDE 13 Assessment)? Does the software collect all of the HUD Universal Data 14 Elements (see worksheet labeled UDE Assessment)? Does the software collect all of the HUD Program- 15 Specific Data Elements (see worksheet labeled PDE Functionality to Support Case Management 16 User Capacity friendly for on-line interface data input and real-time access to 17 data 18 Reminder capability ( tickler ) 19 Print capabilities 20 Process for flagging incomplete records 21 22 23 24 Data Sharing Capability to share client level data across programs or agencies. Flexible data sharing capability so that clients and agencies can identify which part or parts of client files can be shared. Flexible data sharing capability so that clients and agencies can identify the agencies with which information can be shared. Capacity to set time limits on the sharing of client level data or agency information.

Software Selection Check Sheet 25 26 27 28 29 30 31 32 Description Yes No Notes Reporting Capacity and Import/Export Capacity Built-in standard reports and forms for the U. S. Department of Housing and Urban Development such as the Annual Progress Report/Annual Performance Report (APR), including a report on missing data. Built-in standard reports and forms for the U. S. Department of Housing and Urban Development such as the Homeless Prevention and Rapid-Rehousing Program (HPRP) Quarterly Performance Reports (QPR), including a report on missing data. Built-in standard reports and forms for the U. S. Department of Housing and Urban Development such as the Annual Homeless Assessment Report (AHAR), including a report on missing data. Built-in standard reports and forms for other federal reports and forms, such as the PATH Annual Report or RHYMIS. Has canned program-level demographic report with numbers and characteristics of clients served. Has canned program-level data quality assessment reports for analysis and correction. Has canned Continuum-level data quality assessment and HMIS usage reports for monitoring and compliance. Ability to generate and save customized reports and forms from within the application without programmer s assistance on multiple levels: a. Client and program level reports and forms that permit individual users to build their own reports and forms by choosing fields, sort orders, data ranges, etc. b. Agency level reports that permit reports and forms to be built reflecting data collected by multiple users in multiple programs within a given agency. c. System-wide reports that demonstrate the usage of services based on data collected by multiple users and multiple agencies within the Continuum of Care. d. Communal reports that can be generated by the Continuum of Care, including the HUD Outcome Measures and CoC defined Outcome Measures. e. Reports and forms must be viewable onscreen in a print f. Reports preview and and forms exportable must be to able PDF, to be Excel printed and in user-friendly format. Print screen capability is also desirable. g. Flexibility in generating queries to extract information based on specific data elements or configurations of data elements to use with industry standard applications including common databases, spreadsheets, and report writing tools such as Access, Excel, or Crystal Reports. h. Statistical analytic tools.

Software Selection Check Sheet 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 Description Yes No Notes Information and Referral, Housing Information I & R application must adhere to the AIRS Data Transfer Protocols. I & R application must incorporate the AIRS XML file protocols. Experience in importing and exporting I&R data from other database systems. Referral tracking and reporting capacities specific to services referred from I&R application and allowing for tracking from within the client data collection module. Real-time capability to handle residential logs of bed availability, a bed reservation system, and waiting list capacity. Capability of handling vacancy and rental information for transitional and permanent housing. Security Technical safeguards to ensure a high level of client confidentiality, specifically to the: a. Back end server(s) including data encryption and transmission b. User name and password access c. Automatic timeout/logoff d. Read, write, edit and delete capabilities e. Module and sub-module access f. Group level access g. Automated audit trail h. 128-bit encryption and SSL certifications Compliant with HIPAA and any and all applicable federal, state and local laws and regulations regarding privacy and confidentiality. Must have capacity to securely manage data stripped of identifiers that is transferred from each agency to an aggregate level database. Ability to define and redefine levels of access to client information within each agency and the CoC. Systems Integration Programming: Willingness and experience in customizing automated and manual import/export utilities, with date specification and a transaction Open programming language that would permit integration and transfer of data between diverse database systems. Project management: Capability and experience to manage migration of data from legacy systems. Capability to integrate from multiple databases for communal reporting. Capacity for import/export data transfer through Comma Separated Values (.CSV). Capacity for import/export data transfer through Extensive Markup Language (.XML).

Software Selection Check Sheet Description Yes No Notes Training & Documentation Training to ensure successful implementation and 49 continuing operation of the software. 50 On-line help available and easily comprehended. Help desk (24 hour or Local Standard Time 51 compatibility 800 toll free number). Software problem/issue submission and resolution 52 tracking capacity with follow up protocols. Demo database available for training and testing use. Must be able to be refreshed for sequential training 53 sessions. Understandable user and system administrator manuals 54 updated to the current version of the software. 55 56 Software Development Provisions for receiving and responding to software client feedback on future development. Provisions for receiving, evaluating, and responding to software fixes. Support & Maintenance 57 Provisions for ongoing system maintenance. Technical support and maintenance for web based 58 system hardware and software. Technical support and assistance for system 59 administrators. 60 Technical support for system users. Ability to have on-site technical support for initial 61 implementation of the system. Unobtrusive maintenance: frequency and nature of 62 upgrades timing of implementation with notification. 63 64 User-Friendliness Rate ease of use of screens for: (1= very easy 2=somewhat easy 3=somewhat difficult 4= very difficult) a. client intake b. assessment of need c. history of services provided d. identification of resources through Information and Referral (I&R) e. program exit/discharge f. client follow-up (i.e. long term outcomes of Rate overall: (1=very satisfied 2=somewhat satisfied 3=somewhat dissatisfied 4=dissatisfied) a. ease of navigation b. look of HMIS screens

Software Selection Check Sheet Description Yes No Notes Vendor History and HMIS Services Demonstrated successful implementation in HMIS in at 65 least 3 CoCs. Has sufficient, dedicated support staff knowledgeable of 66 HMIS application. Help desk availability during shelter operating hours 67 with demonstrated, satisfactory response times. 68 Technical support for system administrators. Technical support for system users. (any additional 69 cost?) Ability to have onsite technical support for initial 70 implementation. Provisions for ongoing system maintenance. (any 71 additional costs?) Has understandable user and system administrators 72 manuals updated to the current version of the software. Has demo database available for training and testing use. Demo DB must be updated with latest version of 73 software upgrades. Has demonstrated ability to make ongoing product enhancements to comply with industry standards. (any 74 additional costs?) Has demonstrated, satisfactory response times for fix 75 and patch releases. Costs 76 Licensing 77 Support and/or help desk 78 Training Add-ons to general HMIS product (PATH reporting, call 79 center management, etc.) 80 Fees for custom software necessary for reporting Fees for correction of data (consolidation of duplicate 81 records) 82 Fees for data imports/exports 83 Fees for software updates and/or upgrades (new versions, fixes, and/or patches)

HUD Data Elements Program Descriptor Data Elements (PDDEs) Description Response Categories Yes No Notes Organization Identifier Organization Identifier A unique Organization Identifier needs to be assigned to each distinct organization that operates a CoC Program. There is no specified format for this data element. Organization Name Organization Name An Organization Name needs to be identified for each distinct organization that operates a CoC Program. Program Identifier Program Identifier A unique Program Identifier needs to be assigned to each distinct CoC Program. There is no specified format for this data element. Program Name Program Name A unique Program Name must be recorded to each distinct CoC Program. Direct Service Code Direct Service Code Yes, No Site Information Program Site Configuration Type Single site, single building, Single site, multiple buildings, Multiple sites Site Address Address, City, State (two-letter state abbreviation), Site Address, Zip code (5-digit numeric code) Geocode Numeric geocode format Site Type Non-residential: services only, Residential: special needs and non-special needs, Residential: special needs only Housing Type Mass shelter/barracks, Dormitory/hotel/motel, Shared housing, Single Room Occupancy (SRO) units, Single apartment (non-sro) units, Single homes/townhouses/duplexes, Not applicable: non-residential program

Continuum of Care Number Continuum of Care Number Program Type Code HUD Assigned Number Emergency shelter, Transitional housing, Permanent Supportive Housing, Homeless Outreach, Homelessness Prevention and Rapid Re-Housing, Services Only program, Other, Safe Haven, Permanent Housing (e.g., Mod Rehab SRO, subsidized housing without Program Type Code services) Bed and Unit Inventory Information: Households with children, Households Household Type without children Bed Type Facility Based, Voucher, Other Availability Year round, Seasonal, Overflow Bed Inventory Integer CH Bed Inventory (PSH Only) Integer Unit Inventory Integer Inventory Start Date / / (Month/Day/Year) Inventory End Date / / (Month/Day/Year) HMIS Participating Beds Integer HMIS Participation Start Date / / (Month/Day/Year) HMIS Participation End Date / / (Month/Day/Year) Target Population A SM, SF, SMF, CO, SM+HC, SF+HC, HC, YM, Target Population A YF, YMF, SMF+HC Target Population B Target Population B DV, VET, HIV, NA Method of Tracking Residential Program Occupancy Program Entry and Exit Date Comparison, Bed Management Model, Service Transaction Method of Tracking Residential Program Model Occupancy Grantee Identifier Grantee Identifier Integer

HUD Data Elements Universal Data Elements (UDEs) Description Response Categories Yes No Notes Name Name First, Middle, Last, Suffix Social Security Number - Social Security Number _/ / (Example, 000/11/2222) Full SSN Reported, Partial SSN Reported, Don't - Social Security Number Type Know or Don't Have SSN, Refused Date of Birth / / Month/Day/Year (Example, - Date of Birth 01/23/1967) Full DOB Reported, Approximate or Partial DOB - Date of Birth Type Reported, Doesn't Know, Refused Ethnicity and Race American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or Other Pacific - Race Islander, White, Don't Know, Refused Non-Hispanic/Latino, Hispanic/Latino, Don't Know, - Ethnicity Refused Gender Female, Male, Transgendered Male to Female, Transgendered Female to Male, Other, Don't Know, - Gender Refused Veteran Status - Veteran Status Yes, No, Don't Know, Refused Disabling Condition - Disabling Condition Yes, No, Don't Know, Refused Residence Prior to Program Entry Emergency shelter, including hotel or motel paid for with emergency shelter voucher; Transitional housing for homeless persons (including homeless youth); Permanent housing for formerly homeless persons (such as SHP, S+C, or SRO Mod Rehab); Psychiatric hospital or other psychiatric facility; Substance abuse treatment facility or detox center; Hospital (nonpsychiatric); Jail, prison or juvenile detention facility; Staying or living in a family member s room, apartment or house; Staying or living in a friend s room, apartment or house; Hotel or motel paid for without emergency shelter voucher; Foster care home or foster care group home; Place not meant for habitation (e.g., a vehicle, an abandoned building, bus/train/subway station/airport or anywhere outside); inclusive of non-housing service site (outreach programs only) ; Other; Safe Haven; Rental by client, with VASH housing subsidy; Rental by client, with other (non-vash) ongoing housing subsidy; Owned by client, with ongoing housing - Type of Residence subsidy; Rental by client, no ongoing housing subsidy;

One week or less; More than one week, but less than one month; One to three months; More than three - Length of Stay in Previous Residence months, but less than one year; One year or longer Zip code of Last Permanent - Zip code _ (Example, 12345) - Zip code Data Quality Code Full or Partial Zip Code Reported, Don't Know, Housing Status Literally homeless, Imminently losing their housing, Unstably housed and at-risk of losing their housing, Housing Status Stably housed, Don t Know, Refused Program Entry Date - Program Entry Date (Month) (Day) (Year) Program Exit Date - Program Exit Date (Month) (Day) (Year) Computer Generated UDEs Personal Identification Number A PIN must be created, but there is no required format as long as there is a single unique PIN for every client served in the CoC and it contains no - Personal Identification Number personally identifying information. Household Identification Number A Household ID number must be created, but there is no required format, as long as the number allows for identification of clients that receive services as a - Household Identification Number household.

HUD Data Elements Program-Specific Data Elements (PDEs) Description Response Categories Yes No Notes Income and Sources - Financial Resources: Income receivedyes, fromno, anydon't source Know, in past Refused 30 days? Earned Income, Unemployment Insurance, Supplemental Security Income (SSI), Social Security Disability Income (SSDI), Veteran s disability payment, Private disability insurance, Worker s compensation, Temporary Assistance for Needy Families (TANF) (or use local program name), General Assistance (GA) (or use local program name), Retirement income from Social Security Veteran s pension, Pension from a former job Child support, Alimony or other - Sources of Income spousal support, Other source - Receiving Income Source Yes, No - Amount of Income $.00 - Total Monthly Income $.00 Non-Cash Benefits - Non-cash benefits received from any source Yes, No, indon't past 30 Know, days? Refused Supplemental Nutrition Assistance Program (SNAP) (Previously known as Food Stamps); MEDICAID health insurance program (or use local name); MEDICARE health insurance program (or use local name); State Children s Health Insurance Program (or use local name); Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); Veteran s Administration (VA) Medical Services; TANF Child Care services (or use local name); TANF transportation services (or use local name); Other TANF-funded services (or use local name); Section 8, public housing, or other ongoing rental - Source of Non-Cash Benefits assistance; Other source; Temporary rental Physical Disability - Physical Disability Yes, No, Don't Know, Refused - (If yes) Currently receiving services or treatment for this condition? Yes, No, Don't Know, Refused Developmental Disability - Developmental Disability Yes, No, Don't Know, Refused - (If yes) Currently receiving services or treatment for this condition? Yes, No, Don't Know, Refused Chronic Health Condition - Chronic Health Conditions Yes, No, Don't Know, Refused - (If yes) Currently receiving services or treatment for this condition? Yes, No, Don't Know, Refused HIV/AIDS - HIV/AIDS Yes, No, Don't Know, Refused - (If yes) Currently receiving services or treatment for this condition? Yes, No, Don't Know, Refused

Mental Health - Mental Health Problem Yes, No, Don't Know, Refused - (If client has a mental health problem) Expected to be of longcontinued and indefinite duration and substantially impairs ability to live independently Yes, No, Don't Know, Refused - (If client has a mental health problem) {At entry] Currently receiving services or treatment for this condition? [At annual assessment and at exit]: Received services/treatment while in the program? Yes, No, Don't Know, Refused Substance Abuse No, Alcohol abuse, Drug abuse, Both alcohol and - Substance Abuse Problem drug abuse, Don t Know, Refused - (If client has a mental health problem) Expected to be of longcontinued and indefinite duration and substantially impairs ability to live independently Yes, No, Don't Know, Refused - (If client has a mental health problem) {At entry] Currently receiving services or treatment for this condition? [At annual assessment and at exit]: Received services/treatment while in the program? Yes, No, Don't Know, Refused Domestic Violence - Domestic violence victim/survivor Yes, No, Don't Know, Refused Within the past three months, Three to six - (If yes) When experience months ago, From six to twelve months ago, occurred More than a year ago, Don t Know, Refused Destination Emergency shelter, including hotel or motel paid for with emergency shelter voucher; Transitional housing for homeless persons (including homeless youth); Permanent supportive housing for formerly homeless persons (such as SHP, S+C, or SRO Mod Rehab); Psychiatric hospital or other psychiatric facility; Substance abuse treatment facility or detox center; Hospital (nonpsychiatric); Jail, prison or juvenile detention facility; Rental by client, no ongoing housing subsidy; Owned by client, no ongoing housing subsidy; Staying or living with family, temporary tenure (e.g., room, apartment of house); Staying or living with friends, temporary tenure (e.g., room, apartment of house); Hotel or motel paid for without emergency shelter voucher; Foster care home or foster care group home; Place not meant for habitation (e.g., a vehicle, an abandoned building, bus/train/subway station/airport or anywhere outside); Other; Safe Haven; Rental by client, VASH Subsidy; Rental by client, other (non-vash) ongoing housing subsidy; Owned by client, with ongoing housing subsidy; Staying of living with family, permanent tenure; Staying of living with friends, permanent tenure; Deceased, D - Destination Type

Date of Contact : (Month) (Day) (Year) (Hour) (Minute) (Use 24- Date of Contact hour military time) Place not meant for habitation (e.g. vehicle, abandoned building, bus/train/subway station/airport or anywhere outside that is not a Homeless Connect-type event); Service setting, non-residential (e.g. Homeless Connect-type event, drop in center, day services center, soup kitchen, etc.); Service setting, residential (e.g. emergency, transitional or permanent housing; treatment facility, including health, mental health, or substance abuse clinic or hospital; jail, prison, or juvenile detention facility; family or friend s room, apartment, condo, or house; foster Location of Contact care or group home) Date of Engagement Date of Engagement (Month) (Day) (Year) Financial Services Provided Start Date of Financial Assistance (Month) (Day) (Year) End Date of Financial Assistance (Month) (Day) (Year) Rental assistance, Security deposits, Utility deposits, Utility payments, Moving cost Financial Assistance Type assistance, Motel & hotel vouchers Financial Assistance Amount $.00 Housing Relocation and Stabilization Services Provided Start Date of Service (Month) (Day) (Year) End Date of Service (Month) (Day) (Year) Case management, Outreach and engagement, Housing search and placement, Legal services, Type(s) of Service Credit repair