NHAP/ESG/HSATF ServicePoint Workflow...Workflow 2016 Instructions on how to enter data for NHAP/ESG/HSATF programs in ServicePoint. ... This document is designed as a reference guide

NHAP/ESG/HSATF ServicePoint Workflow

2016Instructions on how to enter data for NHAP/ESG/HSATF programs in ServicePoint.

Currently HUD does not mandate that all items listed in this document be in HMIS; however the process listed in this document is HIGHLY encouraged by the NHAP/ESG/HSATF funder.

1 | P a g e UNL-Center on Children, Families, and the Law 10/2016

Table of Contents Introduction ............................................................................................................................................................................ 2

Documentation of eligibility ............................................................................................................................................... 2

Documentation of ineligibility ............................................................................................................................................. 3

Intake Requirements ............................................................................................................................................................... 3

Street Outreach ....................................................................................................................................................................... 4

Emergency Shelter ................................................................................................................................................................ 10

Rapid Rehousing.................................................................................................................................................................... 23

Homeless Prevention ............................................................................................................................................................ 39

Recap ..................................................................................................................................................................................... 55

Reporting Requirements ....................................................................................................................................................... 55

Forms Appendix .................................................................................................................................................................... 56


This document is designed as a reference guide for basic data entry in the Nebraska Management Information System (NMIS) for NHAP/ESG/HTSF Programs. This guide is set up by Project Type and the requirements of each project type. Locate your project type from the contents and review the guidance provided. If you do not have one of the project types listed, you do not need to review that workflow. All projects funded with NHAP/ESG/HSATF funds, except victim service providers, must participate in the Homeless Management Information System (HMIS Data from the HMIS is necessary to meet several federal and state reporting requirements. Providers are expected to have staff who are licensed users of the HMIS collect the required information from participants at specified times and enter the information directly into the database. All applicants must be assessed to determine eligibility for receipt of NHAP/ESG/HSATF funded services and assistance. All new project entries must be recorded in HMIS, ensuring that the date of entry corresponds correctly to the date that the participant was found to be eligible and entered into the program. This document should assist you with entering the data in HMIS in order to meet the reporting and recordkeeping requirements determined by your funder. Currently HUD does not mandate that all items listed in this document be in HMIS; however the process listed in this document is HIGHLY encouraged and recommend best practice.

Steps:

1) Verify a completed Release of Information (ROI) has been completed for all adult members of the household. 2) Search for the consumer in HMIS. 3) If the consumer is already in HMIS update the information that has changed based on the Intake Form and enter the consumer

into the project by doing a HUD Entry/Exit. 4) If the consumer does not have an HMIS record, create a new record making sure to include all information from the Intake

Form and enter the consumer into the correct project. 5) If the consumer household consists of more than one person, be sure to join members together in the household, making sure

to check for a record in HMIS before creating a new one for any additional members.

Project participant(s) HMIS records include:

Documentation of eligibility and ineligibility NHAP/ESG/HSATF programs must keep records that not only demonstrate the eligibility of the participants that are served, but also the determination of ineligibility for any individual or family refused services. For each individual and family determined ineligible to receive NHAP/ESG/HSATF assistance, the record must include documentation of the reason for that determination (24 CFR 576.500). All participants applying for NHAP/ESG/HSATF Transitional Housing (TH), Rapid Rehousing (RRH) and Prevention (PH) will document Eligible and Ineligible participants in HMIS using Service Transactions. Eligible participant(s) will be documented with a Need and Service of “Benefits Screening”. The Need Status is “Closed” and the Outcome of the Need is “Fully Met”.


Ineligible participant(s) will be documented with the Need of “Benefits Screening” with the Need Status of “Closed” and the Outcome of Need as “Not Met”. Under “If need is not met, reason, select the appropriate reason why the participant(s) is not eligible for NHAP/ESG/HSATF from the drop down list.

Intake Requirements In order to ensure that all data that is necessary to meet several federal and state reporting requirements ALL ESG/HUD funded providers will do a HUD Entry/Exit-Entry when the participant(s) enters the NHAP/ESG/HSATF project. All questions on the HUD CoC and ESG Entry (2015) Assessment will be completed at the time of entry noting the section headers on the assessment defining question answering requirements for all persons or adults and heads of household only. NOTE: Emergency Shelter and Street outreach will ONLY document consumers that are eligible by completing a HUD Entry/Exit Entry and completing the HUD CoC ESG Entry (2015) ES and SO are not required to document ineligible participants. Street Outreach projects will not be expected to meet data quality standards until the point of Engagement. The field “Housing Status” on the HUD CoC and ESG Entry (2015) assessment at the time of entry will be used for reporting initial homeless status for ES and SO projects.



Street Outreach (SO) Component -576.101 People who qualify as “unsheltered homeless” based on category 1 of the “homeless” definition 24 CFR 576.2, are eligible for the following actives, as indicated in 24 CFR 576.101: engagement, case management, emergency health and mental health services and transportation. * Currently HUD does not mandate that all items listed in this document be in HMIS; however the process listed in this document is HIGHLY encouraged and recommend best practice. HUD CoC and ESG Entry (2015) Completed on all eligible participants to the best of your

ability at Outreach. “Housing Status” must be entered at the time of Entry.

Outreach Contacts All Outreach Contacts are to be documented via the Outreach sub assessment on the HUD CoC and ESG Entry (2015) assessment until Engagement.

Engagement At the time of Engagement you will no longer be required to enter contacts into the Outreach sub assessment and it is at this time data quality will be monitored and evaluated.

Services All eligible services are expected to be recorded in the Service Transactions module using the drop down list of eligible services for your NHAP/ESG/HSATF project.

HUD CoC and ESG Exit (2015) Completed when the participant(s) exit the project. Complete the assessment in its entirety. Reason for leaving and destination must be documented at exit.

For Street Outreach Projects the Entry will be recorded on the date you made the first contact with the consumer. You do not have to collect all the data at this first meeting, but you will need to have it by the time you enroll the client in the project. For any fields where you do not have the data to complete at entry, leave the responses at “select” until you can get that information from the consumer. Use Interim Updates to add any new information as you collect/receive it. To create an Entry go to the Entry/Exit Tab 1. and click on Add Entry/Exit 2.to open the assessment. If a consumer is part of a household make sure that all members are checked. Reminder: Household members must be established on the Households tab BEFORE creating Entry/Exits. Double check that you have selected your correct Provider 3. and make sure that your Type 4. is listed as HUD. The Entry Date 5. is the date of the intake (initial contact). Click on Save& Continue.


The HUD CoC and ESG Entry (2015) will be the default assessment at the top of the screen you will see Provider, Type and Household Members Associated with the Entry Data. The questions listed on the HUD CoC and ESG Entry (2015) are required for all HUD and NHAP/ ESG funded Projects. Remember for your Street Outreach Program the information may not all be available at your initial contact but you must have all the data collected by the time the consumer is enrolled in the project.

Until your consumer becomes Engaged you must complete the Outreach Sub-assessment located on the HUD CoC and ESG Entry (2015) to record all contacts with the consumer that build your relationship and encourage the consumer to enroll in the program. You must also complete Sections 3 and 4, if possible at Intake on the HUD CoC and ESG Entry (2015) assessment.

After the Initial Contact and until Engagement all updates to data should be made via the Entry/Exit Tab and Interims Review Assessment. You must specify the Interim Review Type and Review Date.


If you offered services at your initial contact meeting you must record those in the ServiceTransactions tab. To add services you must go to the Service Transactions Tab

Once you click on the Service Transactions tab the Service Transaction dashboard will open giving you multiple options to record transactions with your consumer.


To add a service click on the Add Service or Add Multiple Services making sure to include any household members when applicable. Make sure to set the Start Date 1. and End Date 2. (These are typically the same date as they are the date the service took place). Next select the Service Type 3. indicating what you provided to the consumer. Once you are done filling out all of the information on the screen click on Save & Continue.

After you select Save & Continue a new screen will open showing all of the service and now the need information. Scroll down to the bottom of the screen to update the Need Information Section. Since you provided this service you will want to set the Need Status 1. to Closed and the Outcome of Need 2. to Fully Met. Click on Save & Exit.


Each time you meet with a consumer in the Outreach Project you must add an Outreach Contact via the Outreach Sub-assessment until the consumer becomes Engaged i.e. “when an interactive client relationship results in a deliberate client assessment or beginning of a case plan” remember once a consumer is “engaged” you will be expected to get all of the data for the HUD CoC and ESG Entry (2015) and this is when data quality will begin to be monitored. Exit-The HUD CoC and ESG Exit (2015) will be completed when the participant(s) exits the project. To create an Exit go to the Entry/Exit Tab 1. and click on the pencil 2. by the Exit Date a new window called Edit Exit Data will pop up.

In the Edit Exit Data window complete the Exit Date, Reason for Leaving, and Destination (making sure to select from the drop down boxes the appropriate Exit Date, Reason for Leaving and Destination) and then hit Save and Continue.

Once you hit Save & Continue the Entry/Exit Data screen will open and you will need to complete the HUD CoC and ESG Exit (2015) Remember if there is more than one consumer in the household you will need to complete the HUD CoC and ESG Exit (2015) assessment for each consumer.



Emergency Shelter (ES) Component-576.102 People, who qualify as “homeless”, based on categories (1, 2 or4) of the “homeless” definition 24 CFR 576.2 are eligible for the following activities, as indicated in 24 CFR 576.102: Case management, child care, education services, employment assistance and job training, outpatient health services, life skills training, metal health services, substance abuse treatment services and transportation and services for special populations. Case management component services include:

• Using the centralized or coordinate assessment system as required 576.400(d) • Conducting the initial evaluation required under 576.401 (a) including verify and documenting eligibility. • Counseling • Developing an individualized housing and service plan, including planning a path to permanent housing stability. • Monitoring and evaluation program participants progress • Providing information and referrals • Providing ongoing risk assessment and safety planning • Developing individual housing and service plans

* Currently HUD does not mandate that all items listed in this document be in HMIS; however the process listed in this document is HIGHLY encouraged and recommend best practice. HUD CoC and ESG Entry (2015) Completed on all eligible participant. “Housing Status” must be entered at

the time of Entry in order to report on Initial homeless status. HMIS Participation in Coordinated Entry A VI-SPDAT should be completed on Category 1-Literally homeless or

Category 4-Fleeing Domestic Violence persons and families. An appropriate housing referral should be made following your CoC’s requirements. (Lincoln and BOS any score of 10 or above for a single must be referred to the MVRT)

Housing Stability Plan Will be documented by placing a Goal of “Housing” under case plans on all adults or head of household of all eligible participants. The Goal Classification will be selected from the picklist under “Housing” that best suits the need of individual participants. Included in the plan but not limited to the following:

• Determination and verification of eligibility under the Homeless definition. 576.2.

• No subsequent residence has been identified; and the individual or family lacks the resources or support networks, e.g., family, friends, faith-based or other social networks, needed to obtain other permanent housing.

• Updates upon completing monthly case management as to how the participant(s) are progressing on the housing plan.

Services All eligible services are expected to be recorded in the Service Transactions module using the drop down list of eligible services for your NHAP/ESG/HSATF project. All Financial assistance will be documented by using the funding source of NHAP/ESG/HSATF. A monthly case management service is required.

HUD CoC and ESG Update (2015)

Completed via Interim when participants have been in the project for 90 days and will continue to be entered every 90 days until they exit the project. The Interim Review type in HMIS may be either 90-day review or Update.


Intake Requirements

In order to ensure that all data that is necessary to meet several federal and state reporting requirements ALL ESG/HUD/HSATF funded providers will do a HUD Entry/Exit-Entry when the participant(s) enters the NHAP/ESG/HSATF project. All questions on the HUD CoC and ESG Entry (2015) Assessment will be completed at the time of entry noting the section headers on the assessment defining question answering requirements for all persons or adults and heads of household only. NOTE: Emergency Shelter and Street outreach will ONLY document consumers that are eligible by completing a HUD Entry/Exit Entry and completing the HUD CoC ESG Entry (2015) ES and SO are not required to document ineligible


participants. The field “Housing Status” on the HUD CoC and ESG Entry (2015) assessment at the time of entry will be used for reporting initial homeless status for ES and SO projects. For Emergency Shelter Projects the Entry will be recorded on the date you house the consumer. For Emergency Shelter Projects using ShelterPoint you will need to go to ShelterPoint select your appropriate Unit List and select View All from the ShelterPoint Dashboard

Once you select View All your Unit list will appear and you will want to select the bed with the green plus sign to check your consumer in.

After you select the bed with the green plus mark to “check” your consumer in you will be taken to the ShelterPoint>Client Search


Enter the consumer’s full name and click on the search button. Review the search responses; compare names, SS numbers and date of birth to locate the correct consumer. If your consumer is not listed, then you will need to Add New Client with This Information Reminder: you must first search for a consumer before you can add them to the system; this ensures that duplicates are not created. If there are additional household members make sure to search for/add in order to create your household.

Select your consumer from the Client Results (or “Add New Client with This Information, if they did not show up in the search). You will be taken to the ShelterPoint>Check In. Here you will enter or verify the Date In (this would be the date they physically checked into your shelter). Confirm the Unit Name/ Number if you made an error in the bed you plan to place them in you can fix that via the Assign Unit button. Fill out any other fields relating to supplies, locker, notes that your agency requires and then move on to the Household Overview(if this is a single person confirm their household, if they do not have one, create one). Next add your ROI and then complete the HUD CoC and ESG Entry (2015)


Once the HUD CoC and ESG Entry (2015) has been completed hit Save & Exit and this will check your consumer in. You will be taken back to the Shelter Inventory Information and your consumer should appear in the bed you assigned them.

HMIS Participation in Coordinated Entry: any consumer that is a Category 1-Literally homeless or Category 4-Fleeing Domestic Violence should have a VI-SPDAT completed. To enter this in ServicePoint you will go to ClientPoint>search for and locate your consumer>go to the Assessment Tab>Select VI-SPDAT Coordinated Entry and hit submit. You must complete all information listed on the VI-SPDAT Coordinated Entry Assessment.


To complete the VI-SPDAT go to the VI-SPDAT sub-assessment and select Add. The VI-SPDAT assessment will open in a new window. Complete the assessment in its entirety.

Once you have entered all response, hit the Calculate Button this will provide the score and housing recommendation.


Housing Stability Plan: to enter a housing stability plan in ServicePoint you will go to 1. ClientPoint>search for and locate your consumer>go to the 2. Case Plans Tab> 3.Add Goal

When you click on Add Goal a new window will open. Make sure to select all Adults and Head of Household Consumers by placing a check mark next to their name (if this is a single person they should already be selected). 1.Confirm your Provider 2.Enter the Date Goal was Set 3. Choose the Classification of Housing 4. For Type Select the choice from the picklist that best suits the need of the consumer. Provide any Goal Description that you feel may be beneficial. 5. Provide a Target Date for expected completion and 6. Set the Overall Status To Identified or In Progress. If you would like a reminder to show on your Home Page Dashboard of ServicePoint enter a 7. Projected Follow Up date.

Once you have entered all necessary sections of the Goal hit Add Goal, three new sections of the Goal sub-assessment will open i.e. Case Notes, Actions Steps Planned, and Service Items for this Goal.


Per the Recordkeeping requirement use the Case Notes section of the Goal to reflect Determination and verification under the Homeless definition 576.2, any meetings and progress that takes place during the consumer’s time in the project. Action Steps Planned can also be used to track small achievements leading up to the overall Achievement of the main goal i.e. a Case Manager is required to meet with a consumer monthly, you can add an Action Step of Meet with Case Manager and later when the consumer meets with the Case Manager you can add a service via the Service Items for this Goal. (Please see form appendix for naming guidance) To add a Case Notes just click on Add Case note a new window will open called Case Note. Complete as appropriate. Save Case Note to save.


To add an Action Steps Planned click on Add Action Step, a new window will open you will need to select the Adult or Head of Household that this Action Step is planned or relevant for. 1. Confirm your provider 2. Enter the Date Action Step was set 3. Type what the Action Step is Provide a 4. Target Date (this is a date you expect it will be achieved) Select the 5. Overall Status and provide a 6. Projected Follow up Date if you want a reminder on your ServicePoint Home Page Dashboard. Click on Save Action Step to save the Action Step.

To add Services Related to the Goal, click on Add Multiple Services, you will get a message that says “This will close the Goal popup and take you to the Service Transactions page. Click OK.

You will now be taken to the Service Transactions page and can enter any/all services related to this consumer and any Case Plans/Goals you have created.


You should continue to add all services as they occur in the Service Transactions tab. You should continue to enter and update all CasePlans/Goals as appropriate. HUD CoC and ESG Update: This assessment should be completed on all participants that have been in the via the project for 90 days and a new HUD CoC and ESG Update should be completed every 90 days until they exit the project. To enter a HUD CoC and ESG Update go to ShelterPoint, locate your consumer and click on the Entry/Exit Tab via the Unit Stay Entry Data Assessment.

Once you click on the Entry/Exit tab you will see a screen similar to this.

You will want to click on the icon in the Interims Column related to your project Entry. A new window called Interim Reviews will open. Click on Add Interim Review.


Another new window will open called Add Interim Review. You will want to select the consumers that you want to include in this review by placing a check mark by their names. Confirm your Entry/Exit Provider, Entry/Exit Type and then pick either 90-Day Review or Update from the picklist. Enter the date of the review in the Review Date section. Once you have entered all required elements click on Save & Continue.

A new window will open with the Entry/Exit Interim Review that contains the HUD CoC and ESG Update (2015) Assessment that must be completed per Recordkeeping Requirements. Make any necessary changes to all sections of the Update Assessment; if there is more than one person in the Household you must make any appropriate changes and/or updates to them as well.


Once you have entered/updated all necessary information on each consumer hit Save & Exit. The Entry/Exit Interim Reviews Assessment will close and the Interim Reviews window will show the Interim Reviews Associated with this Entry/Exit. Hit Exit. Note the Client Count on the Interim Reviews window, which will indicate how many participants were included in the Interim Assessment.

After you hit Exit you will be taken back to the Entry/Exit tab and you will see in the Interims column for your project stay a number indicating the number of Interims completed for this consumer. Hit Exit and this screen will close. HUD CoC and ESG Exit (2015): This assessment will be completed when participants exit your shelter. To complete this assessment go to ShelterPoint>View All from the ShelterPoint Dashboard>Click the bed with the red minus sign next relating to the participant that is exiting your project.


After you click on the bed with the red minus sign you will be taken to the ShelterPoint>Check Out>Unit Exit Data Screen. 1. Confirm the Date Out (this would be the date they are exiting your shelter). Indicate the 2. Reason for Leaving by selecting the best response from the pick list. Indicate the 3. Destination by selecting the best response from the pick list. 4. Make sure to check all family members that are also checking out by placing a check mark next to their name. Complete the 5. HUD CoC and ESG Exit (2015) by updating any information that has changed.

Click on Save & Exit, your participant has been exited out of your project.



Rapid Rehousing (RRH) Component-576.104 ESG funds may be used to provide housing relocation and stabilization services and short- and/or medium-term rental assistance as necessary to help a homeless individual or family move as quickly as possible into permanent housing and achieve stability in that housing. This assistance, referred to as rapid re-housing assistance, may be provided to program participants who meet the criteria under paragraph (1) of the “homeless” definition in 576.2 or who meet the criteria under paragraph (4) of the “homeless” definition and live in an emergency shelter or other place described in paragraph (1) of the “homeless” definition. The rapid re-housing assistance must be provided in accordance with the housing relocation and stabilization services requirements in 576.105, the short- and medium-term rental assistance requirements in 576.106, and the written standards and procedures established under 576.400. Eligible costs include: Rental Assistance: rental assistance and rental arrears, financial assistance: rental application fees, security and utility deposits, utility payments, last month's rent, moving costs, housing search and placement, housing stability case management, landlord-tenant mediation, credit repair. Case management consists of:

• Using the centralized or coordinate assessment system • Conducting the initial evaluation required under 576.401 (a) including verify and documenting eligibility. • Counseling • Developing, securing, and coordinating services • Monitoring and evaluating program participant progress • Providing Information and Referrals • Developing an individualized housing and service plan, including planning a path to permanent housing stability. • Records and recording keeping including re-evaluation

* Currently HUD does not mandate that all items listed in this document be in HMIS; however the process listed in this document is HIGHLY encouraged and recommend best practice. HUD CoC and ESG Entry (2015) Completed on all eligible participants. HMIS Participation in Coordinated Entry A VI-SPDAT should be completed on Category 1-Literally homeless or Category 4-Fleeing

Domestic Violence persons and families. An appropriate housing referral should be made following your CoC’s requirements. (Lincoln and BOS any score of 10 or above for a single must be referred to the MVRT)


• Determination and verification of eligibility “homeless” criteria in paragraph (1) or (4) of the “homeless” definition 576.2.

• Documentation that the participants have an annual income below 30 percent of median family income for the area, as determined by HUD.

• Must include documentation that program participant lacks sufficient resources and support networks necessary to retain housing without ESG assistance.


• Certification of need and eligibly every 90 days for Rent assistance. • Rent reasonableness and Fair Market Rent must be documented (24 CFR part

888 and 982.507) • Referrals must be documented.

Services • All eligible services are expected to be recorded in the Service Transactions module using the drop down list of eligible services for your NHAP/ESG/HSATF project.

• All Financial assistance will be documented by using the funding source of NHAP/ESG/HSATF.

• A monthly case management service is required. Short-term and medium-term rental assistance must also document Unit and Unit Type.

• All participant(s) housing placement receiving NHAP/ESG/HSATF Rent Payment Assistance will comply with HUD Habitability Standards and Lead Based Paint Standards where applicable. Documentation includes a Service Transaction of Building Inspection and/or Lead based Paint Screening.

Referrals

Documentation of assisting participants in obtaining appropriate supportive services as well as connecting them to other federal, state, local, and private benefits and services for which they may be eligible. This includes but is not limited to:

• Medicaid • Snap • WIC • Unemployment • SSI/SSDI • Services for Veterans • TANF •

HUD CoC and ESG Update (2015) Completed via Interim when participants have been in the project for 90 days to reflect eligibility and need for continued assistance. Continue to be entered every 90 days for continued eligibly and need until they exit the project. The Interim Review type in HMIS may be either 90-day review or Update. The Housing Stability Plan must be updated to reflect completion of an evaluation of eligibility. Required Annual Eligibility documented to show income at or below 30% AMI, must use Annual Review.



Intake Requirements

In order to ensure that all data that is necessary to meet several federal and state reporting requirements ALL NHAP/ESG/HSATF funded providers will do a HUD Entry/Exit-Entry when the participant(s) enters the NHAP/ESG/HSATF project, for Rapid Rehousing an entry into a project would be the date the participant began receiving services from the project. All questions on the HUD CoC and ESG Entry (2015) Assessment will be completed at the time of entry noting the section headers on the assessment defining question answering requirements for all persons or adults and heads of household only. For Rapid Rehousing projects sign into ServicePoint. Go to ClientPoint and Search for your consumer. Enter the consumer’s full name and click on the search button.

Review the search responses; compare names, SS numbers and date of birth to locate the correct consumer. If your consumer is not listed, then you will need to Add New Client with This Information Reminder: you must first search for a consumer before you can add them to the system; this ensures that duplicates are not created. If there are additional household members make sure to search for/add in order to create your household.

Select your consumer from the Client Results (or “Add New Client with This Information, if they did not show up in the search). You will be taken to the Client Information>Summary Tab. The Summary tab allows you to see the history of entries/exits, services, household information, ROI etc. depending on how your agency has decided this screen appears. Please do NOT enter data from this screen unless that is part of your projects’ workflow.


To create an Entry go to the Entry/Exit Tab 1. and click on Add Entry/Exit 2.to open the assessment. If a consumer is part of a household make sure that all members are checked. Reminder: Household members must be established on the Households tab BEFORE creating Entry/Exits. Double check that you have selected your correct Provider 3. and make sure that your Type 4. is listed as HUD. The Entry Date 5. is the date of the intake (initial contact). Click on Save& Continue.

The HUD CoC and ESG Entry (2015) will be the default assessment at the top of the screen you will see Provider, Type and Household Members Associated with the Entry Data. The questions listed on the HUD CoC and ESG Entry (2015) are required for all HUD and NHAP/ ESG funded Projects. Pay attention to the section headers that are there to guide you for which sections are required of which participants.


For Rapid Rehousing pay special attention to Section 4: RRH and Outreach Projects only ALL Consumers one the HUD CoC and ESG Entry (2015)










Per the Recordkeeping requirement use the Case Notes section of the Goal to reflect any meetings and progress that takes place during the consumer’s time in the project. Action Steps Planned can also be used to track small achievements leading up to the overall Achievement of the main goal i.e. a Case Manager requires a consumer to meet with them once per month, you can add an Action Step of Meet with Case Manager and later when the consumer meets with the Case Manager you can add a service via the Service Items for this Goal. To add a Case Notes just click on Add Case note a new window will open called Case Note. Complete as appropriate. Save Case Note to save.


To add an Action Steps Planned click on Add Action Step, a new window will open you will need to select the Adult or Head of Household that this Action Step is planned or relevant for. Confirm your provider 1. Enter the Date Action Step was set 2. Type what the Action Step is 3. Provide a Target Date (this is a date you expect it will be achieved) 4. Select the Overall Status 5. And provide a Projected Follow up Date if you want a reminder on your ServicePoint Home Page Dashboard. Click on Save Action Step 6. to save the Action Step.

To add Services Related to the Goal, click on Add Multiple Services, you will get a message that says “This will close the Goal popup and take you to the Service Transactions page. Click on OK.



You should continue to add all services as they occur in the Service Transactions tab. You should continue to enter and update all CasePlans/Goals as appropriate.

Services: All eligible services are expected to be recorded in the Service Transactions module using the drop down list of eligible services for your NHAP/ESG/HSATF project. All Financial Assistance must be documented by using the funding source of NHAP/ESG/HSATF see example below:

Fill in all fields related to your service, remember when paying rent the Start Date is the first day the rent covered and the End Date is the last date the rent covered i.e. if you are paying December rent it would look like the example above. Hit Save & Continue and the Edit Service Screen will open allowing you to complete additional sections relating to the service.

Make sure to 1. Confirm Service Provider, 2. Start Date, 3. End Date, 4. Service Type, 5. Service Notes: use this section to type any relevant notes related to this service. 6. When paying rent you must indicate the information in the Service Costs section. 7. You must click on the triangle to expand the Apply Funds for Service section in order to assign NHAP/ESG/HSATF funds to this service. 8. Attach any documentation related to eligibility in this section. See Criteria and Recordkeeping Requirements and Forms Appendix for how to name any attached documents Apply Funds for Service: When you expand this section, your screen will look similar to this


To apply the NHAP/ESG/HSATF Funds click on Add Funding Source

The Add Funding Source search screen will open, search or locate the NHAP/ESG Funding Source and click on the green plus sign to select.

Once you have selected the funding source it will be visible on the Service Transactions Screen. Enter the amount in the Amount box and select Calculate.

Support Documentation can be added by selecting *Add Support Documentation, this will open up a window allow you to upload any file. Select Choose File to locate the information you want to upload, type an appropriate description and select Upload. Once you hit upload the file will appear in the Support Documentation section. See forms appendix for how to name any attached documents. * Currently HUD does not mandate that all items listed in this document be in HMIS; however the process listed in this document is HIGHLY encouraged and recommend best practice.


Make sure to complete the information in the Need Information section and hit Save & Exit to complete the Service Transaction.

Reminder: All participants(s) housing placement receiving NHAP/ESG/HSATF Rent Payment Assistance will comply with HUD Habitability Standards and Lead Based Paint Standards where applicable. Documentation should include a Service Transaction of Building Inspection and/or Lead Based Paint Screening. A monthly case management service is also required. Please enter any/all services in the Service Transactions module as necessary. Referrals: Documentation of assisting participants with obtaining supportive services and connecting to other services they may be eligible should be recorded in the Service Transactions> Referral section of ServicePoint. To add a Referral locate your consumer’s file in ServicePoint>Service Transactions>Referrals.

To add the Referral click on Add Referral. The Referral screen will appear. Make sure to select any household members if applicable. In the Needs Assignment look in the Service Code Quick list for the service you are making a referral for, if it is not listed click on the Service Code Look-Up and locate the appropriate service. Complete each section making sure to put the Outcome and If Not Met, Reason. HUD CoC and ESG Update: This assessment should be completed on all participants that have been in the project for 90 days to reflect eligibility and need for continued assistance. A new HUD CoC and ESG Update should be completed every 90 days for continued eligibility and need until they exit the project. The Housing Stability Plan (Via CasePlans see above

instructions) must be updated to reflect completion of an evaluation of eligibility. An Annual Update must be completed as well to show income at or below 30% AMI. To enter a HUD CoC and ESG Update go to ServicePoint, locate your consumer and click on the Entry/Exit Tab. Your screen will look similar to this:



Another new window will open called Add Interim Review. You will want to select the consumers that you want to include in this review by placing a check mark by their names. Confirm your Entry/Exit Provider, Entry/Exit Type and then pick either 90-Day Review or Update or if you are completing your Annual you will select Annual from the picklist. Enter the date of the review in the Review Date section. Once you have entered all required elements click on Save & Continue.



Once you have entered/updated all necessary information on each consumer hit Save & Exit. Reminder: for RRH projects you want to make sure to update the “In Permanent Housing” question at the bottom of the Assessment to reflect any changes since Intake. The Entry/Exit Interim Reviews Assessment will close and the Interim Reviews window will show the Interim Reviews Associated with this Entry/Exit. Hit Exit. Note the Client Count on the Interim Reviews window, which will indicate how many participants were included in the Interim Assessment.

After you hit Exit you will be taken back to the Entry/Exit tab and you will see in the Interims column for your project stay a number indicating the number of Interims completed for this consumer. Hit Exit and this screen will close.

HUD CoC and ESG Exit (2015): This assessment will be completed when participants exit your project. To complete this assessment go to ClientPoint>Entry/Exit click on the Pencil next to the Exit Date Column related to your project.

Once you click on the Pencil the Edit Exit Data screen will open. Make sure to check all members of the family who are exiting your project, if applicable. Confirm the 1. Exit Date, 2. Reason for Leaving, and 3. Destination to reflect why the participant(s) are leaving and where they are going. Click on Save & Continue.


After you click on Save & Continue the HUD CoC and ESG Exit (2015) Assessment will open.

Complete the HUD and ESG Exit (2015) making any updates necessary, if there is more than one person in the household make sure to complete the Exit Assessment for ALL members. Once you have completed the Assessment click on Save & Exit, your participants have been exited out of your project.



Homeless Prevention (HP) Component-576.103 ESG funds may be used to provide housing relocation and stabilization services to prevent an individual or family from moving into an emergency shelter or another place described in paragraph (1) of the “homeless” definition 576.2. Homeless Prevention may be provided to individuals and families who meet the criteria under the “at risk of homelessness” definition, or who meet the criteria in paragraph (2) or (4) of the “homeless” definition in 576.2 and have an annual income below 30 percent of median family income for the area, as determined by HUD. Homelessness prevention must be provided in accordance with the housing relocation and stabilization services requirements in 576.105, the short-term and medium-term rental assistance requirements in 576.106, and the written standards and procedures established under 576.400.Eligible costs include: Rental Assistance: rental assistance and rental arrears, financial assistance: rental application fees, security and utility deposits, utility payments, last month's rent, moving costs, housing search and placement, housing stability case management, landlord-tenant mediation , credit repair. 576.103 Case management consists of:

• Using the centralized or coordinate assessment system • Conducting the initial evaluation required under 576.401 (a) including verify and documenting eligibility. • Counseling • Developing, securing, and coordinating services • Monitoring and evaluating program participant progress • Providing Information and Referrals • Developing an individualized housing and service plan, including planning a path to permanent housing stability. • Records and recording keeping including revaluation

*Currently HUD does not mandate that all items listed in this document be in HMIS; however the process listed in this document is HIGHLY encouraged and recommend best practice. HUD CoC and ESG Entry (2015) Completed on all eligible participants. HMIS Participation in Coordinated Entry A VI-SPDAT should be completed on Category 1-Literally homeless or Category 4-Fleeing

Domestic Violence persons and families. An appropriate housing referral should be made following your CoC’s requirements. (Lincoln and BOS any score of 10 or above for a single must be referred to the MVRT)


• Determination and verification of eligibility “at risk of homelessness” definition in paragraph (2) or (4) of the “homeless” definition 576.2.

• Documentation that the participants have an annual income below 30 percent of median family income for the area, as determined by HUD.

• Must include documentation that program participant lacks sufficient resources and support networks necessary to retain housing without ESG assistance.


• Must contain eligibility evaluation every 90 days until exit. • Rent reasonableness and Fair Market Rent must be documented (24 CFR part

888 and 982.507) • Referrals must be documented.

Services • All eligible services are expected to be recorded in the Service Transactions module using the drop down list of eligible services for your NHAP/ESG/HSATF project.

• All Financial assistance will be documented by using the funding source of NHAP/ESG/HSATF.

• A monthly case management service is required. Short-term and medium-term rental assistance must also document Unit and Unit Type.

• All participant(s) housing placement receiving NHAP/ESG/HSATF Rent Payment Assistance will comply with HUD Habitability Standards and Lead Based Paint Standards where applicable. Documentation includes a Service Transaction of Building Inspection and/or Lead based Paint Screening.

Referrals

Documentation of assisting participants in obtaining appropriate supportive services as well as connecting them to other federal, state, local, and private benefits and services for which they may be eligible. This includes but is not limited to:

• Medicaid • Snap • WIC • Unemployment • SSI/SSDI • Services for Veterans • TANF •

HUD CoC and ESG Update (2015) Completed via Interim when participants have been in the project for 90 days to reflect eligibility and will continue to be entered every 90 days for eligibility until they exit the project. The Interim Review type in HMIS may be either 90-day review or Update. The Housing Stability Plan must be updated to reflect completion of an evaluation of eligibility.

HUD CoC and ESG Exit (2015) Completed when the participant(s) exit the project. Complete the assessment in its entirety. Reason for leaving and destination must be documented at exit. The questions on the header “Answer for ALL Clients exiting Homeless Prevention Programs” must be answered.


Intake Requirements In order to ensure that all data that is necessary to meet several federal and state reporting requirements ALL ESG/HUD funded providers will do a HUD Entry/Exit-Entry when the participant(s) enters the NHAP/ESG/HSATF project, for Prevention an entry into a project would be the date the participant was housed. All questions on the HUD CoC and ESG Entry (2015) Assessment will be completed at the time of entry noting the section headers on the assessment defining question answering requirements for all persons or adults and heads of household only. For Prevention projects sign into ServicePoint. Go to ClientPoint and Search for your consumer. Enter the consumer’s full name and click on the search button.

Review the search responses; compare names, SS numbers and date of birth to locate the correct consumer. If your consumer is not listed, then you will need to Add New Client with This Information Reminder: you must first search for a consumer before you can add them to the system; this ensures that duplicates are not created. If there are additional household members make sure to search for/add in order to create your household.

Select your consumer from the Client Results (or “Add New Client with This Information, if they did not show up in the search). You will be taken to the Client Information>Summary Tab. The Summary tab allows you to see the history of entries/exits, services, household information, ROI etc. depending on how your agency has decided this screen appears. Please do NOT enter data from this screen unless that is part of your projects’ workflow.


To create an Entry go to the Entry/Exit Tab 1. and click on Add Entry/Exit 2.to open the assessment. If a consumer is part of a household make sure that all members are checked. Reminder: Household members must be established on the Households tab BEFORE creating Entry/Exits. Double check that you have selected your correct Provider 3. and make sure that your Type 4. is listed as HUD. The Entry Date 5. is the date the consumer is housed. Click on Save& Continue.

The HUD CoC and ESG Entry (2015) will be the default assessment at the top of the screen you will see Provider, Type and Household Members Associated with the Entry Data. The questions listed on the HUD CoC and ESG Entry (2015) are required for all HUD and NHAP/ ESG funded Projects. Pay attention to the section headers that are there to guide you for which sections are required of which participants.










Per the Recordkeeping requirement use the Case Notes section of the Goal to reflect any meetings and progress that takes place during the consumer’s time in the project. Action Steps Planned can also be used to track small achievements leading up to the overall Achievement of the main goal i.e. a Case Manager requires a consumer to meet with them once per month, you can add an Action Step of Meet with Case Manager and later when the consumer meets with the Case Manager you can add a service via the Service Items for this Goal. Reminder: Documentation of annual income below 30 percent of median family income and lack of sufficient resources and support networks. Eligibility evaluation must take place every 90 days until exit. To add a Case Notes just click on Add Case note a new window will open called Case Note. Complete as appropriate. Save Case Note to save.


To add an Action Steps Planned click on Add Action Step, a new window will open you will need to select the Adult or Head of Household that this Action Step is planned or relevant for. Confirm your provider 1. Enter the Date Action Step was set 2. Type what the Action Step is 3. Provide a Target Date (this is a date you expect it will be achieved) 4. Select the Overall Status 5. And provide a Projected Follow up Date if you want a reminder on your ServicePoint Home Page Dashboard. Click on Save Action Step 6. to save the Action Step.

To add Services Related to the Goal, click on Add Multiple Services, you will get a message that says “This will close the Goal popup and take you to the Service Transactions page. Click on OK.



You should continue to add all services as they occur in the Service Transactions tab. You should continue to enter and update all CasePlans/Goals as appropriate.

Services: All eligible services are expected to be recorded in the Service Transactions module using the drop down list of eligible services for your NHAP/ESG/HSATF project. All Financial Assistance must be documented by using the funding source of NHAP/ESG/HSATF see example below:

Fill in all fields related to your service, remember when paying rent the Start Date is the first day the rent covered and the End Date is the last date the rent covered i.e. if you are paying December rent it would look like the example above. Hit Save & Continue and the Edit Service Screen will open allowing you to complete additional sections relating to the service.


Make sure to 1. Confirm Service Provider, 2. Start Date, 3. End Date, 4. Service Type, 5. Service Notes: use this section to type any relevant notes related to this service. 6. When paying rent you must indicate the information in the Service Costs section. 7. You must click on the triangle to expand the Apply Funds for Service section in order to assign NHAP/ESG/HSATF funds to this service. 8. Attach any documentation related to eligibility in this section. See Recordkeeping

Requirements. Apply Funds for Service: When you expand this section, your screen will look similar to this

To apply the NHAP/ESG/HSATF Funds click on Add Funding Source

The Add Funding Source search screen will open, search or locate the NHAP/ESG Funding Source and click on the green plus sign to select.


Once you have selected the funding source it will be visible on the Service Transactions Screen. Enter the amount in the Amount box and select Calculate.

Support Documentation can be added by selecting Add Support Documentation, this will open up a window allow you to upload any file. Select Choose File to locate the information you want to upload, type an appropriate description and select Upload. Once you hit upload the file will appear in the Support Documentation section.

Make sure to complete the information in the Need Information section and hit Save & Exit to complete the Service Transaction.

Reminder: All participants(s) housing placement receiving NHAP/ESG/HSATF Rent Payment Assistance will comply with HUD Habitability Standards and Lead Based Paint Standards where applicable. Documentation should include a Service Transaction of Building Inspection and/or Lead Based Paint Screening. A monthly case management service is also required. Please enter any/all services in the Service Transactions module as necessary.


Referrals: Documentation of assisting participants with obtaining supportive services and connecting to other services they may be eligible should be recorded in the Service Transactions> Referral section of ServicePoint. To add a Referral locate your consumer’s file in ServicePoint>Service Transactions>Referrals.

To add the Referral click on Add Referral. The Referral screen will appear. Make sure to select any household members if applicable. In the Needs Assignment look in the Service Code Quick list for the service you are making a referral for, if it is not listed click on the Service Code Look-Up and locate the appropriate service. Complete each section making sure to put the Outcome and If Not Met, Reason.

HUD CoC and ESG Update: This assessment should be completed on all participants that have been in the project for 90 days to reflect eligibility. A new HUD CoC and ESG Update should be completed every 90 days for continued eligibility until they exit the project. The Housing Stability Plan (Via CasePlans see above instructions) must be updated to reflect completion of an evaluation of eligibility. To enter a HUD CoC and ESG Update go to ServicePoint, locate your consumer and click on the Entry/Exit Tab. Your screen will look similar to this:


Another new window will open called Add Interim Review. You will want to select the consumers that you want to include in this review by placing a check mark by their names. Confirm your Entry/Exit Provider, Entry/Exit Type and then pick either 90-Day Review or Update or if you are completing your Annual you will select Annual from the picklist. Enter the date of the review in the Review Date section. Once you have entered all required elements click on Save & Continue.



Once you have entered/updated all necessary information on each consumer hit Save & Exit. The Entry/Exit Interim Reviews Assessment will close and the Interim Reviews window will show the Interim Reviews Associated with this Entry/Exit. Hit Exit. Note the Client Count on the Interim Reviews window, which will indicate how many participants were included in the Interim Assessment.

After you hit Exit you will be taken back to the Entry/Exit tab and you will see in the Interims column for your project stay a number indicating the number of Interims completed for this consumer. Hit Exit and this screen will close.

HUD CoC and ESG Exit (2015): This assessment will be completed when participants exit your project. To complete this assessment go to ClientPoint>Entry/Exit click on the Pencil next to the Exit Date Column related to your project.


Once you click on the Pencil the Edit Exit Data screen will open. Make sure to check all members of the family who are exiting your project, if applicable. Confirm the 1. Exit Date, 2. Reason for Leaving, and 3. Destination to reflect why the participant(s) are leaving and where they are going. Click on Save & Continue.

After you click on Save & Continue the HUD CoC and ESG Exit (2015) Assessment will open.

Complete the HUD and ESG Exit (2015) making any updates necessary, if there is more than one person in the household make sure to complete the Exit Assessment for ALL members. Once you have completed the Assessment click on Save & Exit, your participants have been exited out of your project.


RECAP • All persons applying for NHAP/ESG/HSATF will have a Service Transition of Benefits Screening prior to any

financial assistance. • All persons accepted into a program will have a HUD Entry/Exit Entry or an attached Shelter Stay. • All participants with the exception of Street Outreach will have a Housing Stability Plan. • All Participants in SO, ES, RRH, HP who are Category 1- Literally Homeless or Category 4-Fleeing Domestic

Violence should have a VI-SPDAT completed. • All participants applying for housing or housing payments i.e. rent or deposits; will have a Building

Inspection Service Transaction completed prior to any financial services. IF the participant(s) have eligible children a Service Transaction Lead Based Paint Screening must be completed prior to any financial services. All Fair Market Rent or Rent Reasonableness will be documented in the participants Housing Stability Plan in Case Plans under Housing.

• All eligible participants will have income documented at intake and at screening and every 3 months at re-certification for ESG HP.

• ES, TH, HP and RRH participants will have monthly Case Management services and documentation in your Housing Stability Plan as to consumer’s progress.

• If you are paying a full month’s rent the Start Date is the 1st of the Month and the End Date is the last date of the month.

• If you are paying Rent Arrears the Start Date is the date you are making payment, the End Date is the same as the Start Date. You must include Arrears in Unit Type.

• If you are paying Rental Deposit the Start Date is the date you are making payment, the End Date is the same as the Start Date.

• If you are paying Utility Assistance the Start Date is the date you are making payment, the End Date is the same as the Start Date.

• All data will be entered into ServicePoint within 7 working days or as close to real time as possible. *Currently HUD does not mandate that all items listed in this document be in HMIS; however the process listed in this document is HIGHLY encouraged and recommend best practice. Reporting Requirements All NHAP/ESG/HSATF programs will be expected to submit the following reports on or before the 7th working day of each month, for the previous months’ data. Report Location Requirements 0260-HUD CoC APR Data Quality/Completeness

ART> Public Folder Art Gallery Reports and Resources ART Gallery Reports 0260 – HUD CoC APR Data Quality/Completeness

Must fax or email Tab A and G ONLY. If faxing the report must contain a signature of someone other than the person pulling the report. If emailing, please CC the person overseeing DQ within projects(cannot be yourself)

NHAP 2016-2017 This is located in the ART Public Folder CCFL-Lincoln

Must fax or email

Lincoln and Balance of State Agencies please send both reports to Tamara and Angel at [email protected] and [email protected] or fax ATTN: Tamara or Angel at 402-472-8412. Omaha agencies please send the reports to your Omaha HMIS SA’s.

mailto:[email protected]

mailto:[email protected]


These forms are provided to assist you with ensuring you are in compliance with record keeping requirements. Please use these forms as appropriate for your projects and make sure to upload the completed documents in HMIS. When uploading the documents into HMIS, please save the document with the name of the document listed i.e. NHAP/ESG Homeless Certification (SO, ES, RR), NHAP/ESG Homeless Certification HP, NHAP/ESG Self Certification of Homeless/DV/At Risk, Certification of Chronic Homeless, Self-Statement of Chronic Homeless etc. if you are using a document not listed below please make sure to label in the same format and manner. *Currently HUD does not mandate that all items listed in this document be in HMIS; however it is HIGHLY encouraged and recommend best practice.

NHAP/ESG HOMELESS CERTIFICATION (FOR STREET OUTREACH, EMERGENCY SHELTER, RAPID REHOUSING)

NHAP/ESG Applicant Name and HMIS ID:_________________________________________________________________

Individual without dependent children (complete one form for each household) Household with dependent children (complete one form for each adult household member) Number of persons in the household: This is to certify that the above named individual or household is currently homeless based on the check mark in the correct section i.e. A, B, C etc., and signature indicating their current living situation. Check only ONE BOX and ONLY complete that section. *IMPORTANT: THIRD PARTY EVIDENCE MUST BE ATTACHED TO THIS FORM IN ORDER TO CERTIFY HOMELESSNESS.

A. Living Situation: place not meant for human habitation (e.g., cars, parks, abandoned buildings, streets/sidewalks)

The person(s) named above is/are currently living in a public or private place not designed for human habitation, or ordinarily used as a regular sleeping accommodation for human beings, including a car, park, abandoned building, bus station, airport, or camp ground. Description of current living situation:

Authorized Referral Agency Representative Signature:_____________________________________________ Date: _________

B. Living Situation: Emergency Shelter DV Shelter? (check if “yes”)

The person(s) named above is/are currently living in a publicly or privately operated shelter designated to provide temporary living arrangements: Emergency Shelter Program Name: ___________________________________________________________________

Authorized Shelter Agency Representative Signature:______________________________________________ Date:_________

C. Living Situation: Transitional Housing DV TH? (check if “yes”)

The person(s) named above is/are currently living in a transitional housing program for persons who are homeless and immediately prior to entering transitional housing the person was residing in Emergency Shelter or A place unfit for human habitation.

Transitional Housing Program Name:__________________________________________________________________

Authorized Transitional Housing Agency Representative Signature:_____________________________________ Date:________

D. Living Situation: Housing With Eviction The person(s) named above was/were evicted or otherwise lost housing. Date of Eviction: _____________________________

Landlord or other Third Party Signature: __________________________________________________________ Date: _______

*Homeless Recording Keeping Requirements 24 CFR 578 https://www.hudexchange.info/resources/documents/HomelessDefinition_RecordkeepingRequirementsandCriteria.pdf

https://www.hudexchange.info/resources/documents/HomelessDefinition_RecordkeepingRequirementsandCriteria.pdf

NHAP/ESG HOMELESS CERTIFICATION (FOR HOMELESS PREVENTION)

NHAP/ESG Applicant Name and HMIS ID: __________________________________________________ Address from which Applicant is being evicted: ____________________________________________ Individual without dependent children (complete one form for each adult in the household) Household with dependent children (complete one form for each adult in the household) Number of persons in the household: This is to certify that the above named individual or household is currently at risk for homeless based on the information indicated below and signature indicating their current housing status. *IMPORTANT: THIRD PARTY EVIDENCE, INCLUDING WRITTEN STATEMENTS, [(B) and (C) below], MUST BE ATTACHED TO THIS FORM IN ORDER TO CERTIFY AT-RISK STATUS. Living Situation: Facing Eviction The person/household above is currently living in rental housing from which they are being evicted. The individual or family: 1. Has income below 30 percent of median income for the geographic area; AND 2. Lacks sufficient resources to attain housing stability. [e.g., family, friends, faith‐based or other social networks immediately available] to prevent them from moving to an emergency shelter or another place described in category 1 of the homeless definition.

Evidence of the second eligibility criterion (#2 above) for this Applicant is:

(A) Source documents (e.g., notice of termination from employment, unemployment compensation statement, bank statement, health‐care bill showing arrears, utility bill showing arrears).

(B) To the extent that source documents are unobtainable, a written statement by the relevant third party (e.g., former employer, public administrator, relative) or written certification by the intake staff of the oral verification by the relevant third party that the applicant meets one or both of the criteria of the definition of ‘‘at risk of homelessness’’ or

(C) If source documents and third-party verification are unobtainable, a written statement by intake staff describing the efforts taken to obtain the required evidence.

The person(s) listed above meet one or more of the following risk factors:

□ (1) Has moved frequently because of economic reasons □ (2) Is living in the home of another because of economic hardship □ (3) Has been notified in writing that their right to occupy their current housing or living situation will be terminated within 14 days of the date of application for homeless assistance □ (4) For individual and families leaving a hotel or motel-evidence that they lack the financial resources to stay □ (5) No subsequent residence has been identified □ (6) The individual lacks the financial resources and support necessary to obtain permanent housing □ (7) Otherwise lives in housing that has characteristics associated with instability and increased risk of homelessness

Evidence of risk factors for this Applicant is: (A) Source documents (e.g., notice of termination from employment, unemployment compensation statement, bank statement, health‐care bill

showing arrears, utility bill showing arrears). (B) To the extent that source documents are unobtainable, a written statement by the relevant third party (e.g., former employer, public

administrator, relative) or written certification by the intake staff of the oral verification by the relevant third party that the applicant meets one or both of the criteria of the definition of ‘‘at risk of homelessness’’ or

(C) If source documents and third-party verification are unobtainable, a written statement by intake staff describing the efforts taken to obtain the required evidence.

Third Party Certification I certify that I have provided verification as indicated above that the ESG Applicant meets eligibility criteria and/or risk factors for being “at-risk” of homelessness. Relevant Third-Party Representative Signature: Date: NHAP/ESG Signature: Date:



NHAP/ESG SELF CERTICICATION OF HOMELESS/DOMESTIC VIOLENCE/AT RISK

NHAP/ESG Applicant Name and HMIS ID:_________________________________________________________________ Household without dependent children (complete one form for each adult in household) Household with dependent children (complete one form for each adult in household) Number of persons in the household: This is to certify that the above named individual or household is currently homeless based on the information below, and signature indicating current living situation.

Check only one: I [and my children] am/are currently homeless and living on the street (i.e. a car, park, abandoned building, bus station, airport, or camp ground).

I [and my children] am/are the victim(s) of domestic violence and am/are fleeing from abuse, have not identified a subsequent residence, and lack the resources or support networks, e.g., family, friends, faith- based, or other social networks, needed to obtain housing where my/our safety would not be jeopardized.

I [and my children] am/are being evicted from the housing we are presently staying in and must leave this housing within the next 14 days.

I certify that I have insufficient financial resources and support networks; e.g., family, friends, faith-based or other social networks, immediately available to obtain housing or to attain housing stability without ESG assistance. I certify that the information above and any other information I have provided in applying for NH AP / ESG assistance is true, accurate and complete. NHAP/ESG Applicant Signature: Date:

ESG Staff Certification * I understand that third-party verification is the preferred method of certifying homelessness or risk for homelessness for an individual who is applying for ESG assistance. I understand self declaration is only permitted when I have attempted to but cannot obtain third party verification.

Documentation of attempts made for third‐party verification: NHAP/ESG Staff Signature: Date: _____________



CERTIFICATION OF CHRONIC HOMELESSNESS

This document may be used to analyze whether or not an individual or family meets the definition of chronic homeless based on 2CFR 91.5 and 24 CFR 578.3. Documentation must be attached to verify status.

NHAP/ESG Applicant Name and HMIS ID:_________________________________________________________________

Individual without dependent children (complete one form for each adult in the household) Household with dependent children (complete one form for each adult in the household) Number of persons in the household:

Applicant or head of household has the following disability check all that apply:

□ A diagnosable substance abuse disorder of long duration that limits ability to live on own

□ A mental health problem

□ A developmental disability

□ A chronic health problem

□ A physical disability AND Has been literally homeless:

□ For at least 12 months or

□ On at least four separate occasions in the last 3 years with combined total of 12 months (break between episodes ≥7 consecutive nights) or

□ Continuously unsheltered or

□ Living in a shelter for the past 12 months or

□ This is the 4th separate occurrence of this living situation in the past 3 years

□ Living in institutional care facility <90 where they were chronic homeless at entry Start Date End Date Number of Days Location of Stay Documented? Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No Total Days Based on this summary, I certify that the client: □is chronically homeless □is NOT chronically homeless

NHAP/ESG Staff Signature: Date: _____________

SELF-STATEMENT OF CHRONIC HOMELESSNESS

Third party verification of chronic homelessness is always preferred*, however; this document of Self-Statement may be used when a person/household applying for NHAP/ESG assistance lacks ability to provide Third Party Verification of chronic homelessness. Documentation must be attached to verify status.

NHAP/ESG Applicant Name and HMIS ID:_________________________________________________________________ Individual without dependent children (complete one form for each adult in the household) Household with dependent children (complete one form for each adult in the household) Number of persons in the household:

Applicant or head of household has the following disability check all that apply:

□ A diagnosable substance abuse disorder of long duration that limits ability to live on own

□ A mental health problem

□ A developmental disability

□ A chronic health problem

□ A physical disability AND Has been literally homeless:

□ For at least 12 months or

□ On at least four separate occasions in the last 3 years with combined total of 12 months (break between episodes ≥7 consecutive nights) or

□ Continuously unsheltered or

□ Living in a shelter for the past 12 months or

□ This is the 4th separate occurrence of this living situation in the past 3 years

□ Living in institutional care facility <90 where they were chronic homeless at entry I certify that I was homeless (sleeping in a place not meant for human habitation or living in a homeless shelter during the following periods of time: Start Date End Date Number of Days Location of Stay Total Days

NHAP/ESG Applicant Signature: Date: _____________ ESG Staff Certification: I understand that third-party verification is the preferred method. I understand self declaration is only permitted when I have attempted to but cannot obtain third party verification. Documentation of attempts made for third‐party verification: NHAP/ESG Staff Signature:____________________________________________________________________________ Date: _____________

*Homeless Recording Keeping Requirements 24 CFR 578 https://www.hudexchange.info/resources/documents/Defining-Chronically-Homeless-Final-Rule.pdf

https://www.hudexchange.info/resources/documents/Defining-Chronically-Homeless-Final-Rule.pdf

CERTIFICATION OF HOMELESSNESS

I certify that (Client Name)____________________________________________ previously resided at

(Agency/Shelter Name)______________________________________________

For the following period(s) of time within the last three (3) years:

Start Date End Date Number of Days Location of Stay Total Days

This facility is classified as one of the following types of institutions:

□ Emergency Shelter □ Transitional Housing □ Permanent Supportive Housing □ Medical Institution □ Mental Health Institution □ Correctional Facility □ Substance Abuse Facility □ Other:____________________________

Authorized Third Party Signature: Date: __________________ I hereby authorize the release of this information: NHAP/ESG Applicant Signature: Date: __________________

NHAP/ESG Income Verification and Asset Declaration

Income Verification

I, __________________________________, currently have monthly income of $________. I know that I am responsible for informing my case manager of any changes in my income within 7 business days of the change, failure to do so could result in loss of services. My income currently comes from:

(Each adult must complete their own form)

Income Category Amount Received How Often

Earned Income $

Unemployment Income $

Worker’s Compensation $

TANF $

Social Security $

Supplemental Security Income (SSI) $

Social Security Disability Income (SSDI) $

Child Support $

Retirement Income $

Pension $

Veteran’s Pension $

Other (Specify): $

Total Monthly Income

Total Annual Income

Currently employed? □Yes □No If unemployed, looking for work? □Yes □No

If yes, employed, how many hours worked in the past week?

Status of employment? □Permanent □Temporary

□Seasonal □Refused

Have you received income from any source in the last 30 days? □Yes □No

Select ALL non-cash benefits that you receive □SNAP-Food Stamps □Medicaid □SCHIP □WIC □VA Medical Services

□TANF Child Care □Section 8, public housing or other rental assistance

□Temporary Rental Assistance □Veteran’s Administration □Other (specify)

Asset Declaration

Select ALL assets you have: □Cash □Checking Account □Savings Account □Retirement Account □Other (Specify):

I certify that the information I am providing is true and could be subject to verification at any time by a third party.

NHAP/ESG Applicant Signature: Date: __________________

For STAFF Use ONLY!

I certify that the above applicant has provided the necessary documentation and:

□Meets Income Requirements □Does Not Meet Income Requirements □Meets Asset Requirements □Does Not Meet Asset Requirements

Case Manager:_____________________________________ Date:____________________________

NHAP/ESG Household Recertification Form

Households receiving NHAP/ESG Prevention and Rapid Re-Housing assistance must be recertified every 90 days. At the end of each recertification the case manager must attach the new evidence to this form demonstrating the household is still eligible for the program and place all documentation in HMIS. It is not acceptable to reattach the evidence from previous eligibility certifications.

NHAP/ESG Participant Name and HMIS ID:_____________________________________________________________________

Consumer is enrolled in: □Prevention Project and must have household income below 30% AMI

□Rapid Rehousing Project and must have household income below 30% AMI (90 day eligibility determination)

□Rapid Rehousing Project and must have household income below 30% AMI (Annual Certification)

Date of Entry into Project: ______________________ NHAP/ESG Case Manager: _____________________________________________

Number of Months (Including arrears) Household has received NHAP/ESG assistance: ______________________

Date of this Re-Certification: ____________________

Current Members in this Household:

Adults: Children (Under 18):

1. 1. 2.

2. 3. 4.

3. 5. 6.

STATUS: Update the household’s current housing status AND attach required documentation:

□Category 1-Literally Homeless Documentation List:

□Category 2-Imminent Risk of Homelessness

□Category 4-Fleeing/Attempting to Flee DV

INCOME: Update the household’s current income status AND attach required documentation:

□Household Income meets AMI requirements Documentation List:

□Household Income DOES NOT meet AMI requirements

Households with an income that is 30% AMI or higher are no longer eligible to receive ANY NHAP/ESG services and should be exited from the project.

Sustainability: For participants that are receiving ongoing NHAP/ESG Financial Assistance, staff must document the inability to pay for the item they are receiving assistance BUT FOR the NHAP/ESG Assistance i.e. bank statements, medical bills etc.

□Household HAS NO other housing options, financial resources, or support networks identified Documentation List:

□Household HAS other housing options, financial resources, or support networks identified

Housing Stability Goals: Household agrees to work on the following goals to ensure a stable housing outcome:

1.

2.

3.

Staff Certification (please check one) □Household Eligible for additional services □Household Ineligible

NHAP/ESG Staff Signature:____________________________________________________________________________ Date: _____________ *Documentation related to information on this form MUST be attached. Filling out this form DOES NOT meet the record keeping requirements-all recertification forms and evidence must be included WITH this form and attached in HMIS.

Documents

NHAP/ESG/HSATF ServicePoint Workflow...Workflow 2016 Instructions on how to enter data for NHAP/ESG/HSATF programs in ServicePoint. ... This document is designed as a reference guide