(exp i1/30/2009) No. OMB Approval 2506-0145 U. S.

Department of Flousing

and Urban DeveloPment Ofhceof CommunigPlanning

and Development

Annual ProgressReport (APR)

for Supportive Housing Program ShelterPlus Care and Section8 Moderate Rehabilitation for SingleRoom Occupancy Dwellings (SRO) Program

HUD-40118

including the time for reviewing insfuctlons' 33 public reporting burden 1brthis collection ofinformation is estimatedto average hours per response' the collection ofinformation This agency may gatheringand maintaining the data needed,and iompleting and reviewing searchingexisting data sources, control number' respondto, a collectionofinformation unlessthat collectiondisplays a valid oMB and a personis not requiredto not conduotor sponsor,

General Instructions Purpose. The Annual ProgressRepofi (APR) is a repofiing tool that HUD usesto track program progressand funding. accomplishmentsand inforrn the Department's competitive processfor homelessassistance Filing Requirements. Recipientsof IfUD's homelessassistance srants must submit 2 APR'S to HUD wilhirl 9ful3Y!-al[ter the end of each operating year. One copy of the report must be submrttedto the Community Plaruring and Development (CPD) Division Director in the local HIID Field Office responsiblefor managing the grant. The other copy must be submitted to HUD Headquarters, Department of Housing and Urban Development,Attn: APR Data Editor, Room 7262, 451 J'" Sueet, SW, Washington, DC. 20410. Failure to submit an APR will delay receiving grant funds and may resuit in a determination of lack of capacity for future funding. An APR must be submitted for each operating year in which HIJD funding is provided. Granteesthat received SHP funding for new construction, acquisition, or rehabilitation are required to operatetheir facilities for 20 years. They must submit an APR 90 days after the end of the first operating year and every year throughout the 20 years. A separatereport must be submitted for each HUD grant received. For Shelter Plus Care (S+C), a separate APR must be submitted for each S+C component. For thosegrantees receivingan extension,a separate report coveringthat period must be submitted(seeExtensionbelow). Recordkeeping. Grantees must collect and maintaininformationon eachparticipantin order to completean APR. Optional worksheetsare attached. The worksheetsmay be used to record information manuaily or to design a computerizedsystem to store and tabulate the inforrnation. The worksheets should not be submitted to HIID with the APR. Organization of the Report. The APR is organizedin the following manner: Part I: Project Progress.This portion of the report describes progressin moving homeless personsto self-sufficiency, the documenting servicesreceived, listing project goals, and accountingfor beds/units. Part II: Financial Information. This portion of the report is completedby all grantees receiving funding under SHP, S+C, and SRO. Final Assembly of Report. After the entire report is assembled, nurnber every page sequentially. Mark any questionsthat do not apply to your program r .ith "N/A" for not applicable. (See Special Instructions for SSO Projects below.) Definitions of Client/Ilousehold Types. Each client/household tlpe is definedbelow. Note that a client's client/household tlpe should be basedon the client's age andlor household composition at the program entry date closest to the start ofthe operatingyear. Families - A family is a householdcomposedof two or more relatedpersons,at leastone of who is a child accompanied by an adult or ajuvenile parent. by not accompanied children,includingpregnantwomen not accompanied other by Singles not in Families - Persons children and unaccompaniedyouth, are singles not in families. When two adults or two unaccompaniedyouth present togetherfor services, eachpersonshouldbe countedin singlesnot in families.. Clients' householdstatusshouldbe determinedbasedon their household composition at the program entry date closestto the start of the operatingyear. This meansthat pregnant women expectedto give birth during their program stay should still be counted as singlesnot in families. of Adults in F amilies - Within a family, an adult is any person 18 yearsof age or older. For the purposes APR reporting, the determination of whether a person is an adult in family should be made basedon their age and householdcomposition at the program entry date closest to the start ofthe operating year. the by Children in Families - Children rn Families are definedas childrenr.inder age of 18 accompanied one or more adults (parent,relative or guardian). Children in famrlies also include both ajuvenile parent and the parent's child(ren). For the purposesof APR reporting, the deterrninationof whether a person is a child in family should be made based on their age and household composition at the program enhy date closestto the start of the operating year. For example,
HUD-40118

year or at program entry (if they enteredduring clients who are iess than 1g years of age on the first day of the operating if they tum i 8 during the course of the operating year' the operatingyear) should be counted as children even persons in Families - Personsin famrlies includes adults in famrlies and chiidren in famrlies'

Other Key Definitions. The following tems are used in the APR. As indicated, in some cases,terms are applied differently depending on rn'hether funding is from SHP, S+C, or SRO. the personas "an unaccompanied homeless individual Chronically homelessperson - HUD definesa chronicallyhomeless with a disabling condition who has either been continuously homelessfor a year or more OR has had at least four (4) in episodesof homelessness the past three (3) years." To be considered chronicallyhomeless, personmust havebeen on a shelter(i.e., not in transitionalhousing)during thesestays. the streets in an emergency or personis basedon the following components: HUD's dehnition of a chronicallyhomeless r homelessindividual has the samecharacteristics homelessindividual: an unaccompanied Unaccompanied of a Singlenot in a Family (describedabove). r Disabling condition: seethe instructions under disabling condition (below) to determinewhether a client is disabled. Did not leave the program - This terrn refers to clientswho were in the program on the last day of the operatingyear. Disabling condition - HUD definesa disabling condition as: (1) A disability as defined in Section223 of the Social Security Act; (2) a physical, mental, or emotional impairment which is (a) expectedto be of long-continued and indehnite duration, (b) substantially impedes an individual's ability to live independently,and (c) of such a nature that such ability disability as definedin section102 of the could be improvedby more suitablehousingconditions;(3) a developmental Developmental Disabilities Assistanceand Bill of Rights Act; (4) the diseaseof acquired immunodeficiency syndrome or any conditions arising from the etiological agency for acquired immunodeficiency sgrdrome; or (5) a diagnosable substance abusedisorder. progranq Entered the program - Enteredthe program refersto the first day a client receivesservices. For a residential this date would representthe first day of residence in the program's housing. For services,this date may representthe day of program enrollment, the day a service was provided, or the first date of a period of continuous participation in a ser-vice (e.g., daily, weekly, or monthly). For S+C and SRO prograrr$, the program entry date is the date that the participant starts to receive rental assistance.For S*C, servicesprovided prior to this point are recognized as necessaryfor outreachlenrollment and are eligible to count as match. An Extension APR applies to SHP and S+C granteesthat requestedand received an extension of their grant term from the HUD fie1d office. The only difference befween an APR for the extensionperiod and the regular APR (besidesthe amount of time covered) is the signaturepage. Granteesshould circle "yes" to indicate the APR is for an extension period and circle the operating year for which the reporl is an extension.For example, if the granteeis extending year 3, the granteeshould submit an APR as usual for year 3 and submit another APR for the extension period, indicating the page. secondis an extensionand also circling year 3 on the signafure Grantee meansa direct recipient of the HUD award. Left the program - Left the programrefers to the last day a client receivesservices. For a residentialprograr4 this date the the in would represent last day of residence the program'shousing. For services, exit datemay represent last day the a servicewas provided or the last date of a period of continuousservice. If a client leavesthe program temporarily(e.g., for a hospitaiizatton) but is expectedto return within 30 days, do not count that client as having left the program. and is not For S+C prograrns,the program exit date refers to the date the participant stops receiving rental assistance expectedto retum to S+C assistedhousing. if the participant returns to S+C assistedhousing within 90 days,the person should not be oonsideredas exiting from the program. If the person returns to S+C assistedhousing after 90 days, that person is considereda new participant. The worksheet is designedto capturethis infor:rnation. 3 18 i-iuD-401

Match for S+C is the value of supporfive seryicesreceived by participants in the S+C project which, in the aggregate, provided over the life of the project. For SHP, match is cash must at leastequaithe value of the S+C rental assistance used to provide the grantee'sportion of acquisition, rehabilitation, new construction, operations and supportive services expenses. Operating year * For SHP progralr'N,the first operating year begins after developmentactivities for acquisition, rehabiiitation, and new construction are complete, after a copy of the Certificate of Occupancy is sent to the iocal HUD office, and when the hrst participant is acceptedinto the project. For projects without acquisition, rehabilitation, or new construction, the operating start date begins when the granteeacceptsthe first participant. For dedicatedHMIS projects, the operating year begins when any eligible cost included in the approvedproject budget is incurred. For S+C (SRA, PRA and TRA components),the first operating year begins on the date HIID signs the grant agreement. For S+C/SRO and for Sec. 8 SRO, the first operating year begins wrth the effective date of the Housing AssistancePagnents (HAP) Contract. To determine which operating year to circle on the APR cover page, begin counting from the initial grant operating starl date and include renewal grants. For example, a project receiving an initial grant for three years and a renewal grant for two years would circle years 1, 2, and 3 respectively on the APR cover sheetfor the initial grant and would circle 4 and 5 respectively for the renewal grant. For any future renewal grants,the granteewould begin by circling 6 on the APR cover sheet. Participants - The term participant refers to Singlesnot in Famrlies and Adults in Families as defined above. Participant does not include children or caregiverswho live with the adults assisted. Project Sponsor meansthe organization responsiblefor carryringout the daily operation of the project, if the organization is an entity other than the grantee.

Special Instructions for Supportive Service Onlv (SSO) Programs. SSO grantees should completeall questions, unless a written agreementhas been reachedwith the field office concerning which questionscan be answeredusing estimates, or in rare instances. skipped. Below is an exampleof how informationcould be derivedin a large, single-service SSOproject: A granteeisponsor staff member could be assignedto collect information from the organizationshousing the participants. The staffperson would contact theseindividual organizationsto request information regarding the persons in that facility that use the service. For participants living on the street,the grantee/projectsponsormay provide estimates. Information could be collected for eachparticipant or for participants receiving servicesat a point-in-time. If estimatesor point-in-time counts are used, the method used must be describedin the APR and the documentationkept on frle. grants,granteesoperating SSO projects are expectedto As with all projects funded under IILID's homelessness assistance complete all APR questionsthat are applicable to them. Note that all projects have been awarded funds as a result of responding to the program goals of assistinghomelesspersonsobtain/remainin permanenthousing and increasetheir slslis and income. The APR documentstheir progressin meeting thesegoals. In some circumstances field offices and granteesmay sign a written agreementconceming questionsthat can be answeredusing estimates, in rare instances, below for reporling on specialtypes of projects,suchas or skipped. Seethe specialinstructions outreachonly projects, projects providing servicesto children only, and transportation,medical, dental, and other single, shorlprojects. duralionservice SSO programs are a third priority for local HMIS implementation, following emergencyshelters,transitional housing programs, outreachprograms, and permanentsupportive housing programs. Once SSO programs are included in the HMIS, SSO grantees will be able to answer all APR questionsusing their HMIS data. SSO granteesthat are not yet participating in HMIS will need provided above. using the specialinstructions to collect datato answerthe APR questions are Outreach Only Projects. Projectswhich are solely devotedto streetouheachand connectionto housingand services not required to track participants beyond their contact with persons on the street. It is sufficient for theseproj ects to enter
HUD-401 18

for questions 5-9 are allowed,given that information on questions1-10(skipping questionsl1-13 and 17). Estimates participantsmay be reluctantto answerpersonalquestions' number of people,providing basic that the granteeis servingthe appropriate will demonstrate Answering the questions the personsare being served,demonshating types of that homeless demographiciniormation for Congress,demonstrating they are receiving' to, are housing parlicipants connected and the type of services Hotline Projects. Hotline servicesare similar to outreach only projects, but contactbetweengranteeand parlicipantis often of very short duration- peopleenter and leave the program nearlysimultaneousiy.It is sufficient for theseprojectsto answer questions (skipping4), 10, and 14-19(skipping17). 1-5 ProjectsProviding ServicesTo Children Only. Projects that provide child care, after school care, counselingfor children, While the main focus of the project is etc. make an important contribution toward moving a family out of homelessness. providing services the children, it is the adults who are reported on in questions6-16 of the APR. Like all other to projects,this type is also targeted toward getting the familiesinto housingand increasingthe families' incomes. (except 17). Grantees may skip question9; all other questionsshould be answered providea Transportation, Medical, Dental, and Other Single, Short-Duration Serwice Projects. Somegrantees in single serviceof fairly short duration focusedONLY indirectly on assistirghomelesspersonsto obtain/remain permanent housing and increase their skiits and incomes. It is sufficient for theseprojectsto enter informaion on questionsl-10 and 14would have to it services, is unreasonable think that someone 19 (question 17 may be skipped). However, with transportation to give their age,race,and ethnicity to a bus driver to get a ride a few blocks provide a narrative,which gives the number of rides given during the operatingyear, and providesestimates For theseservices, on the above statistics basedon the population that utilizes the service. servedduring the shouldreport on all participants For Safe Haven (SH) Proiects. C-rrantees Special Instructions orantees ..,ear Nole: this is a chansef..om nrior inst.n-:ctions to oneraf!no where .'..-.-D.-..'----r_--_-were !'lsf-n-lcted reDorton the first 25 participants served.

Special Instructions for HomelessManagement Information Svstem fIIMIS) Proiects.HMISgrantees

should fill out the cover sheetof the APR Part II Financial Informatioq and the HMIS Activities section.

HUD-40118

THIS PAGE. TO BE COMPLETEDBYALL GRANTEES

Grantee:

Services of Department Human city andcountyof san Francisco,

ProjectSponsor:

Number: or HUDGrant Project cAo1c50i037

ProjectName:

center of servicesAffiliate the BernalHeightsNeighborhood Housing

Apts. Blvd. Monterey

Reporting Period: (month/day/year)

or) year the OperatingYear: (Circle operating beingreported

lr J z [ l n + D s n o 3 t X a trs l to nrr l r z n t : n t + n ts n to n tz D ts n tq n zo
Indicate extension: if Indicateif renewal: X Yes ! No n Yes X No from:c/ l/uo

to:4130107

for Numbers thisproiect: Previous Grant

cA39C96-0102

Check the componentfor the proglam on which you are reporting Supportive Housing Program (SHP) Shelter PIus Care (S+C)

Section8 ModerateRehabilitation n RoomOccupancy Single (Sec.8 SRO)

tr I tr tr n T

Housing Transitional for Housing Home]ess Permanent with Persons Disabilities Haven Safe Housing Supportive Innovative Only Services Supportive HMIS

tr n ffi X

(TRA) RentalAssistance Tenant-based (SRA) Assistance Rental Sponsor-based (PRA) RentalAssistance Project-based (SRO) RoomOccupancy Singte

year) this operating with a descriptionof population,number servedand accomplishments Summary of the project; (One or two sentences

families. AIIthe housingto homeless up year,this projectprovided to four unitsof permanent Duringthis operating to and had one or more specialneedsrelated mental shelters came from eitherthe streetsor emergency families use, and/orHIV/AIDS. substance health,
Name & Title of the Personwho can answerquestionsabout this report: Phone: (include areacode)

of Affiliate the BHNC (415)206-2140 HousingServices Asset Manager, Sumi lmamoto,

Address: Fax Number: (include areacode)

Center of Affiliate the BernalHeightsNeighborhood Services Housing Ave. 515 Cortland CA San Francisco, 9411d nc.org Address simamoto@bh E-mail

(415)648-0793

I hereby certify that all the information stated herein is true and accurate
false claims and statements.Conviction may result in criminal andloV Warning: HUD will prosecute

(1 8 . s . c . u

, 1012; U. S . C3 7 2 93 8 0 2 3l . 1 0 10.
Name & Title of Authorized Grantee Official Signature&

0+
,,'
,:! a,

& Program GrartsAnal PlusCare Shelter Adviento, Offcial: Sponsor Project and Name Title of Authorized

& Signature

JustineLauderback-Strebler
'--lt'-''
{,_i

,f,*a

a 'rl ,, ,rc[[
HUD-40118

PART I. TO BE COMPLETED BY ALL GRANTEES (EXCEPT

HMTS)

ON PLEASE SEE SPECIAL INSTRUCTIONS PAGE 3 OF THE APR SSOGRANTEES,

Part I: Project Progress

1. Projected Level of Persons to be served at a given point in time. (This information comesfrom the most recentCoC
icall0n. Number of SinglesNot in Families Number of Adults in Families
A

a.

Proiected Level Persons be servedat a given point in time to

Number of Children in Families

IJ

Number of Families
A +

2.

PersonsServedduring the operating year.

Number of SinglesNot in Families Number of Adults in Families Number of Children in Families
+
A

Number of Families
A

a.

Nunrber on the first day ofthe operatingyear Number entering program during the operating year Number who left the program during the operatingyear Number in the program on the last day of the operatingyear (a+b-c):d

0 0 0 0

b.
c.

0
1
?

0
0 4

0
1
J

d.

Explanatory notes: SeeDefinitions of Client/HouseholdTypes in the GeneralInstructionsaboveto determinewhich clients should be countedas SinglesNot in Families,Adults in Families, and Children in Families. Note that this table doesnot accountfor changes client4rousehold in type that may occur during the courseofthe operatingyear. Instead,eachclient shouldbe assigned single client/household a type basedon the client's age and/or household composition at the progranl entry date closestto the start of the operating year. In this way, each client is counted only once in the table. Use the following graphic and explanations to determine who should be counted in rows a-d:

Client in program on llrst day of operating year, leff during the

tc c ,. LU U ,,L

Ciient in program on first day of operatingyear and lasl day of operaling year: clunt in 2a and 2d. |+ Client entered and lell program duf ng operating year: count in2b and2c. Client entered Frogram durifg operatingyear and still in program of lasl day of year: counl in 2b and 2d.

HI

Clienl entered and Left i j pfogram before slart of operalinq vear: do nol coufl in i quesilon r. I

FiFt day oflhe operaling year

Last day of the operating year

a.

Number on the first day ofthe operating year: This row includesall clientswho enteredthe programbeforethe first day ofthe operatingyear and djd not leavethe program until after the first day ofthe operatingyear. Number entering the program during the operating year: This row includesall clientswho enteredthe programon or after the first dayoftheoperatingyear,uptoandincludingthelastdayoftheoperatingyear.Forclientswithmultipleprogramentrydates,usethe entry date closestto the start ofthe operatingyear. Do not count the client more than once evenifhe/she enteredthe programmore than once during the operatingyear. Numtrer who left during the operating year: This row includesall clientswho left the programon or after the first day of the operatingyear.up to and including the last day ofthe operatingyear. For clients with multiple program exit dates,use the exit date HUD-40118

b.

c.

closestto the end ofthe operatingyear.Do not count the client more than once even ifhelshe exited ihe programmore than once during
t Lo ^^- . . t inn. , oar

d.

Numberin the programon the last day of the operating year: Thisrow includes ciients all who werein theprogram of thefirst as dayofthe operating or who entered year year duringtheoperating andwhodid not leave duringtheoperating year. Thenumber of clients families theprogram thelastdayofthe operating is calculated or in on year based theresponses rows2a through For on to 2c. each column, thenumber clients families row 2ato thenumber clients families row 2b andsubtract number add of or in of or in the of clients families row 2c. Therefore, - 2a + 2b - 2c. or in 2d

3.

Project Capacity.

Explanatory Notes: Rowb refers themostrecent to coc application whichtheprogram reporting. for is 4' Non-homelesspersons. This questionis to be completedfor Section8 SRO projects. Not Applicable

5.

Age and Gender. Of those who entered the project during the operating year, how many people are in the following age and gendercategories?
(from 2b. column I Single Persons
a.

b. d.

Aee 62 and over 5 1-61

Male

Female

3r-50
18-30
17 and under Personsin Families(from 2b. columns2 & 3) f.
g

62 and over

h.

51 61 31 - 50

t8 - 30
1.

13-17 6-12 Under1

m.

Explanatory Notes: Thisquestion refers onlyto Singles in Families Persons Families not and in who entered program the duringtheoperating year.Onlyclients who meetthese criteria be counted thistable. Thetotalnumber can in ofclientsreported underSingle Persons should equal the be to number reported question columni . Thetotalnumber clients in 2b, of reported under Persons Families in should equal thesumof be io columns and3 in question 2 2b. Answer questions6 - 10 only for participants who entered the project during the operating year (from 2b, columns| & Z). The term participant meansSinglesnot in Famrliesand Adults in Families. It doesnot include children or caregivers.NOTE: The total for questions 7, 8 and i 0 below shouldbe the same;respondto eachof thosequestions all participants.Some of , for the questionslisted throughoutthe APR will be asking informationfor indivrdualswho are chronicallv homeless.

H U D - 4 01 8

militaryduty starus. 6a. Veterans Status.A veteranis anyonewho has ever been on actlve
were veterans? How many participants

lo

homelessindividual with a disabling condition who has eitherbeen continuously person. An unaccompanied 6b. Chronically homeless in ofhomelessness the past three (3) years. To be considered had at leastfour (4) episodes homelessibr a year or more OR has or a chronically homeiess personmust have been on the streets in an emergencyshelter(i.e. not transitionalhousing) during see these stays. For further discussionof the definition of chronic homelessness, Other Key Definitions under the GeneralInstructions above. How many participants were chronically homelessindividuals?

7,
a.

Ethnicity. How many participantsare in the following ethnic categories? Hispanic Latino or Non-Hisoanicor Non-Latino

b.

0 0

Explanatory Notes: Each participantshouldbe listed in only one category. The total number of participantsin this tabie should equal the number of particlpants in question 2b, columns1 and 2.

8.
a.

Race. How many participantsare in the following racial categories? American Indian/Alaskan Native
Aslan

b.
c. d.
t.

I
h.

BlacVAfrican American Native Hawaiian/Other Pacific Islander White American Indian/Alaskan Native & White Asian & White Black/AfricanAmerican & White American Indian/Alaskan Native & Black/African American Other Multi-Racial

Explanatory Notes: Each participantshouldbe listed in only one category. A participantwhoserace does not corespond to categories through i shouldbe a countedin j, Other Multi Racial. The total number of participantsin this table should equal the number of participantsin question2b, columns 1 and 2. If using HMIS data,you may combineHMIS race response categories generate APR response to the categories.

9a. Special Needs. How many participantshave the following? Participants may have more than one Ifso, count them in all applicablecategories.For eachcondition, also indicate the number that were chronically homeless. All Chronic a. Mentalillness b Alcohol abuse Druq abuse d. HIV/AIDS and relateddiseases

Develoomental disabilitv
I

s.
h

Phvsical disabrlitv Domesticviolence Other (piease specifv)

9b. How manyof theparticipants disabled? n are Explanatory Notes: To determine whichparticipants HLID'sdefinition "disabled," "DisablineCondition"underOther KeyDefinitions the General meet of see in Instructions.
HUD-401 18

10. Prior Living Situation. How many participantsslept in the following placesin the week prior to enteringthe project? (For each participant,chooseone place. The total number of participantsin the "All" column shouldequalthe number of participantsin question2b, columns 1 and 2). Also, indicatehow many chronically homelessparticipantssleptin the following piaces. (Chooseone)

All
a.

Chronic

(street. park.car.bus station. Non-housinq etc.)

Emergencv shelter

b,
d.

f h.
1. v

Transitionalhousing for homeiess Dersons Psychiatric facility* Substance abusetreatmentfacilitv* Hospital* Jail/prison* Do mestic violenc e it uat ion s Livin g with relatives/friends Rentalhousing Other (pleasespecify)

; . .;

*Ifa participantcamefiom an institution (psychiatricfaciiity, substance abusetreatment facility, hospital,orjail), but was there lessthan 30 days and was living on the streetor in emergencyshelterbefore enteringthe treatmentfaciliiy, heisheshould be countedin eitherthe sffeetor shelter category, appropriate. as

Complete questions 1 1 - 15 for all participants who left during the operating year (from 2c, columns 1 and, 2). The tenn pafticipant means single persons and adults in families. It does not include cluldren or caregivers. The term chronically homeless person means an unaccompanied homeless individual with a disablhg condition who has either been continuously homeless for a year or more OR has had at least foru (4) episodes of homelessnessin the past three (3) years. To be considered chronically homeless a person must have been on the sheets or in an emergency shelter (i.e. not transitional housing) dunng these stays.

I 1. Amount and Source of Monthly Income at Entry and at Exit. Of thoseparticipants ,,l,ho left during the operatingyear,how many participantswere at eachmonthly income level and with eachsourceof income? Also, pleaseplace the monthly iniome level and each sourceof income for chronically homelesspersons in the secondcolumn of eachchart. The number of participantsin Chart A and B shouldbe the same. AII *: Chrcnic Ail Chronic

a.

A. Monthly Income at Entrv No income

*' ' f l" : . ,,"

b.

C. Income Sources Entry At

Supplemental SecurityIncome (SSD S o c i a lS e c u r i t y i s a b i l i t yI n c o m e( S S D I ) D Social Security

b
c. d.

s 1-150
$151 $250 -

s25I - $s00
$501 $r , 0 0 0 $1001$15 0 0 $1501- 0 0 $20

d.

GeneralPublic Assistance Temporary Aid to Needy Families (TANF) 1

f.
g

f
g

StateChildren's Health Insurance Program (SCHIP)

Veterans Benefits
Employnent Income Unemplovrnent Benefits

h.

+ $2001

h.

J
't.

Veterans Health Care Medicaid Food Stamps Other (pleasespecify) No FinancialResources

I
m.. n.

10

H U D .4 O1 1 B

All

Chmnic

All

Chronic

B. Monthlylncome at Exit
a.

.-: .
a.

at D. incomeSources Exit
SecurityIncome (SSI) Supplemental

No income

b.
c.

s t - 150

b. c d.
e

(SSDI) Social Security Disability Income

Social Security GeneralPublic Assistance TemporaryAid to Needy Families (TANF) StateChildren's Health InsuranceProgram(SCHIP) VeteransBenefits Employnent Income Unemplol,rnent Benefits

sr 5 r- $2s0
$251$50 0

d
e.

s501 s1.000 $1001- 5 0 0 $1 1

f
o'

f
g

$1s0r$2000
+ $2001

h.

h.

J
1.

VeteransHealth Care Medicaid Food Stamps

m. n.

Other (pleasespecify) No Financial Resources

Explanatory Notes: Table A: Monthiy income at entry refersto the participant'smonthly income on the day he/sheenteredthe program(i.e., on the program entry date or as close as possibleto that day). You should not report on income receivedbefore enteringthe programor income received during the progrant stay. Table B: Monthly income at exit refersto the participant'smonthly income on the day he/sheleft the program (i.e., on the programexit date or as close as possibleto that day). You should not repoft on income receivedduring the program stay. Table C: Income sources entry refersto the participant'ssources at ofincome on the day he/sheenteredthe program(i.e., on the program entry date or as close as possibleto that day). You should not report on sourcesofincome receivedbefore enteringthe programor income receivedduring the programstay. Participantswith no income at the time of programentry should be reportedin categoryn, No Financial Resources. Table D: Income sources exit refersto the participant'ssourcesof income on the day he/sheleft the program (i.e., on the program.exitdate at or as close as possibleto that day). You should not report on sourcesof income receivedduring the program stay. Participants rvith no income at the time of program exit should be reportedin categoryn, No Financial Resources.

12a. Of thoseparticipantswho left during the operatingyear (from 2c, columns 1 and2), how many were in the project for the followrng lengthsoftime? Also, pleaseplace the length ofstay for chronically homelesspersonswho left during the operatingyear in the second column. AII
a.
D.

Chronic

c.

d f.
I

Lessthan 1 month I to 2 months 3 6 months 7 months - 12 months 13 months - 24 months

25m on th s -3 v e a rs
4 ve ars-5v ear s

h.
I

6v ear s -T v e a rs
8 years- 10 years Over 10 years

Explanatory Nores: Cornputeeachpanicipant's length ofstay using the participant'sprogram entry date and program exit date. Ifthe participanthas only one program exit ciateduring ihe operatingyear. caiculatelength ofstay by subtractingthe program entry date from the program exit date. Ifthe participanthas multiple programexit datesduring the operatingyear,calculatethe length ofstay for eachprogram stay (by subtracting the programeniry date from the program exit date for eachprogram stay) and add them togetherto produce a cumulativelength ofstay. Each 1I HUD-401 18

participantshouldbe associated with only one length of stay category. The totai number of participantsin the first column ("All") should equalthe number of participantsin question2c, columns 1 and2. 12b. Length of Stay in Program. For thoseparticipants who did not leave during the operatingyear (from 2d. columns 1 and 2), how long r'^.'^ +t'^" r'^^- i- *Le project? Also, please place the length of stay for chronically homelesspersonswho did not leave during the operatingyear in the secondcolumn.
r r qvr Lur f

All
a.

Chronic

b. c.
d,

Less than 1 month 1 to 2 months 3 - 6 months 7 months - 12 months

13months 24 months f.
g

1 1
1

h.
t.

25 mon ths - 3y ear s 4yea rs- 5y ear s 6yea rs- Ty ear s 8 years- 10 years Over l0 years

0 0

Explanatory Notes: Computeeachparticipant'slength ofstay using the participant'sprogram entry date and the last day ofthe operatingyear. To calculate length ofstay, subtractthe programentry date from the last day ofthe operatingyear. Each participantshouldbe associated with only one length ofstay category. The total number ofparticipantsin the first column ("A11")should equalthe number ofparticipants in question2d, columns 1 and2.

13. Reasons for Leaving. Ofthose participants who left the project during the operating year (from 2c, columns I and 2), how many left for the following reasons? If a participant left for multiple reasons,include onlythe primary reaso,r. The total number of participants in the first column ("All") shouldequalthe number of participantsin question2c, columns 1 and2. Also, pleaseplace the primary reasonfor chronically homelesspersonswho left the project during the operatingyear in the secondcolumn. All Left for a housing opportunity before completing program b. Completedprogram Non-paynent of rent/occupancycharge d. Non-compliance with proj ect Criminal activity I destruction ofproperty / violence f
g

Chronic

Reached maximum time allowed in project Needscould not be met by projecl Disagreement with rules/persons Death

h.

J
1,

Other (pleasespecify) Unknown/disappeared

I2

HUD-401 18

1zl. Destination. Of thoseparticipantswho left during the operatingyear (from 2c, columns 1 and 2), how many left for the following destination? Also, pleaseplacethe destinationofchronically homelesspersonswho left during the operatingyear in the second column.

All
PERMANENT (a-h)
a.

Chronic

Rentalhouseor apartment(no subsidy) PublicHousing Section8 Shelter PlusCare HOME subsidized house or aDaftment

b.
c.

d.

f.
g

Other subsidizedhouse or apartment Homeownership Moved in with family or friends Transitionalhousing for homeless persons Moved in with family or fiiends Psychiatrichospital Inpatient alcohol or other drug treatmentfacility Jail/prison Emergencyshelter

TRANSTTTONAL (i-j)
INSTITUTION (k-m)

i
J
t.

1
m.

(n) EMERGENCY SHELTER OTHER(o-q)

n. o.
n' Y

Othersupportive housing
Placesnot meant for human habitation (e.g. street) Other (please specify) Death

q.

LINKNOWN

I.

Unknown

Explanatory Notes: Identify eachparticipant'sdestinationupon leavingthe program using the categories provided.The response categories combine "destination"(e.g.,rental houseor apartment, public housing,homeownership, etc.) and "tenure" (e.g.,permanent, transitional,etc.). Considerboth destinationand tenureto determinethe most appropriateresponse, and be sureto look at all ofthe response categories before making a selection.The table below provides a briefdescription ofeach response category. Enter the number of participantsunder eachdestinationcategoryin either the flrst column of the table or in both columns if the particrpantis chronicallyhomeless. Only one reasonfor leaving should be recordedper participant.The total number ofparticipants in the firit column ("A11")should equalthe number of parlicipantsin question2c, columns I and2.

Tenure
Penlanent

Destination Rental house or apartment (no subsidv) b. c.

A

Description Participant is moving to an apartmentor house without any subsidy

Publichousine Section 8
ShelterPlus Care

Participant moyingto a publichousing is unit

Participantwill use a housing choicevoucher(formerly known as a Section 8 voucher) to rgnt a houseor apaftment. Participantis moving to a unit funded by the Shelterplus Care program (e.g.,TBA, SRA, PRA, Section8 SRO). Participantis moving to a unit with rental assistance provided by the HOME program (tenanlbasedor project-based assistance). Participantis moving to a unit subsidized someprogramother than by public housing,housing choicevoucherprogram (formerly Section g), ShelterPlus Care,or HOME. Participantis moving to a unit thar he/shehas purchased. Participantis moving in with family or friendsand expectsto live there for 90 days or more. Parlicipantis moving into a unit funded by a transitionalhousing program for homelesspeople (e.g.,transitionalhousing funded through the SupportiveHousing Program). Participantis moving in with family or lriends and expectsto live there lessthan 90 days. Participant moving to a psychiarric is hospital.

HOME subsidized house or apartment

f. Other subsidizedhouseor aDartmenl

Homeownership
Moved in with family or friends Transitionalhousingfor homeless people Moved in with family or friends Psvchiatrichosoital

h. I ransrtional
L

Institution

k.

IJ

HUD-40118

Tenure

Destination alcoholor otherdrug lnpatient treatment facility m n.

o

Description Participantis moving to an inpatient alcohol or drug treatmentfacility.

Jail/Prison
shelter Emergency Other supportive housing

is Participant movingto a 1ailor prison.

Participantis moving to an emergencyshelterfor homelesspeople. Participantis moving into supportivehousingthat doesnot correspond (a-h) and is not transitional to any ofthe permanenthousing categories people (i), such as Section81 t housing.* housins for homeless Participant is moving to a place not meant for human habitation, such as a car, park, sidewalk,or abandoned building. Participantis moving to a place that doesnot correspond any ofthe to categories above(a-p). This response categoryshould be usedifyou are unsure aboutwhere the participantis moving or ifthe participanthas disappeared and there is no wav to find out where he/sheis.

Emergency Shelter Other

n Y'

q. Unknown r

Places meantfor human not habitation Other (pleasespecify) Unknown

*HUD encouragesprograms to limit the use of the "Other Supportive Housing" APR responsecategoty. Programs should report deslinations to ltousing that are pernxatxent transitional in APR categories (a) through (h) or in categories (i) through (j), respectively. or Exits to emergencyshelters should be reported in category ftr).

15. Supportive Services. Ofthose participantswho left during the operatingyear (fiom 2, columns I and 2), how many receivedthe receivedfor chronically foliowing supportiveservices during their time in the project? A1so,pleaseplace the supporliveservices may have receivedmultiple servicesand all homelessparticipants who left during the operatingyear in the secondcolumn. Participants servicesshouldbe reoortedin the table. All
a.

Chronic
U

Outreach Casemanagement

b.

Life skills (outside case of management)

d. e f
g

Alcohol or drug abuseservices Mental health services HIV/AIDS-related services Other health care services Education Housingplacement EmPlol'rnent assistance Child care Transportation Legal

h.
l.

l
L

l. m. n.

Other(please specify)

IA l+

HUD-40118

objectivesfor this operatingyear (from your application,Technical 16. Overall program Goals. Under objectives,list your measurable descnbeyour progressin meetingthe objectives ApR) for eachof the three goals listed below. Under Progress, Submission.or objectivesfor the next operatingyear. Under Next OperatingYear's Objectives,specifythe measurable ResidentialStability objectives:See Attachment 16El

^.

Progress:

Next OperatingYear's Objectives:

b.

IncreasedSkills or Income

Objectives: Attachment 168 See

Progress:

NextOperating Year'sObjectives:

c.

Greater Self-determination

Objectives: Attachment 168 See

Progress:

NextOperating Year's Objectives:

17a. recipients 17b. recipients 17. Beds. SHP recipients answer S+C answer SRO answer (SHP-SSOprojects do I7c. not complete tltis question)
a. SHP. How many bedswere included in the applicationapprovedfor this project under 'Current Level' and under 'New Effort'? How many of theseNew Effort beds were actually in place at the end of the operatingyear? New Effort in Place Current Level New Effort Number of Beds: with project funds at the end of the operatingyear? S+C. How many beds and dwelling units were being assisted (Include beds for a1lparticipants,other family members,and caregivers.) Number of Beds: Number of Dwelline Units: c. g 4

b.

g at SRO. How many dwelling units were being assisted the end of the operatin year? (lnclude units occupiedby "in place" non-homeless personswho qualify for assistance.) Numberof Dwelline Units:

15

HUD-40118

Part II: Financial Information

18. Supportive Services. was spentduring For SupportiveHousine (SHP), this exhibit provides information to HUD on how SHP funding for supportiveservices the operating year, Enter the amount of SHP funding spenton thesesupportiveservices. Include HMIS costsunder "Other". For ShelterPlus Care (S+C), this exhibit tracksthe supportiveservices Specifythe value ofsupportive services from all match requirement. shouldkeep sources that can be countedas match that all homelesspersonsreceivedduring the operating year. (S+C grantees documentation file, including source,amount,and type ofsupportive services.) on For Section8 SRO, this exhibit provides information to HUD on the value of supportiveservices personsduring the receivedby homeless operating year.

SupportiveServices
Outreach

Dollars

b.
c.

Casemanagement Life skills (outsideof casemanagement) Alcohol and drus abuseservrces Mental health services

$20,821.04

d.

i
o

AIDS-relatedservices Other healthcare services Education Housing placement Emplol,rnent assistance Child care Transportation Legal Other (pleasespecify) TOTAL (Sum of a through n)

h.
I

k.
I m n.
o.

$20,821.04

Cumulative amount of match provided to date for the Shelter Plus Care Prosram under this srant

$20,821.04

t6

HUD-40118

Operating Costs,HMIS Activities and Administration 19. Supportive Housing program: Leasing,SupportiveServices, year'For expansion operating each charts these mustcomplete Program Uousing the under Supportive funding receiving All grantees projects:IfSHpgranttundsarefortheexpansionofapre-existinghomelessfacility,onlythepeopleandexpendituresfortheadditional to used of Documentation resources is not required be or application anygrantamendments. as maybe included, in the original "*punrio., made any by inspection HUD andAuditors.Do not include expenditures be but with thrsreport shouid kepton file for possible submitted
before the SHP erantwas executed Summary of Expenditures. Enter the amount of SHP grant funds and cashmatch expendedduring the operatingyear for eachactivity. a total should b e t h e s a r n e s t h e S H P s u p p o r l i ve and vertically. The SHP supportiveservices This table shouldadd up both horizontally services in

TotalExpenditures

SupportiveServices Operating Costs HMiS Activities Administration

and Note: Payments principal interest on any loan or mortgage may not be shown as an operating expense. of

Sourcesof Cash Match. Enter the sources of cash identified in the Cash Match column, above, in the following categories.Use additional as sheets, necessary. Amounl
a. b.

ect Grantee/proj sponsorcash Local govemment(pleasespecify)

c.

Stategovemment (pleasespecify)

d.

Federalgovemment(pleasespecify)

Block Grant(CDBG) Development Community

Foundations(pleasespecify)

(pleasespecify) Private cashresources

g. h.

Occupancycharge/ fees Total

T]

I HUD-4018

and Rehabilitation, New Construction Program: Acquisition, 20. Supportive Housing

must completethesechartsin the year one APR All grantees that receivedSHP funds for acquisition,rehabilitation,or new construction only. This exhibit wiil demonstrate HUD that the granteehas contributedenoughcashto at leastequally match the amount of SHP funds to spentfor acquisition,rehabilitation,or new construction. Documentationthat matching funds were provided is not requiredto be submitted with this report but should be kept on file for possibleinspectionbv HUD and Auditors. Summary of Expenditures. Enter the amountof SHP grant funds and cashmatch expended during the operatingyear for eachactivity SHP Funds
a b. c.

Cash Match

Total Expenditures

Acquisition Rehabilitation New construction Total

Cash Match' Enter the sourcesof cashidentified in the CashMatch column, above,in the following categories. Use additionalsheets, necessary. as

Amount
a.

Grantee/projectsponsor cash Local government (please specify)

b.

c.

Stategovemment(pleasespecify)

d.

Federalgovernment(pleasespecify) Community DevelopmentBlock Grant (CDBG)

c.

Foundations(pleasespecify)

f.

Private cashresources (pleasespecify)

Occupancycharge/fees Total

h.

18

H U D - 4 01 8 1

FOR HMIS ACTIWTIES O]VLY

21. For SupportiveHousine (SHP) - HMIS Activities year. Enter This exhibit providesinformation to HUD on how SHP-HMIS funding for supportiveseNiceswas spentduring the operating the amountof SHP-HMIS funding spenton theseactivities.

HMIS Activities Onllt CentralServer(s) PersonalComputers and Printers Networking

Software/ User Lice Software Installation Support and Maintenance Software Tools

Trainins bv Third Parties Hostiner TechnicalServices Programming: Customization Programming: SystemInterface Data Conversron Programming: and Setup SecurityAssessment Access) Connectiviry(Internet On-line

/ ProjectManagement Coordination Data Analysis Technical Assistanceand Training Admrnistrative Support Staff e snil

i9

HUD-40118

Describe any problemsand/or changes implemented during the operatingyear.

Technical Assistance and Recommendations Based on your experienceduring the last year, are there any areasin which you need technical advice or assistance?If so, please describe

20

HUD-40119

Report PersonsServed Worksheet - HUD Annual Progress

Collection of the ProtectedPersonalInformation (PPI) on thrs form is done with the knowledgeor consentof the clients. The PPI is only usedfor the following purpose: Accuratecompletionof the Annual Progress Report (APR) for the Continuumof Care (CoC) HomelessAssistance Program in which the client is eruolled. Thisworksheet optional is intended helpyou collect is and to information needed complete Annual to the Progress Report. Instructions and Codes follow. Do not submitthis worksheet HUD. to
Number of Months in Project (calculate) 12a Number of Months in Project-Participant did not leave (calculate) New Participant (Y /N )

Non-Honeless (SI Only) ( Y/N ) 4

12b

PersonsServed Worksheet (contrnued)

Collection of the ProtectedPersonalInformation (ppD on this form is done with the knowledge or consentof the clients. The PPI is only usedfor the following pulpose: Accurate completion of the Annual ProgressReporl (ApR) for the Continuumof Care (CoC) Homeless program in Assistance which the client is enrolled. Do not submitthis worksheet HUD to
No. Veterans Status (Y,4',1) 6a Chronically Homeless

(Y.A{) 6b

Ethnicity (code) 7

Race (code) 8

SpecialNeeds (code) 9a

SpecialNeeds (code) 9b

Prior Situation 10

Monthly Income At Project Entry 1l a

Monthly Income At Project Exit l 1b

t
1

2l

HUD-40118

22

HUD-40118

PersonsServedWorksheet (continued)

Collection of the protected PersonalInfonnation (PPI) on this forrn is done with the knowledge or consentof the clients. The PPI is only usedfor the following pulpose: Accurate completion of the Annual ProgressReport (APR) for the Continuum of Care (CoC) HomelessAssistanceProgram in which the client is enrolled.
Do not submit this worksheet to HUD
Reasonfor Leaving Ploglam (code) 13

Instructions and Codes for PersonsServed Worksheet T he u se of this wo r k s heet is opt ional. I t was des i g n e d t o help you colle ct inf or m at ion on par t ic r pant s n e e d e d to comp lete the An nual Pr ogr es s Repor t . I f t he w orkshe et is up da ted as par t ic ipant s m ov e in and m o v e out o f you r pro ject, m os t of t he inf or m at ion r equ i r e d for comp letio n will be c ont ained in t he wor k s hee t . D o not su bmit th is wo r k s heet wit h t he APR. F or proje cts th at ser v e f am ilies , HUD only r equi r e s reporting on the nu m ber of c hildr en s er v ed, and t h e age and g en de r of t hes e c hildr en. O nXy nam e, relation sh ip, d ate o f bir t h, and age on t he wor k s h e e t
z)

n e e d t o b e c o m p l e t e d f o r c h i l d r e n . A s s i g n t h e a d u l ts a n u m b e r , b u t n o t e a c h f a m i l y m e m b e r . U s e t hi s n u m b e r t o t r a n s f e r t o t h e o t h e r p a g e s o f t h e w o r k s h e e t, B e g i n n i n g w i t h n u m b e r 4 , t h e n u m b e r s i n t he co l u m n s refer to the questions on the APR form. If any q u e s t i o n s a r e a n s w e r e d w i t h " O t h e r , " p l e a s e e n te r th e s p e c i f i c " O t h e r " a n s w e r f o r i n c l u s i o n i n t h e APR . Participant Numtrer. This column allows you t o e i t h e r n u m b e r p a r t i c i p a n t s c o n s e c u t i v e l y o r to a s s i g n a c a s e n u m b e r . O n e n u m b e r s h o u l d be assigned to each adult.

HUD-4018

s Na m e. Nam esof p e rs o nw i l l n o t b e re p o rte dto HUD. T he us e of na me si s fo r y o u r re c o rdk e e p i n g

conven i en ce . R elatio nship . En ter t he appr opr iat e r elat ions hip. E xamp les in clu de : S elf , Head of hous ehold, Spou s e , child . E ntry Da te. Ente r dat e par t ic ipant ent er ed t he pro-ie ct. Usu ally this will be t he dat e of ac t ual physica l mo ve -in fo r a hous ing pr ojec t . E xit Da te. En ter d at e par t ic ipant lef t t he pr oiec t . U sua lly this will b e t he dat e t he par t ic ipant physically moved o ut f or a hous ing pr ojec t . Do n o t include a p articipa nt who t em por ar ily lef t t he pr o j e c t and is e xp ected to r et ur n in les s t han 90 day s ( e. g . , h o spita l izatio n). 4. Income -elig ible Non- hom eles s in SRO . The S R O pro gra m a llows as s is t anc e t o unit s oc c upied b y Section 8 in co m e- eligible per s ons r es iding at t h e SRO p rior to re habilit at ion. For SRO pr ojec t s on ly, ind ica te w het her t he par t ic ipant is an income -elig ible , non- hom eles s per s on ( Y) or n o t (N). SHP an d S+ C pr ojec t s s hould s k ip t his i t e m .

a. Mental illness b. Alcohol abuse c. Drug abuse d. HIV/AIDS and related diseases e. Developmental disability f. Physical disabilities g. Domestic violence h. Other (please specify) 9 b . E n t e r t h e n u m b e r o f p a r t i c i p a n t s w i t h a d i sa b i l i ty 1 0 . P r i o r L i v i n g S i t u a t i o n . E n t e r t h e l e t t e r th a t b e st d e s c r i b e s w h e r e t h e p a r t i c i p a n t s l e p t i n th e w e e k prior to entering the project. Do not double co u n t . N o n - h o u s i n g ( s t r e e t , p a r k , c a r , b u s s t a t i o n , e tc..1 Emergency shelter Transitional housing for homeless persons Psychiatric facility* Substance abuse treatment facility* Hospitai * Jail/prison + Domestic violence situation Living with relatives/friends Rental housing Other (please specify) *I f a p a r t i c i p a n t c a m e f r o m a n i n s t i t u t i o n b u t w a s t h e r e l e s s t h a n 3 0 d a y s a n d w a s l i v i n g on th e s t r e e t o r i n a n e m e r g e n c y s h e l t e r b e f o r e e n t e r i n g th e f a c i l i t y , h e / s h e s h o u l d b e c o u n t e d i n e i t h e r th e str e e t or shelter category, as appropriate.

5a. Da te o f Birth . Ent er dat e of bir t h inc ludr ns m on th, d ay, an d y ear . 5b. Ag e. En ter a ge at ent r y . 5c. Gen de r. Ente r appr opr iat e let t er f or gender . M -Male F- Fe m ale. 6a. Ve tera ns Sta tus . I ndic at e if t he par t ic ipant i s a ve tera n. Plea se not e: A y et er an is any one w h o has ever b ee n on ac t iv e nt ilit ar y dut y s t at us f o r th e Un ited State s . 6b. Chro nically h om eles s per s on. I ndic at e t he nu mbe r o fpa rtic ipant s t hat ar e c hr onic ally ho mel ess.

Instructi on C odesfor P ersonsS erved W orksheet (conti nued)

1 I a . G r o s s M o n t h l y I n c o m e a t P r o j e c t E n t r y. E n t e r t h e a m o u n t o f g r o s s m o n t h l y i n c o m e th e p a r t i c i p a n t i s r e c e i v i n g a t e n t r y i n t o t h e p r o j e ct. I l b . G r o s s M o n t h l y I n c o m e a t P r o j e c t E x i t . En te r the gross monthly income the participant is receiving when exiting the project. I l c , I n c o m e S o u r c e s R e c e i v e d a t P r o j e c t E ntr y, E n t e r a l 1 t y p e s o f a s s i s t a n c e t h e p a r t i c i p an t i s receiving at entry to the project. a. Supplemental Security Income (SSI) b . S o c i a l S e c u r i t y D i s a b i l i t y I n s u r a n c e ( S SD I) c. Social Security d. General Public Assistance e . T e m p o r a r y A i d N e e d y F a m i l i e s ( T A N F) f. StateChildren's Health InsuranceProgram(SCHIP) g. Veterans benefits h. Employment income i. Unemployment benefits j. Veterans Health Care k. Medicaid l. Food Stamps m. Other (please specify) n. No Financial Resources
aA

7.

Ethn icity. Ente r appr opr iat e let t er f or et hnic gro up . a. Hisp an ic or L at ino b . No n-Hispa nic or Non- Lat ino Ra ce . En ter ap pr opr iat e let t er f or r ac e. a. American Ind ian or Alas k an Nat iv e b . Asian c . Black or Afric an- Am er ic an d . Native Ha waiian or O t her Pac if ic I s lander e . Wh ite f. American In dian/ Alas k an Nat iv e & W hit e g . Asia n & Wh it e h. Black/African Am er ic an & W hit e i. Ame rica n Ind ian/ Alas k an Nat iv e & BIack/African Am er i c an j. Oth er Multi-R ac ial Sp ecial Ne ed s. Ent er t he let t er ( s ) f or t he ca teg ory(ies) th at des c r ibe t he par t ic ipant ' s disab ilitylie s). ( y ou m ay double c ount ) .

8.

9a

HUD-401 18

lld.Income Sou rc es Rec eiv ed at Pr ojec t Ex it . En ter a ll type s of inc om e t he par t ic ipant r s re ce ivin g at p r ojec t ex it . ( Us e c odes as in 1 1 c . ) 12a L en gth in Stay in Pr ogr am . c alc ulat ed r t e m . (Se e En try Da t e and Ex it Dat e abov e. ) 12b. Le ng th o f St ay in Pr ogr am . ( Par t ic ipant d i d no t le ave du ring t he oper at ing y ear . How lo n g ha ve th ey be en in t he pr ojec t ?) 13. Rea so n for L eav ing Pr ojec t . Ent er t he pr i m a r y rea so n wh y the par t ic ipant lef t t he pr ojec t . (Comp lete on ly f or par t ic ipant s who lef t t he pro ject a nd ar e not ex pec t ed t o r et ur n wit hin 9 0 days. a. L eft for a hous ing oppor t unit y bef or e comp letin g th e pr ogr am
lr C n ttrn l e l e d nr no1411

l5.Supportive Services, Enter all types of s u p p o r t i v e s e r v i c e s t h e p a r t i c i p a n t r e c e i ve d d u r i n g the time in the project. a. Outreach b. case management c . L i f e s k i l l s ( o u t s i d e o f c a s e m a n ag e m e n t) d. Alcohol or drug abuse services e. Mental health servrces f. HIV/AIDS-related services g. other health care servrces h. Education i. Housing placement j. Employment assistance k. Child care l. Transportation m. Legal n . O t h e r( p l e a s e p e c i f y ) s

c. No n-p aymen t of r ent / oc c upanc y c har ge d. No n-comp lianc e wit h pr ojec t e. Crimin al a c t iv it y / des t r uc t ion of pr oper t y / vi o len ce f. Rea ch ed ma x im um t im e allowed in pr ojec t g. Ne ed s cou ld not be m et by pr ojec t h. Disag ree ment wit h r ules / per s ons i. De ath j. Oth er (p lea s e s pec if y ) k. Un kn own /di s apr : ear ed

14. De stin atio n. Ent er t he des t inat ion of t hos e Iea vin g the p rojec t . Pe rman en t: a . Re nta l h ous e or apar t m ent ( no s ubs id y ) b . Pub lic Hous ing c. Section 8 d . She lter Plus Car e e . HOME s ubs idiz ed hous e or apar t m en t f. Othe r s ubs idiz ed hous e or apar t m ent g . Home owner s hip h . Moved in wit h f am ily or f r iends T ra n sition al: i. Tra nsitional hous ing f or hom eles s per s o n s j. Moved i n wit h f am ily or f r iends Institutio n: k. Psych iat r ie hos pit al. l. Inp atie nt alc ohol oi dr ug t r eat m ent f a c r l i t y m. Jaillp ris on Eme ng en cy: n . Erne rge nc y s helt er Otlee r: o . Othe r suppor t iv e hous ing. p. Pla ce s not m eant f or hum an habit at ion (e.g ., stre et ) q. Othe r ( pleas e s pec if y ) Un kn own : r. Unkno wn

25

HUD-4018 r

Monterey Boulevard Apartments cAO1cs01037

Reporting Period: 511106 4130107 16. Overall Program Goals.

Residential Stability : Objective: 7Sohof the participants will remain in permanent housing for at least one year. Exceeded. 100% @of Q of the parlicipantshave remainedin housing for at least one year. The participant who died was in housing for nearlylwo years. Parlicipantshave been able to remain in permanenthousing through the efforts the supportive service providers working with property management services. 75o/o the participantswill remain in permanent of housing for at leastone year.

Progress:

Next Operating Year's Objective:

IncreasedSkills or Income: Objective: 50"h of participants will obtain and maintain employment in the operating year. Achieved. 50% (2 out of 4) of the participantsobtainedemplolrnent in the operating year. During the reporling period, one participant reported starting a part-time job. Another participant who was in a training prograln got a job aspart of the training program. Supportiveservices have continuedto provide information on employrnent all participants. to

Progress:

Next Operating Year's Objective:

50o/o participantswill obtain and maintain of employrnent in the operating year.

Objective:

507o of participants will enroll in an education program and/or volunteer work in the operating year and will continue for at leastone year. Not aclrieved.25a/o of a) of participantsenroiledin an education (1 program and has continuedfor at leastone year. one participanthasbeen enrolledin a vocationaltraining program in the areaof construction administration.

Progress:

Next operating Year's Objective:

50% of participants will enroll in an education program and./or volunteer work in the operatingyear and will continue for at least one year.

Greater Self-determination: objective: Progress: 50o/oof participants who relapsewiil seektreatment. Exceeded100%(1 out of 1) of the participantswho have relapsed have soughttreatment. This participanthas been supporled supportselices by staff in seekingtreatment. All the other participants are in regular contact with the supportiveservices casemanagers and are involved with support groups or have their own supportivenetwork with which they regularly connect. 50Yoof participants who relapsewill be seek treatment.

Next Operating Year's Objective:

Objective:

75o/" of families responding to a tenant survey will rate the overall quality ofservices received as at least satisfactory. Achieved. 75%(3 out of 4) of families respondingto a tenantsurveyrated. the overall quality of servicesreceived as at least satisfactory.

Progress:

Next Operating Year's Objective:

of 75o/o familiesrespondingto a tenantsurveywill rate the overall quality ofservices receivedas at leastsatisfactorv

Objective: Progress:

100"/0of the participants will reunite with their families. Achieved. I00% (4 out of 4) of participantsare reunitedwith their families. All participants were fully re-unitedwith their families when they enteredinto the housingprogram.

Next Operating Year's Objective: I00% of the participants will reunitewith their families.

Objective:

l00oh of the participants' children will have medicaVdentalcheckups, and/or immunizationsas needed,at least onceper year. Achieved. 100% (3 out of 3) of the parlicipants' children received medical and dental check-upsat least once during the year. Parlicipants

Progress:

repofied thatall of theirchildren received regular medical dental and check-ups year. Oneparticipant duringthe had an adultchild living with her asa caregiver, that adultchild movedout of the home. but
Next Operating Year's Objective: lA0% of the participants'children will have medical/dental check-ups, and/or immunizationsas needed, leastonceper year. at

Objective:

100' of the residents'school-aged children will have no more than five unexcusedabsences from schoolwithin one year. Achieved. 100% (a of a) of the school-aged children at the properlyhad no more than five unexcused absences from school. participantsreported. that their children havebeenattendingschoolregularly. I00% of the residentschool-aged childrenwill have no more than five unexcused absences from school within one year.

Progress:

Next Operating Year's Objective:

Objective:

100"h of those participants who require ongoing medication will keep their appointments and maintain medication while in the program. Achieved. r00% (1 of 1) of participantwho requiredongoingmedication kept their appointmentsand maintained medication while in the program. one participant reported that she was having health problems and was seeingher doctor regularly. Shewas admittedto the hospitalin the late summerof 2006 and died while in the hosoital. I00% of thoseparticipantswho requireongoing medicationwill keep their appointments and maintainmedicationwhile in the program.

Progress:

Next Operating Year's Objective: