(exp.I l/30/2009) No.

OMB Approval 25060145

U, S. Departmentof Housing and Urban Development Office of Community Planning and Development

GOPY
Annual Progress Report (APR)
for Prograrn Housing Supportive PlusCare Shelter
and SectionI ModerateRehabilitation for SingleRoom Occupancy Dwellings (SRO) Program

HUD-401i8

including the time for reviervinginstructions, Fublic reporting burden for this collectiol ofinformation is estimatedto average33 hours per response, searchingexistingdata sources,gathering and maintaining the data needed,and completing and reviewing the collection of information. This agencymay not conductor sponsor,and a person is not required to respondto, a collection ofinformation unlessthat collecftrndisplaysa valid OMB control number.

General Instructions Furpose. The Annual ProgressReport (APR) is a reportingtool that HUD usesto track program progressand accomplishments infonn the Deparlment'scompetitiveprocessfor homelessassistance and funding. grants must submit 2 APR'S to HUD within 90 daysafter Filing Requirements.Recipients HUD's homeless of assistance the end of each operating year. One copy of the report must be submittedto the Community planning and Dwelopment (CPD) Division Director in the local HUD Field Office responsible managingthe grant. The other copy must be submifted for to HUD Headquarters, Departmentof Housing and Urban Development,Attn: APR Data Editor, Ftoom7262,45 I 7r'Street, SW, Washington, DC. 20410, Failure to submit an APR wiil delay receiving grant funds and may result in a determination of Iack of capacityfor future funding. An APR must be submittedfor each operatingyear in which HUD funding is provided. Grantees that receivedSHP funding for new consttuction,acquisition,or rehabilitationare requiredto operatetheir facilities for 20 years. They must submit an APR 90 days after the end of the first operatingyear andeveryyearthroughoutthe 20 years. A separate repofi must be submittedfor eachHUD grant received. For ShelterPlus Care(S+C), a separate APR must be submittedfor eachS+C component. For thosegrantees receiving an extension,a separate report covering that period mustbesubmitted(seeExtensionbelow). Recordkeeping. Grantees must collect and maintain information on eachpafiicipant in order to completean APR. Optional worksheets attached.The worksheetsmay be usedto record information manually or to designa are computerized systemto storeand tabulatethe information. The worksheets shouldnot be submittedto HUD with the APR. Organizationof the Report. The APR is organized the following manner: in Part I: Project Progress. This portion of the reporl describes progressin moving homeless the personsto selFsufficiency, documenting servicesreceived,listing project goals,and accountingfor bedsiunits. Part II: Financial Information. This portion of the report is completedby all grantees receivingfunding under SHP, S+C, and SRO. Final Assembly of Report. After the entire report is assembled, number every page sequentially.Mark any questions that do not apply to your program with "N/A" for not applicable. (SeeSpecialInsfructionsforSSO Projectsbelow.) Definitions of Client/flousehold Types. Each clienVhousehold type is defined below. Note that a client's client/household shouldbe basedon the client's age and./or householdcomposition theprogram entry date closestto the start of the at rype operating year. Families - A family is a householdcomposedof h.voor more relatedpersons,at leastone ofwho is a child accompanied by an adult or ajuvenile parent. Singlesnot in Families- Persons accompanied children,includingpregnant not by women not accompanied other by youth, are singlesnot in families. When two adultsor two unaccompanied childrenand unaccompanied youth present togetherfor services,eachperson shouldbe countedin singlesnot in families.. Clients' householdstatusshouldbe determined basedon their householdcompositionat the program entry date closestto the startof the operatingyear. This meansthat pregnantwomen expectedto give birth during their program stay shouldstili be countedas singlesnot in fa m ilies . Adults in Families - Within a family, an adult is any person 18 years of age or older. For the purposes APR reporting, of the determination whether a personis an adult in family should be made basedon theirageand householdcomposition of at the programentry date closestto the starl ofthe operatingyear. Children in Families - Children in Familiesare defined as children under the age of 18 accompanied one or more by a d u lt s ( par ent , r ela ti v e o rg u a rd i a n ). i l d re n i n fa mi l i esal soi ncl udebothaj uveni l eparentandtheparent' schild( r en) . Ch For the purposesof APR reporting, the determination whether a personis achild in family shouldbe made basedon of their age and householdcompositionat the programenhy date closestto the starl of the operatingyear. For example,
HUD-401 l8

during clientswho are lessthan 18 yearsofage on the first day ofthe operatingyear or at program entry (ifthey entered the operatingyear) shouldbe countedas children even ifthry turn 18 during the courseofthe operatingyear. Persons in Families - Persons families includesadults in families and children in families. in

Other Key Definitions. The following terms are used in the APR. As indicated,in some cases, terms are appiieddifferently dependingon whetherthe funding is from SHP, S+C, or SRO. Chronically homeless person- HUD definesa chronically personas"an unascompanied homeless homeless individual with a disablingcondition who has either been continuouslyhomeless a year or moreoR has had at leastfour (4) for episodes homelessness the pastthree (3) years." To be considered of in chronically homelesga personmust havebeen on the streets in an emergency or shelter(i.e, not in transitionalhousing)during thesestays. HUD's definition of a chronicallyhomelesspersonisbasedon the following components r Uuaccompanied homeless individual: an unaccompanied homeless individualhasthe samecharacteristics of a Singlenot in a Family (described above). o Disabling condition: seethe instructions under disablingcondition (below) to determinewhethera client is disabled. Did not leave the program - This term refersto clientswho were in the program on the last day of the operating year. Disabling condition - HUD defines disablingconditionas:(l) A disabilityas definedin Section223 of the Social a SecurityAct; (2) a physical,mental,or emotionalimpairmentwhich is (a) expectedto be of long-continued.and indefinite duration,(b) substantially impedesan individual's abiliry to live independently, and (c) of such a naturethat suchability could be improved by more suitablehousing conditions;Q) a developmental disability as defined in section 102 of the DevelopmentalDisabilitiesAssistance and Bill of Rights Act; (4) the disease acquiredimmunodeficiencysyndromeor of any conditionsarising from the etiological agencyfor acquiredimmunodefciency syndrome;or (5) a diagnosable substance abusedisorder. Entered the program - Enteredthe program refersto the first day a client receivesservices.For a residential program, t his dat ewoul d re p re s e n tth e h rs td a y o fre si dencei ntheprogram' shousi ng Forservi ces,thi sdatemayrep r esent t heday of program enrollment,the day a servicewas provided,or the first dateof a period of conthuous prticipation in a service (e.g., daily, weekly, or monthly). For S+C and SRO programs,the program enfry dateis the datethattheparlicipantstartsto receiverental assistance. For S*C, services provided prior to this point are recognizedas necessary outreach/enrollment are eligible to count as for and match. An Extension APR appliesto SHP and S+C grantees that requested receivedan extensionof their grant term fiom and the HUD field office. The only diffrrence betweenan APR for the extension period and the regularAPR (besides the amount of time covered)is the signaturepage. Grantees should circle "yes" to indicatethe APR is for an extension period and circle the operatingyear for which the reportis an extension. For example,if the granteeis extendingyear 3, the granteeshould submit an APR as usual for year 3 and submit anotherAPR for the extensionperiod, indicatingthe secondis an extensionand also circling year 3 on the signaturepage. Grantee meansa direct recipientof the HUD award. Left the program - Left the programrefers to the last day a client receives services.For a residentialprogram,this date would represent last day of residence the program'shousing. For services, exit date may represent lastday the in the the as er v ic ewas p ro v i d e d o rth e l a s td a te o fa p eri odofconti nuousservi ce. i entl eavestheprogramtempor ar ily( e. g. , Ifacl for a hospitalization) is expected return within 30 days,do not count that client as having left the program. but to For S+C programs,the programexit daterefersto the datethe participantstopsreceiving rental assistance is not and expectedto refurn to S+C assisted housing. If the participantreturnsto S+C assisted housing within 90 days,the person should not be considered exiting from the program. f the personreturnsto S+C assisted as housingafter 90 days,that person is considered new participant. The worksheetis designed capfurethis information. a to
HUD-40118

Match for S+C is the value of supportiveservicesreceivedby participantsin the S+C poject which, in the aggregate, provided over the life of the project. For SHP,matchiscash must at leastequal the value of the S+C rental assistance usedto provide the grantee'sportion ofacquisition, rehabilitation,new construction,operaticns and supportiveservices expenses. Operating year - For SHP programs, first operatingyear beginsafter developrnent the activitiesfor acquisition, rehabilitation, and new constructionare complete aft.er copy of the Cerlificate of Occupancyis sentto the local HUD a , office, and when the first participantis acceptedinto the project. For projectswithout acquisition,rehabilitation, new or constmction, operatingstartdatebeginswhen the granteeaccepts first participant. For dedicated the the HMIS projects, the operatingyear begins when any eligible cost included in the approvedproject budget is incurred.For S+C (SRA, PRA and TRA components), first opemtingyear beginson the dateHUD signsthe grant agreement.For S+C/SRO the and for Sec.8 SRO, the first operatingyear beginswith the effectivedate of the Housing Assistance (HAP) Payments Contract. To determine which operatingyear to circle on the APR cover page,begin counting from the initial grant operatingstarl dateand includerenewalgrants. For example,a project receivingan initial grant for three years and a renewalgrant for two yearswould circle years 1, 2, and3 respectivelyon the AIR cover sheetfor the initial grant and would circle 4 and 5 respectively the renewal grant. For any future renewalgrants,the granteewould begin by circling 6 on the APR cover for sheet. Participants - The term participantrefersto Singlesnot in Familiesand Adults in Families as defined above. Participant doesnot include children or caregivers who live with the adultsassisted. Project Sponsor meansthe organization responsiblefor carrying out the daily operationof the project, if the organizationis an entity other than the grantee.

Special Instructions for Supportive Service Only (SSO) Programs. SSO grantees shouldcomplete questions, all unlessa written agreement has beenreachedwith the field office concerningwhich questionscan be answered using estirates, or in rare instances, skipped. Below is an exampleof how information could be derived in a large,singleserviceSSO project: A grantee/sponsor staff member could be assigned collect information from the organizations to housing the participants. The staff personwould contactthese individual organizations requestinformation regardingthepersons that facility that use to in the service.For participantsliving on the street,the granteelproject sponsormayprovide estimates. Information could be collectedfor eachparticipantor fbr participants receiving servicesat a point-in-time. If estimates or point-in-timecountsare used,the method usedmust be describedin the APR and the documentationkept on file. grants,grantees As with all projectsfunded underHUD's homelessness assistance operatingSSO projects are expected to completeall APR questions that are applicableto them. Note that all projectshave been awardedfunds as a result of respondingto the program goals of assisting hcrneless personsobtain/remainin permanenthousing and increase their skills and income. The APR documentstheir progressin meeting thesegoals. In some circumstances field offices and grantees may sign a written agreement concerningquestionsthat can b answered using estimates, in rare instances, or skipped. Seethe specialinstructions below for reporting on specialtypes of projects,suchas outreachonly projects,projectsproviding servicesto children only, and transportation, medical, dental, ad other single,shortduration serviceprojects. SSO programsare a third priority for local HMIS implementation, following emergencyshelters, transitionalhousingprograms, outreachprograms,and permanentsupportivehousing programs. Once SSO programsare included in the HMIS, SSOgrantees will be able to answerall APR questions using their HMIS data. SSO grantees that are not yet participatingin HMIS will need to collect datato answerthe APR questions using the specialinstructionsprovided above. Outreach Only Projects. Projectswhich are solely devotedto streetouheachand connectionto housing and services are not requiredto track participantsbeyondtheir contactwith personson the street. It is sufficient for theseprojectsto enter
HUD-40118

E sti i n fo rm at iononque s ti o n s l -1 0 (s k i p p i n g q u e s ti o nsl l -i 3and17). matesforquesti ons5-9areal l ow ed,gi vent hat parlicipantsmay be reluctantto answerpersonalquestions. number of people,providing basic that the granteeis servingthe appropriate will demonstrate Answering the questions the personsare being served,demonstrating types of that homeless demonstrating demographiciniormation for Congress, are receiving. they to, housingparticipants connected and the type of services are Hotline Projects, Hotline servicesare similar to outreach only projects, but contactbetweengranteeand participantis often of very short duration- people enterand leave the programnearlysimultaneously.It is sufficient for theseprojectsto answer questions (skipping4), 10, and 14-19(skipping17). l-5 Projects ProvidingServices ChildrenOnly. Projectsthat provide child care, after schoolcare, counseling children, To for etc. make an important contribution toward moving a family out of homelessness. While the main focusof the project is 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 questionsshouldbe answered providea Transportation, Medical, Dental, and Other Single, Short-Duration Service Projects. Somegrantees homelesspersonsto obtair/remainin permanent single serviceof fairly shorl duration focusedONLY indirectly on assisting housing and increase their skills and incomes. It is sufficientfor theseprojectsto enter informaton on questions1-10and 14services, is unreasonable think that someone it to would have l9 (question 17 may be skipped). However, with transporlation 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, basedon the populationthat utilizes the service. on the abovestatistics servedduring the For Safe Haven (SH) Proiects. Granteesshouldreport on all participants Special Instructions were instructedto repoft on the frrst 25 where grantees operatingyear. Note: this is a changefrom prior instructions parlicipantsserved.

grantees SpecialInstructions for HomelessManagementInformation System(HMIS) Proiects.HMIS

should fiil out the cover sheetof the APR Part II FinancialInformation,and the HMIS Activities section.

HUD-40118

THIS PAGE - TO BE COMPLETEDBYALL GRA]VTEES

urantoe:

of Department HumanServices of City and County San Francisco,

ProjectSponsor:

Number: HUD Grantor Project 027 cA Ol 8501

ProjectName:

Center Neighborhood Heights Affiliate the Bernal of Housing Services

Operating Year: (Circle the operatingyear being reportedor)

Project Boulevard Monterey

ReportingPeriod: (month/daylyear)

trr lz nl n+ ns Xo nz tr8 tre nro nn Ir z [rr [r + D i s []renr7 nrs l tq nz o

Indicate extension: n Yes X No if
PreviousGrant Numbersfor this oroiect:

trom:711106 to:6/30/07

cAo1 8401 036 cA3989601 10 cAO1 B00 '1017 cAO1 8301 023

Check the componentfor the program on which you are reporting.

SupportiveHousing Program (SHP) ! X I f n ff TransitionalHousing Permanent Housing for Homeless Persons with Disabilities SafeHaven InnovativeSupportiveHousing SupportiveServicesOniy HMIS

ShelterPIus Care (S+C) ! f] n I Tenant-based Rental Assistance(TRA) Sponsor-based Rental Assistance(SRA) Project-based RentalAssistance(PRA) SingleRoom Occupancy(SRO)

Section Moderate 8 Rehabilitation n Single RoomOccupancy (Sec. SRO) 8

year) and number served accomplishments operating this with of Summaryof the project:(Oneor two sentences a description population,

provides units permanent supportive housing multiplyfour of for Project Boulevard Apartments TheMonterey by American Recovery persons families. are Supportive services provided Asian with diagnosed homeless population formerly is homeless women withchronic Thetarget Center. Woodward Counseling Services/Lee programs problems, theirchildren, areexiting residential outpatient and treatment upon who abuse and substance program completion.
Name & Title ofthe Personwho can answer questionsabout this report: Phone: (include areacode)

Lauderback-Strebler SumiImamoto/Justine
Address:

415-206-2140
Fax Number: (include area code)

CA Ave.,San Francisco, 941'10 515 Cortland nc.org Address simamoto@bh orgijlstrebler@bh nc. E-mait

415-648-0793

I hereby certify that all the information stated herein is true and accurate.
. l Warning : HUDwillpro se c ut ef als ec laim s ands t at em entC o n v i c t i o n m a y r e s u l t i n c r i m i n aa n d / o r c i v i l p e n a l t i e s ( 1 8 U . S . C . 1 0 0 1 , s.

i0 1 0 .1 012;3l U. S . C. 2 9 ,3 8 0 2 37
& Official: Name Title of Authorized Grantee & Signature Date:
-, ... l

Mikyung Kim-Molina, GrantsManager

Sponsor Official: and Project Name Title of Authorized

f'. "'7 L'/

&-DaE: Signature

Dir. of & Justine Lauderback-Strebler, Finance Admin.

{*.1 x -v

,i

+ rSln
H UD- 401r 8

(EXCEPT ETMTS) BY PARTI. TOBE COMPLETED ALL GRANTEES

3 ON SEESPECIALINSTRT]CTIONS PAGE OF THE'4PR PLEASE GRANTEES, SSO Part I: Project Progress
l.
a

CoC projected Level of personsto be served at a given point in time. (This infonnationcomesfrom themostrecent ication.
Number of Not Singles in Families Number of Adultsin Families
a J

ProiectedLevel to Persons be servedat a given point in time

Number of Children in Families

+
A

Number of Families

2.

PersonsServedduring the operating year.

N umber of S i ngl es ot i n N Fami l i es Number of Adults in Fami l i es Number of C hi l dreni n Fami l i es

Number of Families

Number on the first day of the operatingyear

D.

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

0
1
0
tl A t

Explanatory notes: Not in SeeDefinitions of Client/HouseholdTypes in the GeneralInstructionsaboveto determinewhich clients shouldbe countedas Singles type that may and Chiidren in Families. Note that this table doesnot accountfor changesin client/household Families,Adults in Families, occurduringthecourseoftheoperatingyear.Instead,eachclientshouldbeassignedasingleclient/householdtypebasedontheclient's attieprogramentrydateclosesttothestartoftheoperatingyear. Inthisway,eachclientiscounted ageand/orhouseholdcomposition the table. only once in who should be countedin rows a-d: to Use the following graphic and explanations determine

on in Client program iiFt dayol year,leflduring the operating year couniin 2a and2c. on in Client program llrsldaY
' I . ofoperaling year and last

,
}-"''..",..+
H

I
and entered lefi Client pfogramduringoperaling year:countin 2b and2c.

l"i'J oPe"t'ng tount Y"tr in2aand2d.

d C l i e ne n l E rea n dl e i t program slartof before year:do nolcounlin operating queslion 2.

Clienl entered program durang operatingyear and still in program on last day of year: count in 2b and 2d.

FiEl day of the operating year

Last day of the operating yeat

Number on the first day of the operating year:This row includesall clientswho enteredthe program beforethe first day of the operatingyear and did not leavethe program until afterthe first day of the operatingyear b. Number entering the program during the operating year: This row includesall clients who enteredthe program on or afterthe first usethe day of the operatingyear, up to and including the last day of the operatingyear. For clientswith multiple programentry dates, date ciosestto the start of the operatingyear. Do not count the client more than once even if he/sheenteredthe programmore than eniry once during the operatingyear. Number who left during the operating year: This row includesall clientswho left the program on or after the first day of the the exit date operatingyear, up to and including the last day of the operatingyear. For clientswith multiple program exit dates,use HUD-40118

during morethanonce exitedtheprogram year.Do not counttheciientmorethanonceevenif he/she to closest theendof the operating year. theopelatir-rg d. as who werein theprogLam of thefirst all year: Thisrow includes clients on Numberin the program the lastday oftheoperating of year'. Thenumber year theoperating andwhodid not leaveduringthe operating year during dayofthe operating or who entered 2c. to on based therespnses lows2athlough For year on in clientsor families thepr.ogram the lastdayof theoperating is calculated of the or of add eachcolumn, thenumbelof clientsor famiiiesin row 2a to thenumber clients familiesin row 2b andsubtract numbel' 2d : 2a+ 2b- 2c' in clientsor families row 2c. Therefore,

3.

Project Capacity,
of Number Not Singles in Families Numberof Adultsin Families
:t t:

Nunrber of in Children Families

,:r , .'t.,

Nurnberof Farnilies

Numberon thelastday(from2d, columns1 and4) b. 1 (fi'om la, columns and4) in Numberproposed application
Capacity Rate (divide aby b): %

0 1 0%

i::l!;.

-: , . :

1AA%

Explanatory Notes: to Row b r.efers the most recentCoC application for which the programis repotting.

4.

Non-homelesspersons, This questionis to be completedfor Section8 SRO projects.

Not Applicable.

5.

Age and Gender. Of thosewho entered the ploject during the operatingyear, how many people are in the foliowing age and gendercategories?
Sinsle Persons(from 2b. column 1) b. d. Age 62 and over Male Female

51-61

3l-50
I 8-30 [7 andunder
62 and over

Pcrsonsin Families(from 2b, colqmn!?-e J)

f,
h.

5t-61 31-50 18-30

t3-t7
t.

6-12
l-)

l. m.

Under1

Explanatory Notes: yeat. Only clients the This question refersonly to Singlesnot in Families and Pelsonsin Familieswho entet'ed proglam during the operating in this table. The total number of clientsreporledunder Single Personsshould be equalto the who meet thesecriteriacan be counted to the sum of in number r.eported question2b, column 1. The total number of clientsreportedunder Personsin Families should be equal columns 2 and 3 in question2b.

| 6 Answerquestions - 10only for participantswho enteredthe projectduring the operatingyear (from2b,columns &'2)' NOTE: or It doesnot includechildren caregivers' and The termparticipant*.uni Singl"snot in Families Adultsin Families. Some of questions all participants' for to r'espond eachof those be 7, The totalior questions, 8 and i0 b"lo* should thesame; who areghrggigSlly-homelesl. for information individuals the listedthroughout APR will be asking the questions
t8 HUD-40r

6a. Veterans Status.A veteranis anyone who has ever beenon active military duty status. were veterans? How many participants beencontinuously individualwith a disablingconditionwho has either homeless person An unaccompanied 6b. Chronically homeless in ofhomelessness the past three (3) years. To be considered homeless a year or more OR has had at leastfour (4) episodes for or a chronicallyhomeless personmust have beenon the streets in an emergencyshelter(i.e.not transitionalhousing)during see thesestays. For further discussionof the definition of chronic homelessness, Other Key Definitions under the GeneralInstructions above. individuals? werechronically homeless How many participants

7,

Ethnicity. How many parlicipantsare in the following ethnic categories? Hispanicor Latino Non-Hisoanicor Non-Latino

b.

Explanatory Notes: Each participantshould be listed in only one category. The total number of participantsin this table should equal the numberof participants 2b, in question columnsI and2.

8.

Race. How many participantsare in the following racial categories? American Indian/AlaskanNative Asian Black/African American Pacific Islander Native Hawaiian/Other White AmericanIndian/AlaskanNative & White

b. d. f,

s.
h.

Asian& White
Black/AfricanAmerican & White Native & Black/African Amertcan American.Indian/Alaskan Other Multi-Racial

Explanatory Notes: a Each participantshould be listed in only one category. A participantwhose race doesnot correspondto categories through i shouldbe in countedin j, Other Multi Racial. The total number of participants this table should equal the number of participantsin question2b, categories. categories generate APR response to the columns I and 2. If using HMIS data,you may combineHMIS raceresponse

may have more than one. 9a. Special Needs. How many participantshave the following? Participants Ifso, count them in atl applicablecategories.For eachcondition, also indicatethe number thatwerechronically homeless. All Chronic
a.

b. c.
d.

Mental illness Alcohol abuse

Drus abuse
HIV/AIDS and relateddiseases disabilitr Developmental Physicaldisabilitr Domesticviolence specify) Other (please

f. h.

are 9b. How manyof theparticipants disabled? E

Explanatory Notes: meet HUD's definition of "disabled,"see"Disabling Condition" under Other Key Definitions in the General To determinewhich participants Instructions. HUD-40118

in sleptin the following places the week prior to enteringthe project? (Foreach 10. prior Living Situation. How many participants parlicipant,chooseone place. The total number of participantsin the "All" column should equalthe number of participantsin question2b, one) slept how many chronically homelessparlicipants in the following places.(Choose columns1 and 2). Also, indicate All
a.

Chronic

b. c.
d.

Non-housing (street,park, car, bus station,etc.) Emergencyshelter persons Transitional housingfor homeless Psvchiatric facilirv* abusetreatmentfacility+ Substance Hospitalx Jaillorison* Domestic violence situation Livinq with relatives/friends Rentalhousing

f h.

. ::r

t.

Other(please specifu)

*If a participant less abuse treatment facility,hospital, jail), but wasthere than or facility,substance froman institution(psychiatric came in the the facility,heishe should counted either be shelter before entering treatment or 30 daysandwasliving on thestreet in emergency as street shelter or category, appropriate.

questions i - l5 for ail participants who left during the operatingyear (from 2c, columnsI and 2). The term I Complete participantmeanssingle personsand adults in families. It doesnot include children or caregivers. The termchronically homelessindividual with a disablingcondition who has either been continuously homelessperson meansan unaccompanied in of homeless a year or more OR has had at leastfour (4) episodes homelessness the pastthree (3) years.To be consideted for shelter(i.e. not transitionalhousing)during chronically homelessa personmust have been on the streetsor in an emergency thesestays. year, participants leftduring operating howmany the who at 11. Amountand Source MonthlyIncome Entry and at Exit.Of those of place monthlyinome levelandeach the of source income?Also,please income levelandwith each participants at each were monthly Thenumberofparti ci pantsi nC h ar t AandB so u r c eof inc om ef o rc h ro n i c a l l y h o m e l e s s p e rs o nsi nthesecondcol umnofeachchart. should thesame. be
AII A. Monthly Income at Entry No income b. $l 150
, '-1
-.:,!

Chronic At C. IncomeSources Entry a.

AII

Chronic
.::":t.. .:: ':-.:. l ,:.f" ;

(SSI) Income Security Supplemental

DisabilityIncome(SSDI) SocialSecurity Social Security

b.
1 I

$151 $2s0 d.

$251$500 $501 $1, 000 $1001$1500 $1501$2000

A u

PublicAssistance General
TemporaryAid to Needy Families (TANF)

f.
q

f
o

StateChildren's Health lnsuranceProgram (SCHIP) VeteransBenefits Income Employment UnemploymentBenefits

h.

+ s2001

h.

VeteransHealth Care Medicaid Food Stamps

k.
m..

Other (pleasespecify) Resources No Financial

10

H U D 4 0 l1 8

Atl
B. Monthly Income at Exit No income

Chronic at D. IncomeSources Exit

a.

All

Chronic

a.

Security Income (SSI) Supplemental

b.
c. d,

$I 150 s 151 $250 I $25 - $500 $501 $1, 0 0 0 $1001- 150 0 s $20 $1501- 0 0 + $2001

b.
c

(SSDI) Income Disabiliry Security Social Security Social

PublicAssistance General

d.

(TANF) Aid Temporary to NeedyFamilies

f.
b.

f.
a

StateChildren's Health InsuranceProgram (SCHIP) VeteransBenefits EmploymentIncome UnemploymentBenefits

h.

h.

J
L

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

m. n.

Notes: Explanatory
Table A: Monthly income at entry refersto the participant'smonthly income on the day he/sheenteredthe program(i.e., on the progran entry date or as closeas possibleto that day). You should not report on incomereceivedbefore enteringthe programor incomereceived during the programstay. Tabte B: Monthty income at exit refersto the participant'smonthly income on the day he/sheleft the progranr(i.e., on the programexit date or as close as possibleto that day). You should not report on incomereceivedduring the program stay. of at Table C: Income sources entry refersto the participant'ssources incomeon the day he/sheenteredthe program(i.e., on the program ofincome receivedbefore enteringthe programor income entry date or as closeas possibleto that day). You shouldnot reporton sources with no income at the time of program entry should be reporled in categoryn, No Financial receivedduring the programstay. Participants Resources. of at Table D: Income sources exit refersto the participant'ssources incomeon the day he/sheleft the program (i.e., on the programexit date with no ofincome receivedduring the program stay. Parlicipants or as close as possibleto that day). You should not report on sources program exit should be reporledin categoryn, No FinancialResources. income at the time of

who left during the operatingyear (from 2c, columns I and 2), how many were inthe projectfor the following 12a. Of thoseparticipants who left during the operatingyear in the second lengthsof time? Also, pleaseplacethe length of stay forchronically homelesspersons column.

A II
Lessthan I month b. c. d.

C hroni c

I to 2 months 3 - 6 months
7 months- 12 months

f
e.
n-

13months 24 months 25m ont h s -3 v e a rs

4vea rs-5 v ear s 6yea rs-T y ear s

8 years l0 years Over l0 years Explanatory Notes: Computeeachparticipant'slength ofstay using the participant'sprogramentry date and programexit date. Ifthe participanthasonly one the programexit dateduring the operatingyear,calculatelength ofstay by subtracting program entry date from the program exit date. Ifthe year, calculatethe length of stay for eachprogram stay(by subtractingthe participanthas multiple program exit datesduring the operating programentry datefrom theprogram exit date for eachprogramstay)and add them togetherto producea cumulativelength ofstay. Each
I'I

HUD-40118

participantsin the first coiumn ("All") should with only one length of stay category. The total number of participantshould be associated equatttie number of participantsin question2c, columns 1 and2' year (from 2d, columns1 and2), horvlong who did not leayeduringthe operating l2b. Length of stay in program. For thoseparlicipants have the yb ee nin thep"r ojec tAls o, pleas eplac et het .n g t t . r o r r t u y r o r c h r o n i c a l l y h o m e t e s s p e r s o n s w h o d i d n o t l e a v e d u r i n g th e ? operatingyear in the secondcolumn. All b.
u
A

Chronic

f.
o

h.

Less than I month I to 2 months 3 - 6 months 7 months- 12 months 13 months- 24 months 2 5mo nth s-3 y ear s 4 ye ars-5yea r s 6 vears-'1 vears 8 vears- i0 vears Over 10 vears

tt

Explanatory Notes: Computeeachparlicipant'slength ofstay using the participant'sprogram entry dateand the last day ofthe operatingyear. To calculate with only one Iengthofstay, subtractthe program entry date from the last day ofthe operatingyear Each participant should be associated in length of stay category. The total number of participantsin the first column ("All") should equal the number of participants question2d, columnsI an d2 .

13. Reasonsfor Leaving, Of those parlicipantswho left the project during the operatingyear (from 2c, columns I and 2), how many left include only tlte primary reaso,l. The total numberof participants for the following reasons?If a participant left for multiple reasons, in the first column ("All") should equal the number of participantsin question2c, columns 1 and 2. Also, pleaseplacethe piimary year in the secondcolumn. personswholeft the projectduring the operating reason chronically homeless for All Left for a housing opportunity before completing program b.
a

Chronic

Completedprogram charge Non-paymentof renVoccupancy Non-compliancewith project Criminal activity / destructionof property / violence Reachedmaximum time allowed in proiect Needscould not be met by project

f.

h.

Disagreement with rules/persons Death 1

J
t,

Other(please specifi)
Unknown/disappeared

12

HUD-4018 i

14. Destination. Of thoseparlicipantswho !9.;[t during the operatingyear (from 2c, columns I and 2), horv many left forthe following de cfin afin n? n nle45gplac et hedes t inat iO nof c h r o n i c a l l y h o m e l e s s p e r s o n s w h o l e f t d u r i n g t h e o p e r a t i n g y e a r in th e se co n d AIc column. AII Chronic

PERMANENT(a-h)

a.
h

(no subsidy) Rental houseor apartment PublicHousing Section8

d.

PlusCare Shelter
houseor apaftmenl HOME subsidized

f.
g

or house apartment Othersubsidized

Homeownership Moved in with family or friends persons Transitionalhousingfor homeless Moved in with family or ftiends Psychiatrichospital Inpatientalcohol or other drug treatmentfacility

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

l.

J.

k. l.
m. n. o.
n

Jail/prison Emergency shelter housing supportive Other

Placesnot meantfor human habitation(e.g. street)

(n) EMERGENCY SHELTER OTHER(o-q)

q. LTNKNOWN
I

speciff) DEATH Other(please

Unknown

Explanatory Notes: provided.The response categories combine Identif, eachparticipant'sdestinationupon leaving the programusing the categories etc.) and "tenure" (e.g.,permanent, transitional,etc.). "destination" (e.g.,rental houseor apartment,public housing,homeownership, response, and be sureto look at all of the response categories before Considerboth destinationand tenureto determinethe most appropriate category. making a selection. The table below provides a brief descriptionof eachresponse categoryin eitherthe first colirmn of the table or in both columns if the participantis Enter the number of participantsunder each destination chronically homeless. Only one reasonfor leaving shouldbe recordedper participant.The total numberofparticipantsin the first column ("All") should equalthe number of participantsin question2c, columns 1 and2. Tenure Permanent Destination (no Rental house or apartment subsidy) Descriotion Participantis moving to an apartmentor housewithout any subsidy. Participantis moving to a public housingunit.

4.

b,

Public ousine h Section 8

ShelterPlus Care

(formerly will voucher Participant usea housing choice knownasa to 8 or Section voucher) renta house apartment.
Participantis moving to a unit funded by the ShelterPlus Care prosram(e.e.,TBA, SRA, PRA, Section8 SRO). provided by the Participantis moving to a unit with rental assistance HOME prosram (tenant-based proiect-based or assistance). Participantis moving to a unit subsidizedby some programother than public housing, housingchoicevoucherprogram(formerlySection8), ShelterPlus Care, or HOME. is to hasourchased. Particinant movins. a unit that he/she Participantis moving in with family or friends and expects live there to for 90 daysor more. Participantis moving into a unit funded by a transitionalhousing people(e.g.,transitionalhousing fundedthrough programfor homeless the SuooorliveHousins Prosram). Participantis moving in with family or friendsand expectsto live there lessthan 90 days. hospital. Pa:ticioant movine to a psvchiatric is

o.

house or HOME subsidized aDanment

f Other subsidizedhouseor apartment

h.

Homeownership Moved in with family or friends

Transitional

housing homeless for Transitional people

Moved in rvith family or friends Psvchiatrichosoital

Institution

t,

1a IJ

HUD-4018 l

Tenure

I
m n. o,

Emergency Shelter Other

Destination Inpatient alcohol or other drug treatmentfacility Jail/Prison Emergencyshelter housing Othersupportive

Description

is alcoholor drugtreatment facilily. Participant movingto an inpatient

ParticDantrs mo n e t o a i a i l o r o r i s o n . is Participant moving to an emergency people. shelterfor homeless is Participant moving into supportive housingthat doesnot correspond (a-h) and is not transitional to any ofthe permanenthousing categories people(i), such as Section8l I housine.* for housing homeless is Participant moving to a placenot meantfor humanhabitation, such as a car,park,sidewalk,or abandoned buildine. Participantis moving to a place that does not correspond any of the to above (a-p). categories category This response shouldbe usedifyouare unsure aboutwhere is the participant moving or ifthe participant hasdisappeared there and is no way to find out where he/sheis.

Y.

qUnknown

Placesnot meant for human habitation Other (pleasespecify) Unknown

*HUD encourages programs to limit the use of the "Other SupportiveHousing" APRresponsecategoty. Programs should reporl destinations to housing that are perntanent or transitional in APR categories (a) through (h) or in categories (i) through Q), respectitely. Exits to emergencyshelters should be reported in category fu).

15. Supportive Services. Of those participantswho left during the operatingyear (from 2, columns I and 2), how many receivedthe following supportiveservicesduring their time in the project? Also, pleaseplace the supportive servicesreceivedforchronically homelessparticipants who left during the operatingyear in the secondcolumn. Participantsmay have receivedmultiple services and all servicesshould be repoftedin the table. All
4.

Chronic

Outreach
Casemanagement

b.
d.

Life skills(outside case of management)

Alcohol or drug abuseservices Mental health services f
I

HIV/AIDS-related services Other health careservices Education Housingplacement

h.

J
t.

Employmentassistance Child care Transportation

m.
n.

Legal

Other(please specify)

t4

H UD- 401l8

16. Overall ProsramGoals.Underobjectives, your measurable Iist for year(fromyourapplication, objectives thisoperating Technical Submission, APR)for eachof thethreegoalslistedbelow,UnderProgress, or your progress meeting objectives. describe in the UnderNextOperating Year'sObjectives, specify measurable the for year. objectives thenextoperating
a. Reside ntia lStab ilit y

Objectives:

See Attachment 16

Progress:

Next Operating Year'sObjectives:

b,

IncreasedSkills or Income

Objectives:

See Attachment

16

Progress:

Next Operating Year'sObjectives:

c.

Greater Self-determination

Objectives:

See Attachment 16

Progress:

Next Operating Year'sObjectives:

17. Beds. SHP recipients answer S+C 17a. recipients answer SRO l7b. recipients projects do answer (SHP-SSO 17c. not completethis question)
a. project SHP. How manybeds wereincluded theapplication in approved t&rs for under'Current Level'andunder 'NewEffort'? How manyof these New Effort bedswereactuallyin placeat theendof the operatin year? g

CurrentLevel New Effort in Place New Effort Number Beds: of 10 N,A. I b. S+C. How manybeds anddwellingunitswerebeingassisted project with fundsat theendof theoperatingyear? (lnclude givers.) beds all participants, for otherfamilymembers, care and Number Beds: of Number Dwelling of Units: c. gyear? SRO. How manydwellingunitswerebeingassisted theendof theoperatin at (lnclude unitsoccupied "in place"non-homeless persons qualifyfor assistance.) by who Number Dwelline of Units:

t5

HUD-401l8

Part II: Financial Inforrnation

18. Supportive Services, services was spentduring to For Supportive Housine(SHP),this exhibitprovidesinformation HUD on how SHP funding for supportive services.IncludeHMIS costsunder"Other". the operating year. Enterthe amountof SHP fundingspenton thesesupportive For ShelterPlus Care(S+C), this exhibit tracks the supportiveservicesmatch requirement. from all Specify the value ofsupportive services sources that can be countedas match that all homelesspersonsreceivedduring the operating year. (S+C grantees shouldkeep documentation file, including source,amount, and type of supportiveservices.) on For Section8 SRO, this exhibit provides information to HUD on the value of supportiveservices receivedby homelesspersonsduring the operating year.

Supportive Services
a. b. c.
A

Dollars

Outreach Casemanagement Life skills (outsideof casemanagement) Alcohol and drus abuseservrces Mental healthservices AIDS-relatedservices Other healthcare services Education Housingplacement

$16,488.68

E.

f.
o

h.

j
L

Employmentassistance Child care

Transportation
m. Legal

(please Other speciff)Indirectcosts

o

$412.00
$16,900.68

n) TOTAL (Sumof a through

Cumulativeamount of match provided to datefor the ShelterPlus Care Prosram under this grant

t6

H UD 4 0 1 l 8

lg. Supportive Housing Frogram: Leasing, Supportive Services, Operating Costs, HMtrS Activities and.4drninistration year.Forexpansion tl'rese chartseachoperating HousingProgrammustcomplete receiving funding underthe Supportive All grantees projects: IfsHPgra ntfu nds ar ef or t heex pans ionof apr e - e x i s t i n g h o m e l e s s f a c i l i f y , o n l y t h e p e o p l e a n d e x p e n d i t u r e s f o r th e a d d i ti o n a l to of usedis not required be Documentation resources or as may be included, in the originalapplication any grantamendments. expansion made submittedwith this reporl but shouldbe kept on file for possibleinspectionby HUD and Auditors. Do not include any expenditures rvaserecuted. heforethe SHP g.rant Summary of Expenditures Enter the amount of SHP grant funds and cashmatch expendedduring the operatingyear for eachactivity. This table shouldadd up both holizontally and vertically. The SHP supportiveservicestotal shouldbe the sameas the SHP supportive service s Ou estion . rn 18 Cash Match Total Expenditures SHPFunds

Leasing b.
Supportive Services OperatingCosts
d.

$'16,488.68

$4J22.17

20,610.85

HMIS Activities Administration

$412.00
$16,900.68 $4,122.17

$412.00

f.

Total

$21,022.85

Note: Paymentsof principal and intereston any loan or mortgagemay not be shown as an operating expense

Sourcesof Cash Match. Enter the sourcesof cash identified in the CashMatch column, above.in the following categories.Use additional shee

sponsorcash Grantee/project Local government(pleasespecify)

CBHS SF Dept.of PublicHealth,

Stategovernment (pleasespecify)

(please government specifu) Federal BlockGrant(CDBG) Development Community

(pleasespecify) Foundations

(pleasespecify) Privatecashresources

charge/ fees Occupancy

t7

HUD-4018 I

Rehabilitation,and New Construction 20. SupportiveHousing Program: ,Acquisition, mustcomplete these charts theyearoneAPR in All grantees received rehabilitation, newconstruction or that SHPfundsfor acquisition, orough cash at least to equally match amount SHPfunds the only. Thisexhibitwill demonstrate HUD thatthegrantee contributed has of to spent acquisition, for rehabilitation, newconstruction. Documentation matchingfundswereprovided not required besubmitted that is or to with thisreport shouldbe kepton file for possible but inspection HUD andAuditors. by
Summary of Expenditures. Enter the arnountof SHP grant funds and cashmatch expendedduring the operatingyear for eachactivity

SHPFunds
a.

Cash Match

Total Expenditures

Acquisition Rehabilitation New construction Total

b. c d.

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

Amount
Grantee/proj sponsorcash ect b. Local government(pleasespeci!)

c,

Stategovernment(pleasespecify)

d.

Federalgovernment(pleasespeci|)

Community Block Grant(CDBG) Development

(pleasespeciS) Foundations

f.

(pleasespecify) Privatecashresources

Occupancycharge/fees Total

h.

t8

H U D- 4 0 1 1 8

FOR.E{MIS ACTIVITIES ONT'Y

2 1. For SurrportiveHousine (SHP)- HMIS Activities was spentduring the operating year. Enter services to This exhibitprovidesinformation HUD on how SHP-HMIS fundingfor supportive the amount of SHP-HMIS funding spenton theseactivities.

HMIS Actittities Only Central Server(s) PersonalComnutersand Printers Nefworking Securify Subtotal

Dollurs

s
/ Software User Licensing SoffwareInstallation Supporl and Maintenance SupportingSoftwareTools Subtotal Training by Third Parties Hostine / TechnicalServices

':

. ,.!-

Situicbs

.'I

;r. ,

Customization Programming:
Programming:SystemInterface Programming:Data Conversion

and Assessment SefuP Security

On-line Connectivity (InternetAccess) Facilitation

and Disaster Recovery

Subtotal

,,'

Peisonnel: ,:

iil

ril

,:a

/ ProjectManagement Coordination Data Analysis Programming and Training TechnicalAssistance Administrative SupPortStaff Subtotal

HMIS Costs Space

stttd.

OperationalCosts Total

ta

HUD-40118

Descrilre any problems and/or changesimplementedduring the operatingyear.

and Recommendations Technical Assistance Ifso, pleasedescribe. Based on your experienceduring the last year, arethere any areasin which you need technical advice or assistance?

20

HUD-40118

Repod Fersons ServedWorksheet - I{UD Annual Progress The or of (PPI) wih Information onthisfonnis done theknowledge consent theclients. Personal of Collection theProtected
PPI is only usedfor the following puryose: Programin Reporl (APR) for the Continuumof Care (CoC) HomelessAssistance Accuratecompletionof the Annual Progress which the client is enrolled. and needed complete AnnualProgress to the Report. Instructions to is and Thisworksheet optional is intended helpyou collectinformation to Codes follow. Do not submitthis worksheet HUD.
in Number Months of (calculate) Project 12a Number Monthsin of Project -Participant did not leave (calcul ate) 12b (i Non-Homeless Only) ( Y/N ) 4

PersonsSer-ved Worksheet (continued)

Collection of the Protected PersonalInformation (PPI) on this form is done with the knowledgeor consentof the ciients. The PPI is only usedfor the following purpose: Accuratecompletionof the Annual Progress Reporl (APR) for the Continuumof Care (CoC) HomelessAssistance Programin which the client is enrolled.

Do not submitthisworksheet HUD to

No.

Veterans (YAII) Status 6a

Chronically Homeless (Y,AJ) 6b

Ethnicity 7

Race (code) 8

SpecialNeeds (code) 9a

SpecialNeeds (code) 9b

Prior
T ivinq

Situation 10

Monthly lncome At ProjectEntry

I la

Monthl y l nc ome
At Drnicnt F wit

11b

21

HUD-401 8 t

22

H U D- 4 0 1 1 8

Fersons Served Worksheet (continued) Collectionof the ProtectedPersonalInformation (PPi) on this form is done with the knowledeeor consentof the clients. The PPI is only usedfor the following pulpose: Assistance Programin Accuratecompletionof the Annual Progress Report(APR) for the Continuumof Care(CoC) Homeless which the clientis enrolled.
Do not submit this worksheet to HUD
Reasonfor Leaving Program (code)

13

Instructionsand Codesfor PersonsServedWorksheet T he u se of this wo rks heet is opt ional. I t r v as des i g n e d t0 help yo u colle ct inf or m at ion on par t ic ipant s nee d e d t o comp lete th e An nu al 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 of yo ur p roje ct, m os t of t he inf or m at ion r equir e d f or co mple tion will be c ont ained in t he wor k s heet . D o not sub mit this wo rks heet wit h t he APR. F or pr oje cts tha t se rv e f am ilies , HUD only r equir e s reportin g o n the nu m ber of c hildr en s er v ed, and t h e age and g en de r o f th es e c hildr en. O nly nam e, relationship , d ate of bir t h, and age on t he wor k s he e t
zs

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 number, but not each family member. Use this number 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 h e 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 Number. 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 assign a case number. One number shoutd be assigned to each adult

HU D - 4 0 1 1 8

N ame. Name s o f pe rs ons will not be r epor t ed t o HU D. The use o f n ame s is f or y our r ec or d k eeping conven ien ce . Relat ionship . Ente r the appr opr iat e r elat ions hip. E xamples includ e: Sel f , Head of ir ous ehold, Spous e , child. E nt ry Da te. En ter d ate par t ic ipant ent er ed t he project . Usu ally this will be t he dat e of ac t ual physical mo ve -in fo r a hous ing pr ojec t . E xit Date . En ter da te par t ic ipant lef t t he pr o- iec t . Usually th is will b e th e dat e t he par t ic ipant physica lly moved ou t f or a hous ing pr ojec t . Do no t include a p articipa nt w ho t em por ar ily lef t t he pr ojec t a nd is exp ected to re tur n in les s t han 90 day s ( e. g. , h osp it al iza tion ). 4. I nco me-e ligib le N on- hom eles s in SRO . The SR O progra m a llows a s s is t anc e t o unit s oc c upied by S ec tion 8 in co me-e ligible per s ons r es iding at t h e S R O prio r to reh ab ilit at ion. For SRO pr ojec t s only, ind ica te whe t her t he par t ic ipant is an income-e ligib le, n on- hom eles s per s on ( Y) or no t (N ). SHP a nd S+C pr ojec t s s hould s k ip t his it em .

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 s a 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 t ha t b e st describes where the participant slept in the week prior to entering the project. Do not double c o un t . a . 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 , etc.) b. Emergency shelter c. Transitional housing for homeless persons d. Psychiatric facility* e. Substance abuse treatment facility* f. Hospital* g. Jail/prison* h. Domestic violence situation i. Living with relatives/friends . j. R e n t a t h o u s i n g k. Other (please specify) *l 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 o n 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 t h e str e e t or shelter category, as appropriate.

5a. D ate of Birth. En t er dat e of bir t h inc ludins month, da y, a nd year . 5b. A ge. En ter a ge at ent r y . 5c. Gende r. En ter ap pr opr iat e let t er f or gender . M-M ale F- Fema le. 6 a. V etera ns Sta tus. I ndic at e if t he par t ic ipant is . a vete ran . Plea se no t e: A v et er an is any one who has e ve r be en o n a c t iv e nt ilit ar y dut y s t at us f or t he Un ited State s. 6b. Chron ica lly ho mel es s per s on. I ndic at e t he num b er o f p articipa nt s t hat ar e c hr onic ally ho me le ss.

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

I I a.Gross Monthly Income at Project Entry. 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. l 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 . E n te r the gross monthly income the participant is receiving when exiting the project. 1 lc.Income Sources Received at Project Entry. Enter all types of assistance the participant is receiving at entry to the project. a. Supplemental Security lncome (SSt) 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 S DI) c. Social Security d. General Public Assistance e. Temporary Aid Needy Families (TANF) 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
1A

7.

E thnicity. Ente r appr opr iat e let t er f or et hnic group. a. Hispa nic or L ati no b. Non -Hisp an ic or Non- Lat ino Race , En ter ap pro pr iat e let t er f or r ac e. a. Ame rica n In dia n or Alas k an Nat iv e b. Asia n c. Bla ck o r African - Am er ic an d. Na tive Hawa iian or O t her Pac if ic I s lander e. White f . A me rica n Ind ian / Alas k an Nat iv e & W hit e g. Asian & Wh ite h. Black/African A m er ic an & W hit e i. A m e rica n In dia n/ Alas k an Nat iv e & B la ckiAfrica n Am er ic an j. Othe r Multi-Ra cia l

8.

9 a S pecial Nee ds. En t er t he let t er ( s ) f or t he

cat ego ry(ie s) th at des c r ibe t he par t ic ipant ' s disab ility(ie s). (You m ay double c ount ) .

HUD-40t 8 t

l ld.Income So urces Rec eiv ed at Pr ojec t Ex it . En ter a ll typ es o f inc om e t he par t ic ipant is re ce ivin g at p rojec t ex it . ( Us e c odes as in 11 c . ) t2a Le ng th in Stay in Pr ogr am . Calc ulat ed it em . ( Se e En try Date and Ex it Dat e abov e. ) l2b. Le ng th o f Stay in Pr ogr am . ( Par t ic ipant did n ot lea ve d urin g t he oper at ing y ear . How lon g h ave the y b ee n in t he pr ojec t ?) 13. Rea so n fo r Le av ing Pr ojec t . Ent er t he pr im a r y r ea so n wh y the par t ic ipant lef t t he pr ojec t . ( Comp lete o nly f or par t ic ipant s who lef t t he pro ject a nd a 1e not ex pec t ed t o r et ur n wit hin 9 0 days. a. Le ft for a ho us ing oppor t unit y bef or e co mple ting th e pr ogr am b. Co mple ted p r ogr am c. Non -pa yme nt of r ent / oc c upanc y c har ge d. No n-comp lian c e wit h pr ojec t e, Crimina l a cti v it y / des t r uc t ion of pr oper t y / v i o I e nce f. Re ache d ma x im um t im e allowed in pr ojec t g. Nee ds co uld not be m et bY Pr ojec t h. Disag ree men t wit h r ules / per s ons i. De ath j. Oth er (ple ase s pec if y ) k. Un kn own /disappear ed

i5 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 a ge m e n t) d. Alcohol or drug abuse services e. Mental health services f. HIViAIDS-related services g. Other health care services h. Education i. Housing placement j. Employment assistance k. Child care l- Transportation m. Legal n. Other (pleasespecify)

14. Destina tion . E nt er t he des t inat ion of t hos e lea vin g the p roj ec t . Perma ne nt: a . Re nta l ho us e or apar t m ent ( no s ubs idy ) 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. Oth er su bs idiz ed hous e or apar t m ent g. Ho meo wner s hip h. Mo ve d i n wit h f am ily or f r iends Tra n s itio n al: i. Tran sitio nal hous ing f or hom eles s per s o n s j. Moved in wit h f am ily or f r iends Institutio n: k. Psychia tr ic hos pit al. l. Inp atie nt alc ohol or dr ug t r eat m ent f aci l i t y m. Ja il/prison Em e rge n cy: n. Emerg en c y s helt er Oth e r: o. Othe r su pPor t iv e hous ing. p. Places n ot 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. Un kn orvn

25

l HUD-4018

Monterey Boulevard APartments Reporting Period: 7lLl06- 6/30/07 16. Overall Frogram Goals.

a. Residential Stabilifv: Objective: Progress: 75'h of the participants will remain in housing for one year. have remainedin housing for at leastone 100%$of 4) of the participants year. The participantwho died was in housing for nearly two years' have beenableto remain in permanenthousingthroughthe Participants efforts the supportiveserviceprovidersworking with property services. manasement of 75o/o theparticipantswill remain in permanent housingfor one year.

Next Operating Year's Objective:

b. IncreasedSkill Levelrlncome: Objective: Progress: 50% of participants will obtain/maintain employment. obtainedemployment in the operating 50%(2 out of 4) of the participants year. During the reporting period, one participant reported starting apart' time job. Another participantwho was in a training program got a job as part of the training program. Supportiveserviceshave continuedto to provide information on employment all participants.

Next Operating Year's Objective:

will obtain/maintain 25o/o participants of employment.

Objective:

of 50o/o participants will enroll in a mainstream educational, vocational or employmenttraining program (i.e. EDD, City College, one stop career center, etc.)within 6 months of entering housing. will enroll in a mainstreameducational, 0% (0 of 4) of participants vocationalor employmenttraining program(i.e. EDD, City College,One Stop CareerCenter,etc.)within 6 months of entering housing. The newest participantto enterhousingin October2005 found employmentand did vocational,or employment training not enroll in any educational, programs. She is currentlystill employed. Another who hasbeenin housing for over 8 yearshasbeenenrolledin a vocationaltraining program

Progress:

in the areaof construction administration. partof hertraining, As she position. workedin a short-term administrative
Next Operating Year's Objective: 50o/o participants of will enroll in a mainstream educational, vocational or employmenttraining program(i.e. EDD, City College, One StopCareer Center,etc.)within 6 months of enteringhousing.

c. IncreasedSelf-determination: Objective: l00oh of participants who relapsewill be supported in seeking treatment. 100% (1 out of 1) of the participants who have relapsedhavebeen supportedin seekingtreatment.All the other participantsare in regular contactwith the supportiveservices casemanagersand are involvedwith support groups or have their own supportive network with which they regularly connect. I00% of participantswho relapsewill be supported in seekins treatment.

Progress:

Next Operating Year's Objective:

Objective:

75"/oof families responding to a tenant survey will rate the overall qualify of servicesreceivedas at least satisfactory. 75% (3 of 4) of families responding a tenant surveyratedthe overall to quality of services receivedas at leastsatisfactory.

Progress:

Next Operating Year's Objective:

of 75Yo farniliesrespondingto a tenantsurveywill rate the overall quality ofservices received at as leastsatisfactory.

Objective:

100" of the participantswill reunite with their families within the first six months of residency. 100% (4 out of 4) of participants reunited with their families. All are parlicipantswere fully re-unitedwith their families when they entered into the housing program.

Progress:

Next Operating Year's Objective: 100%of the participants will reunitewith their families within the first six monthsof residency.

Objective:

checkl00o of the participants' children will have nnedicaVdental at least once per year. ups, and irnmunizationsas needed, I00% (3 out of 3) of the parlicipants'rvith young children received at medical and dentalcheck-ups leastonce during the year. Participants reporledthat all of their childrenreceivedregularmedical and dental check-upsduring the year. One participanthad an adult child living with her as a caregiver, that adult child moved out of the home. but I00% of the participants' childrenwill have medical/dental check-ups, and immunizationsas needed, leastonceper year. at

Progress:

Next Operating Year's Objective:

Objectiye:

100'h of the residents'school-aged children will have no more than five unexcusedabsences from schoolwithin one year. children at the propertyhad no more than 100% $ of $ of the school-aged five unexcused absences from school. Parlicipantsreportedthat their children havebeenattendingschoolregularly. childrenwill have 100%of the residentschool-aged no more than frve unexcused absences from school within one year.

Progress:

Next Operating Year's Objective:

Objective:

will 100' of thoseparticipants who require ongoing medical services be supported to developand maintain a health plan. were who requiredongoing medical services I00% (1 of 1) of participants maintaininga healthplan. One participant supportedin developingand reportedthat shewas having healthproblemsand was seeingher doctor regularly. Shewas admittedto the hospitalin the late summerof 2006 and died while in the hospital. 100%of thoseparticipantswho requireongoing will be supported developand to medicalservices plan. maintain a health

Progress:

Next Operating Year's Objective:

Objective:

'

staff 75o/"of the participantswill meet quarterly with support services property managementstaff. and

progress:

75% (3 of 4) of participants met with support servicesand property managementstaff during the year. Two meetingswere held for the participants where supportive servicesstaff, property managementstaff, and owner were Present. 75o/o the participants will meet quarterly with of support servicesstaff and property management staff.

Next Operating Year's Objective: