/

and Urban Development Offi ce of Communi ry p laruring and Development

U. S.Department Housing of

OMB Approval 2506_0145 No. (exp. t1/30/2009)

Annual progressReport (ApR)

for SupportiveHousingprogram Shelterplus Care and Section ModerateRehabilitation 8 for SingleRoom Occupancy Dwellings(SRO)program

HUD-40118

including the time for reviewing instructions' to public reporting burden for this collectionofinformation is estimated average33 hoursper response' agencymay gatheringand maintainingthe data needed,and completingand reviewingthe collectionofinformation This existing data sources, searching to, a collection ofinformation unlessthat collectiondisplaysa valid oMB controlnumber' and a personis not requiredto respond rlot conduct or sDonsor,

General Instructions Report (APR) is a reportingtool that HLID usesto track programprogressand Purpose. The Armual Progress funding. and inform the Department's competitive process for homelessassistance accomplishments grants must submit 2 APR'S to HUD within 90 davs after assistance Filing Requirements. Recipientsof HUD's homeless the end of each operating year. One copy of the report must be submrttedto the Community Planning and Development (CPD) Division Director in the local HUD Field Office responsible for managingthe grant. The other copy must be submrtted Atfn: APR Data Editor, Room'1262,451 7' Street, to HLID Headquarters, Departmentof Housing and Urban Development, SW, Washington, DC. 20410. Failure to submit an APR will delay receiving grant funds and may result in a determinationof lack of capacity for future funding. An APR must be submrftedfor each opelatilg year in which HUD 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 operatingyear and every year throughout the 20 years. A separatereport must be submitted for each HIID grant received. For ShelterPlus Care (S+C), a separateAPR must be submrttedfor each S+C component. (see Extension below). report covering that period must be subrrLitted For those granteesreceiving an extension,a separate Recordkeeping. Granteesmust collect and mailrtain information on eachparlicipant in order to complete an APR. Optional worksheetsare attached. The worksheetsmay be used to record information manually or to desigr a cornputerizedsystemto store and tabulate the information. The worksheetsshould not be submittedto HUD with the APR. Organization of the Report. The APR is organized in the following manner: in personsto self-suff,rciency, the Part I: Project Progress.This portion of the report describes progress moving homeless documenting servicesreceived, listing project goals, and accountingfor bedsiunits. by receivingfunding underSHP, S+C, Part II: Financial Information. This portion of the report is completed all grantees and SRO. Final Assembly of Report. After the entire report is assembled,number every page sequentialiy. Mark any questionsthat do for not apply to your programwith "N/A" for not applicable. (SeeSpecialInstructions SSO Projectsbelow.) fype is definedbelow. Note that a client's client&ousehold Definitions of Client/Ilousehold Types. Each client/household tlpe should be based on the client's age and/or householdcomposition at theprogram entty date closest to tlte start of tlte operating year. at composedof two or more relatedpersons, leastone of who is a child accompanied Families - A family is a household by an adult or ajuvenile parent. womennot accompanied other not by by Singlesnot in Families - Persons accompanied children,includingpregnant children and unaccompaniedyouth, are singles not in families. When two adults or two unaccompaniedyouth present eachpersonshouldbe countedin singlesnot in families.. Clients' householdstatusshouldbe togetherfor services, determinedbasedon their household composition at the program entry date closestto the start of the operating year. This meansthat pregnantwomen expectedto give birth during their program stay should still be counted as singlesnot in famrlies, Adults in Families - Within a family, an adult is any person I 8 years of age or oider, For the purposesof 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 closestto the start ofthe operating year. Children in Families - Children in Families are defined as children under the age of i8 accompaniedby one or more adults (parent, relative or guardian). Children in famrlies also include both a juvenile parent and the parent's child(ren). For the purposesof APR reporting, the determinafion of whether a personis a child in family should be made basedon their age and householdcomposition at the program entry date closestto the stafi of the operating year. For example, 2 HUD-40118

(if they entereddurrng clients s,ho are less than 18 years of age on the first day of the operatingyear or at program entry year. during the courseofthe operating rhe uP! r 4r r r r E vear) shouldbe countedas children evenifthey turn 18 nnerzrinoJ u g r / t lr w in Personsin Families - Persons families includesadultsin famrliesand children in families.

tems are applieddifferently Other Key Definitions. The following terms are usedin the APR. As indicated,in somecases, dependingon whetherthe funding is from SHP, S+C, or SRO. personas "an unaccomparued homeless person - HIID definesa chrorucaily homeless individual .Chronicatly homeless with a disabling condition who has either been continuously homelessfor a year or more OR has had at leastfour (4) episodes homelessness the past three (3) years." To be considered in chronicallyhomeless, personmusthavebeen on of a the streetsor in an emergencyshelter (i.e., not in transitional housing) duriag thesestays. personis basedon the following components: HUD's defirutionof a ciuonically homeless o Unaccompaniedhomelessindividual: an unaccompanied homelessindividual has the samecharacteristics of a Singlenot in a Family (described above). c Disabling condition: see the instructions underdisablingcondition (below) to determine whethera client is disabled. Did not leave the program - This term refers to clients who were in the program on the last day of the operatingyear. Disabling condition - HUD definesa disablingconditionas:(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-continuedand indefiaite duration, (b) substantiallyimpedes an individual's ability to live independentiy,and (c) of such a nafure that such ability could be improved by more suitable housing conditions; (3) a developmentaldisability as defined in section 102 of the DevelopmentalDisabilities Assistance and Biil of Rights Act; (4) the diseaseof acquired immunodeficiencysymdromeor any conditions arising from the etiological agencyfor acquiredimmunodeftciency s;mdrome;or (5) a diagnosable substance abusedisorder. Eniered the pr+gram - Entered the program refers to the first day a client receives services. For a residentialprograrrl this date would representthe fust day of residencein the program's housing. For services,ttris daie niay-representthe day of program enrollment, the day a service was provided, or the first date of a period of continuousparticipation in a service (e.g.,daily, weekly, or monthly). For S+C and SRO programs,the program entry date is the date that the participant starts to receive rental assistance.For for S+C, servicesprovided prior to this point are recognized as necessary outreach/enroilmentand are eligible to count as match. An Extension APR applies to SHP and S+C granteesthat requestedand received an extensionof their grant term fiom the HUD field office. The only difference between an APR for the extensionperiod and the regular APR (besidesthe amount of time covered) is the signature page. Granteesshould circle "yes" to indicate the APR is for an extension period and circle the operating year for which the report is an extension.For example, if the granteeis extendingyear 3, the granteeshould submit an APR as usual for year 3 and submit another APR for the extensionperiod, indicating the secondis an extensionand also circling year 3 on the signahre page. Grantee means a direct recipient of the IILD award. program,this date Left the program - Left the program refersto the last day a client receivesservices.For a residential the would represent last day of residencein the program'shousing. For services, exit datemay represent last day the the service. If a client leavesthe programtemporarily(e.g., a servicewas provided or the last date of a period of continuous for a hospitalization)but is expected to return within 30 days, do not count that client as havhg left the program. For S+C programs, the program exit date refers to the datethe participant stops receiving rental assistance and is not expectedto return to S+C assistedhousing. If the participant returns to S+C assistedhousmg within 90 days,the person should not be consideredas exiting from the program. If the person returns to S+C assistedhousing after 90 days, that person is considereda new parficipant, The worksheetis designedto capturethis information.
HUD-40118

receivedby parlicipantsin the S+C project which, in the aggregate, Match for S+C is the value of supportiveservices provided over the life of the project. For SHP, match is cash nilst at leastequal the value of the S+C rental assistance and supportiveservices operations usedto provide the grantee'sportion ofacquisition,rehabilitation,new conshuction, expenses. activitiesfor acquisition, the Operating year - For SHP prograrns, frst operatilg year beginsafter development is and new conshuctionare complete,after a copy of the Certihcateof Occupancy sentto the iocal HUD rehabilitation, nffiee anrlrvhenft1efirst participantis accepted rehabiiitation,or new into the project. For projectswithout acquisition, HMIS projects. the the construction, operatingstart datebeginswhen the granteeaccepts fust participant. For dedicated rlrenneratino lsgits when any eligible cost includedin the approvedprojectbudgetis incurred. For S+C (SRA, 'aa1 PRA and TRA components),the frrst operating year begins on the date Hl,D signsthe grant agreement. For S+C/SRO (HAP) and for Sec. 8 SRO, the first operating year begins with the effective date of the Housing AssistancePa;.'rnents Contract. To determine which operatingyear to circle on the APR cover page,begin countingfrom the initial grant operatingstart 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 respectivelyon the APR cover sheetfor the initial grant and would circle 4 and 5 respectivelyfor the renewal grant. For any future renewal grants, the granteewould begin by circling 6 on the APR cover sheet. Participants - The terrn participant refers to Singlesnot in Families and Adults in Families as defmed above. Participant who live with the adultsassisted. doesnot include children or caregivers Project Sponsor meansthe organizationresponsiblefor carrying out the daily operationof the project, if the organization is an entify other than the grantee.

SSOgrantees shouldcompleteall questions, Special Instructions for Supportive Service Onlv (SSO) Programs. unless a written agreementhas been reachedwith the field offrce conceming which questionscan be answeredusing estimates, or in rare instances,skipped. SSOprojeci: Below is an exampleof how information could be deriveciin a iarge, singie-service staff member could be assignedto collect information from the organizationshousing the participants. The A grantee/sponsor person would contact these individual organizationsto request information regarding the personsin that facility that use staff the service.For parficipants living on the street,the grantee/projectsponsormay provide estimates. Information could be collected for each participant or for participants receiving servicesat a point-in-time. If estimatesor point-in-time counts are used, the method used must be described in the APR and the documentationkept on file. grants,grantees assistance operatingSSOprojectsare expected to As with all projectsfunded under HUD's homelessness complete all APR questionsthat are applicable to them. Note that all projects have been awardedfunds as a result of respondingto the program goals of assistinghomelesspersonsobtain/remain in pemanent housing and increasetheir skills and income. The APR documentstheir progressin meeting thesegoals. In some circumstancesfield offlrcesand granteesmay sign a written agreementconcerningquestionsthat can be answeredusing or skipped. Seethe specialinstructionsbelow for reporlingon specialtypesof projects,suchas estimates, in rare instances, outreachonlyprojects, projects providing servicesto chrldren only, and transportation,medical, dental, and other single, shorlduration service projects. SSO programs are a third priority for local HMIS implementation, following emergencyshelters,transitional housing programs, outreachprograms, and permanentsupportive housing programs. Once SSO programsare 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 to collect data to answer the APR questionsusiag the special iastructions provided above. and conaecfion housingand services to are Outreach Only Projects. Prolectswhich are solely devotedto streetoutreach not required to track participants beyond their contact with persons on the street. It is sufficient for theseprojects to enter 4 HUD- 40118

E sti matesforquesti ons5-9areal l ow ed' gi vent hat i n f or m at iononq u e s ti o n s l -1 0 (s k i p p i n g q u e s ti onsl l -13and17). questions' personal participantsmay be reluctantto answer providing basic that the granteeis serving the appropriate.numberof people, Answering the queshonswill demonstrate p.trots arebeing served, demonstratingthe tipes of demographic informatron for congress, demonstraiing that homeles they arereceiving' to, are housingparticipants corurected and the type of services betweengranteeand participantis often are Hotline projects. Hotline services similar to outreach only projects, but contact simultaneously. It is sufficient for theseproJectsto answer ofvery short iuration - people enter and leave the program nearly 4), questions (skipping 10,and 14-19(skippingl7)' 1-5 for Services To Children Only. Projectsthat provide child care,after schoolcare,counseling of homelessness,while the main focus of the project children, etc. make an important contribution toward moving a family out projects, is providing servicesto the children, it is the adults who are reported on in questions6-16 of the APR. Like all other and increasingthe families' incomes. Granteesmay skip ttris fype is also targetedtoward getting the families into housing shouldbe answered(except 17)' question9; all other questions projects providing provide a grantees Transportation, Medical, Dental, and Other Single, Short-Duration Service Projects. Some homelesspersonsto obtaitvremail in permanent single service of fairly short duration focused ONLY indirectly on assisting on questions1-10 and 14rro,iring and increasetheir skills and incomes. It is sufficient for theseprojects to enter information services,it is unreasonableto think that someonewould have 19 (question l7 maybe skipped). However, with transportation to give their age,race, and ethnicity to a bus driver to get a ride a few blocks. provides estimates For these services,provide a narrative, w'hich gives the number of rides.given during the operating year, and on the above statisticsbasedon the population that utilizes the service' serveddurmg the shouldreport on ali participants For Safe Haven (SH) Proiects. C-nantees Special Instructions where granteeswere instructed to report on the first 25 ,,g;. Note: tt"r " " rh""gr from prior instructions "p*"t-g parricipants served.

ucllons

nt In

Svstem

. HI"{IS grantees

should frll out the cover sheetof tn. epR, Part II Financial Information, and the HMIS Activities section.

HUD-40118

THIS PAGE - TO BE COMPLETED BY ALL GRAI"ITEES

Grantee:

Number: HllD Grantor Project

of Department HumanServices Cityand Countyof San Francisco,

Project Sponsor:

cAO1c401001
Name: Project

Housing Citizens
Operating Year: (Circle the operatingyear being reportedon)

Apartments Folsom/Dore
I lyear) ReportingPeriod:(monthday

n r X z n : n+ E s [o Jt !a n q Dto n r r [ r z ! r : !r+ n rs l to n tz l ts l ts lzo

Indicateif extension: E Yes X No Indicateif renewal: fl Yes X wo PreviousGrant Numbers for this proiect:

trom:6li lp/ co

ta:5131 d -t l$

Check the componentfor the program on which you are reporting. Supportive Housing Program (SHP) Shelter Plus Care (S+C)

Section 8 Moderate Rehabilitation I Single Room Occupancy (Sec,8 SRO)

n fl f ! fi

Transitional Housilg PermanentHousing for Homeless Personswith Disabilities Safe Haven Innovative Supporlive Housing Supportive Ser"'icesCnly

! ! [l I

Tenant-basedRental Assistance(TRA) (SRA) RentalAssistance Sponsor-based (PRA) RentalAssistance Project-based Single Room Occupancy (SRO)

fl

HMis

number and year) of served accomplishmentsoperating with this or of Summary theproject:(One twosentences a description population, housingto homeless year,this projectprovided to 8 unitsof permanent up familiesand 12 Duringthis operating families werefrom the streetsor emergency shelters and with specialneeds.All of the participant unis to individuals (ab)use, andlorHIV/AIDS. including mentalhealthissues,substance are livingwith disabilities;
Name & Tirle ofthe Personwho can answerquestionsabout this report: Phone: (include areacode)

Manager Shelter PlusCareProgram ShaneBalanon,

Address:

(415)558-1980
Fax Number: (include areacode)

Cityand Countyof San Francisco Dept.of HumanServices P.O.Box 7988 (415)558-2834 San FranciscoCA 9412A-7988 E-mail Address shane.balanon@sfqov.orq I hereby certify that all the information stated herein is true and accurate.
(18U.S,C. 1001, Convictionmayresultincriminalan&orcivilpenalties. Warning: HUDwillprosecutefalseclaimsandstatements.

I0 10,l0l2; 31 U.S.C3 ' 7 2 9 ,3 .

Name & Title of Authorized GranteeOfficial:

Man,ager PlusCareProgram Shelter ShaneBalanon,

Official: Sponsor Proiect NameandTitle of Authorized
Signature & Date

' -' --='-" --\:!y'

! ', / r ' +t? i i , i' c"

/

HUD-40118

(EXCEPT HMIS) BY PARTI. TOBE COMPLETED ALL GRANTEES

ON INSTRUCTIONS PAGE3 OF THEAPR SEESPECIAL PLEASE GRANTEES, SSO Part I: Project Progress
1. Projected Level of Personsto be served at a given point in time. (This informationcomesfrom the most recentCoC rcation.
Number of Not Singles in Families Numberof Adultsin Families Numberof Children in Families Number of Families

Proiected Level
a

at Persons be served a givenpointin time to

12

2.

PersonsServed during the operating year.

Number of SinglesNot in Families

Number of Adultsin Families

Number of Children in Families

I

Number of Families

Number on the first day of the operatingyear

D.

12

12
u

Number entering program during the operating year Number who left the program during the operating year

0 0 12

0 0
J

0 1
o

2 10

d.

Number in the program on the last day ofthe operating year (a +b -c):d

Explanatory notes: SeeDefinitions of Client/Household Types in the Generalinstructionsaboveto determine rvhich clientsshould be countedas SinglesNot in Families,Adults in Families,and Children in Families. Note that this table doesnot accountfor changes clien/householdtype that may in occur during the courseofthe operatingyear. Instead,eachclient shouldbe assigned singleclientftouseholdtype basedon the client's a age and/or household composition at the progranr entry date closest to the start of the operating year. In this way, each client is counted only once in the table. Use the following graphic and explanationsto determine who should be counted in rows a-d:

Client program llrsldayof in on year,leffduring the operaling year:count 2a and2c. in

Clienl in program on first day of operaiing year and lasl day ofoperaling year: count in 2a and 2d.

ir-+i
Client enlered and leff program before slad of do opera'ting^year nol counl in que$lon z. i I I i

Clienl entered lsi and program g operalin dufing year:counlin 2b and2c.

Client enteredprogram during operatingyear and still in program on lasl day of year count in 2b and 2d.

a i FiFt day ofihe operating year

Last day of the operating year

a.

year: Thisrow includes clients whoentered program Numberon the first day ofthe operating all the before firstdayofthe the year. yearanddid not leavetheprogram until afterthefirst dayofthe operating operating year: Thisrow includes clients all who entered program or afterthefirst Numberenteringthe programduring the operating the on year. For clientswith muitipleprogram year,up to andincludingthe lastday of the operating day of theoperating entrydates, the use year.Do not counttheclientmorethanonceevenif he/she entrydateclosest the startof the operating to entered progam morethan the year. oncedudngthe operating year: Thisrow includes clients wholeft theprogram or afterthefirstdayof the Numberwho left during the operating all on year, to andincluding lastdayofthe operating year.For clients up operating the with multipleprogram dates, theexit date exit use 7 HUD- 40r r 8

b.

c.

during ciosest the end ofthe operatingyear.Do not count the client more than once evenifhe/she exitedthe programmore than once to the operating,vear. d. Number in the program on the last day of the operating year: This row includesall clientsu'ho u'erein the programas of the first rtavnftlre onerarinsvear or who enteredduring the operatingyearand who did not leaveduring the operatingyear. The number of to basedon the responses rows 2a through 2c. For clientsor families in the program on the last day of the operatingyear is calculated eachcolumn, add the number of clientsor families in row 2a to the number of clientsor families in rou, 2b and subtractthe number of clientsor families in row 2c. Therefore.2d : 2a + 2b - 2c.

3.

Project Capacity.
Number ol S i ngJes ot i n N Fami l i es

Number of Adults in Families

Number of Children in Families

Number of Famiires

a.

Number on the last day ({iom 2d, columns I and 4) Number proposedin application(from 1a,columns 1 and 4) CapacityRate (divide a by b) = o1

tz tz

8
o 75%

b.
c.

100 %

ExplanrtoryNotes: to is Rowb refers themostrecent CoCapplication whichtheprogram reporting. for

4.

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

personswere housedby the SRO programduring the operatingyear? How many incorne-eligible non-homeless

5.

Age and Gender. Of thosewho entered the project dwing the operatingyear,how manypeople are in the following age and gender categories?
SinglePersons(from 2b, column 1
a

Male b. c. d.

Female

62 and over 51-61 31-50 18-30

l7 and under

(from 2b. columns & 3) Persons Families in 2

f. h.

62 and over

51 - 61 31 - 50

18-30
L3-T7 k.
m.
o- tz

Under1

Explanatory Notes: This questionrefersonly to Singlesnot in Familiesand Personsin Families ivho entered programduring the operatingyear. Only clients the who meet thesecriteria can be countedin this table. The total number ofclients reportedunder SinglePersons should be equalto the numberreportedin question2b, coluntr i. The total number ofciients reportedunderPersons Familiesshould be equalio the sum of in columns2 and 3 in question2b. Arswer questions 6 - 10 only for participants who entered the project during the operating year (from 2b, columris 1 &.2). The term participant means Singles not in Families and Adults rn Families. It does not include children or caregivers. NOTE: The total for questions, 7, 8 and 10 below should be the same; respond to each of those questions for ali participants. Some of the questions listed throughout the APR rviil be asking information for individuals u'ho are chronicallv homeless.

HUD-101 I8

6a. Veterans Status. A veteran is anyonewho has ever been on active military duty status were veterans? How many participants individual with a disablingcondition who has eitherbeencontinuously homeless 6b. Chronically homelessperson. An unaccompanied h ome lessfo r ay ear or m or eO Rhas hadat leas t f o u r ( 4 ) e p i s o d e s o f h o m e l e s s n e s s i n t h e p a s t t h r e e ( 3 ) y T a r s . c o n si d e r e d e obe shelter(i.e. not transitionalhousing)during or a chronicallyhomeless personmust have been on the streets in an emergency see these stays. For further discussionof the definition of chronic homelessness, Other Key Definitions under the GeneralInstructions above. were chronically homelessindividuals? How many participants

7.
a.

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

b.

ExplanatoryNotes: of in in The equal number participants Eachparticipant should listed only onecategory. totalnumber participants thistableshould be the of in question columns and2. 2b, 1

8.

Race. How manyparticipants in thefollowingracialcategories? are

American Indian/Alaskan Native Asian

b. d. f.
4

Black/African American
Native Hawaiian/Other Pacific Islander

h.
I

White Native& White American Indian/Alaskan Asian& Whrte Black/African & American White Native& Black/African American American Indian/Alaskan
Other Multi-Racial

Explanatory Notes: Each participant should be listed in only one category. A participant whose race doesnot correspondto categoriesa through i should be countedin j, Other Multi Racial. The total number of participantsin this table shouldequalthe numberof participants question2b, in categories generate APR response to columns I and 2. If using HMIS data,you may combine HMIS race response the categories.

9a. Special Needs. How many participants have the following? Participants may havemore than one. Ifso, count them in all applicablecategories.For eachcondition, alsoindicatethe number that were chronically homeless. All Chronic
a.

b.
s u.

Mentalillness Alcoholabuse Drugabuse diseases HIV/AIDS andrelated

Develoomental disabiliru Phvsicaldisabilitr Domesticviolence Other (olease soecifu)

f.
h

are 9b. How manyof theparticipants disabled? E Explanatory Notes: To determine whichparticipants HIID's dehnition "disabled," "Disabling of see meet Condition" under Other Key Definitions theGeneral in Inshuctions.
HUD-40118

the priorto entering project? (Foreach in slept pafirclpants in thefollowingplaces therveek 10. prior Lir,ingSituation.Hou,many 2b, in of the equal number panicipants questron should in of participant, chooieoneplace.Thetotalnumber participants the"All" column (Choose one) places. in thefollorving participanis slept homeless horvnany chronically columns and2). Also,indicate 1
All
a.

Chronic

b
c.

( e Non -ho us inqs r eet ,par k ,c ar ,bus s t at ion. t c . ) Emergencv shelter Transitionalhousins for homelesspersons Psychiatric facility* Substance abusetreatmentfacility* Hospital* Jaillorisont Domestic violence situation Livine with relatives/friends Rentalhousing Other (pleasespecify)

t
h.

k.

*lfa participant (psychiatric facility,substance abuse treatment facility,hospital, came orjail), butwasthere than fiom an institution less entering treatment the facility,he/she or shelter before should counted either 30 days waslivingon thestreet in emergency and be in the srreet shelter or categorv, appropriate. as

Completequestions11 - 15 for all participants who left during the operating year (from 2c, columns I and2). The tenl participantmeanssinglepersonsand adultsin families.It doesnot include childrenor caregivers.The term chronically individual with a disablingcondition who haseitherbeencontinuously homeless homelessperson meansan unaccompanied of in homeless a year or more OR has had at least four (4) episodes homelessness the past three(3) years.To be considered for or shelter(i.e. not transitionalhousing)during cbronicallyhomeless personmust havebeen on the streets in an emergency a thesestays.

participants left during operating who year, the 11. Amountand Source Monthly Incomeat Entry and at Exit. Of those of howmany source income?Also,please place monthlyincome participants at each levelandwith each of the were monthlyincome levelandeach column each homeless in of chart.Thenumber participants Chart andB of in source incc;r'le chrsnleally of fcr A Dersons thesecond should thesame, be Atl A. MonthlyIncome at Entrv
No income b.
c, a.

Chrunic

AII

Chronic

C. Income Sources Entry At (SSI) Supplemental Security Income

Social SecurityDisability Income (SSDI)

$1 150 s 151 $ 2 5 0 -

b.
c 1

Social Security General PublicAssistance

Temporary Aid to Needy Farnilies (TANF) StateChildren's Health Insurance Program(SCHIP) VeteransBenefits

d.
e.

s251- Ss00 ss0l- $1,000

$1001- 1 5 0 0 $

d.

f.
o

f
q

sl50l-$2000
$200i+

h.
I

Employrnent Income Benehts Unemployrnent

VeteransHealth Care Medicaid Food Stamps speciS) Other (please No Financial Resources

J
1,

t.
m. n,

10

HUD-101 l8

AI
B. Monthly Income at Exit No income b.

Chronic at Sources Exit D, Income

a.

AII

Chronic

$1 150 $151 5 2 5 0 $25r -$5 0 0 $501 $ r,0 0 0 1

U

b.
c.

(SSI) Income Security Supplemental (SSDI) Disability Income Security Social

Social Security

d.

d.

PublicAssistance General (TANF) Aid Families Temporary to Needy

Program(SCHIP) StateChildren'sHealth Insurance Veterans Benefits EmploymentIncome Benefits Unemplo;,rnent Veterans Health Care Medicaid

f.
g

h.

s1001$1500 s150i$2000 + $2001

f.
g

h.
I

J k. I
m.

FoodStamps
specify) Other (please

n.

No Financial Resources

Explanatory Notes: the Tatrle A: Monthly income at entry refersto the participant'smonthly incomeon the day he/sheentered program(i.e., on the program entry date or as closeas possibleto that day). You shouldnot report on incomereceivedbefore enteringthe programor incomereceived during the program stay. Table B: Monthly income at exit refersto the participant'smonthly incomeon the day he/sheleft the program(i.e., on the programexit date or as close as possibleto that day). You should not report on income receivedduring the program stay. ofincome on the day he/sheentered program(i.e., on the program the Table C: Income sourcesat entry refersto the participant'ssources ofincome receivedbefore enteringthe programor income entry date or as closeas possibleto that day). You should not report on sources received during the program stay. Participantswith no income at ihe iii-rieof piogian-i ei;try should be reported in categorv n. No Financial Resources. of Table D: Income sourcesat exit refersto the participant's sources income on the day he/sheleft the program(i.e., on the programexit date ofincome receivedduring the programstay, Participants with no or as close as possibleto that day). You should not report on sources n, income at the time of program exit shouldbe reported in category No FinancialResources.

12a. Of thoseparticipantswho !g[ during the operatingyear (from 2c, columns I and 2), how many were in the projectfor the following personswho lgft during the operating year in the second lenglhs of time? Also, pleaseplacethe length of stayfor chronically homeless column.

Atl
a

Chronic

Less than i month

I to 2 months 3 - 6 months
d. f.
g

7 months - 12 months

13months 24 months
25 mont hs - 3y ear s 4vea r s - 5v ear s

1 t.

6v ea rs -T v e a rs 8 vears l0 vears Over10vears

ExplanatoryNotes: program enfrydate program date.If theparticipant onlyone has participant's and exit each length stayusingtheparticipant's of Compute year,calcuiate lengthofstay by subtracting program the enlry datefromtheprogram date. Ifthe programexit dateduringthe operating exit year,calculate length the ofstayfor each program (by subfracting program dates stay participant muitiple exit duringtheoperating the has program stay)andaddthemtogether produce cumulative to a lengthof stay. Each progam entrydatefrom theprogram exit datefor each ll
18 HUD-401

shouid in of The category. totainumber participants thefirst column("A11") of with be should associated onlyonelength sray participant 1 and2' 2c, in of the equal number par-ticipantsquestion columns year I v,.ho participants did not leaveduringtheoperating (from2d,columns and2), how long 12b. Lengthof Stayin program. Forthose duringthe persons who did not leave homeless place length stayfor chronically of the in havetheybeen theproject?Also,please
n n e re ri n o ve a r in the seCOnd cOlUmn.

All b. d Lessthan I month I to 2 months

Chronic

3 - 6 months
7 months- i2 months l3 months - 24 months

1
4t I+

0
n

f.

25m o n th s -3 y e a rs
4yea rs - 5y ear s 6yea rs - Ty ear s 8 vears- l0 vears Over 10 vears

s.
h.

Explanatory Notes: Computeeachparticipant'slength ofstay usingthe participant'sprogram entry date and the last day ofthe operatingyear. To calculate length of stay, subtract the program entry date from the last day of the operating year. Each participant should be associatedwith only one length ofstay category. The total numberofparticipantsin the first column ("All") shouldequal the number ofparticipants in question2d, columns 1 and 2.

who !g( the project during the operatingyear (from 2c, columns 1 and 2), how many left 13. Reasonsfor Leaving. Of thoseparticipants for the following reasons? If a participant left for multiple reasons,ittclude onlv the pritnary reason. Tlte total number of participants in the first column ("A11")shouldequalthe number of participantsin question2c, columns I and 2. Also, pleaseplace the primary reasonfor chronically homelesspersonswho left the project during the operatingyear in the secondcolumn. All Lefi for a housing oppoituniiy"befo;e ccmpleting prcgram Chronic

b.
c. d.

Completed program Non-payment of rent/occupancycharge Non-compliance with proj ect

/ of activity destruction propefy/ violence Criminal

f.
g

Reachedmaximum time allowed in proiect

Needs couldnot be metby project with Disagreement rules/persons

Death

h.

J
1.

specify) Other(please 1) left independently

Unknown/disappeared 1

t2

HUD-40118

rvho left during the operatingyear (from 2c, columns 1 and 2), how many left for the following 14. Destination. Of thoseparticipants

year rvholeft duringthe operating in thesecond persons ofchronicallyhomeless place destination the Aiso,please destination? column. Chronic All (a-h) PERMANENT
b Rental houseor apartment(no subsidy)

PublicHousing 8 Section PlusCare Shelter

HOME subsidized houseor aDartment houseor apartment Other subsidized Homeownership

d.

Movedin with familyor friends (i-j) TRANSTTTONAL INSTITUTION(k-m)

I

persons Transitional housing homeless for

Moved in with family or friends Psychiatrichospital Inpatient alcohol or other drug treatment facility

J
t,

I EMERGENCYSHELTER(N) oTHER (o-q)

Y'

Jail/prison
n

Emergency shelter housing Othersupportive

Placesnot meant for humanhabitation(e.g. street) Other (pleasespecify)

q. I.INKNOWN
t

Unknorvn

ExplanatoryNotes: provided. response participant's uponleaving program the usingthecategories The categories Identifyeach destination combine publichousing, (e.g., permanent, etc.) "destination" (e.g,, or homeownership, and"tenure" transitional, etc.). rental house apartment, response, be sureto look at ali ofthe response and and the categories Consider before both destination tenureto determine mostappropriate category. cf resFonse The a makinga selection. tabiebeiowproviries brief descriptron each category eitherthefirst columnof thetableor in bothcolumns theparticipant in Enterthe numberof participants undereachdestination if is per for should recorded participant. totalnumber be The chronically homeless. onereason leaving Only ofparticipants thefirstcolumn in ("All") should 1 of in 2c, equal number participants question columns and2. the Tenure
Permanent Destination Rental house or aparfment (no subsidv) Description Participantis moving to an aparfmentor housewithout any subsidy, Participantis moving to a public housineunit wiil use a housing choicevoucher(formerlyknown as a Participant Section8 voucher)to rent a houseor aDartment. Participantis moving to a unit fundedby the ShelterPlus Care prosram(e.e.,TBA, SRA, PRA, Section8 SRO).

b
a

Publichousine 8 Section PlusCare Shelter house or HOME subsidized aDartment Othersubsidized houseor apafiment

d.

is Participant movingto a unit with rental provided the assistance by (tenant-basedproiect-based HOMEprogram or assisfance).
Participant is moving to a unit subsidizedby some program other than public housing,housing choicevoucherprogram(formerly Section8), ShelterPlus Care.or HOME.

f.

Homeownershio
h

Participant movineto a unit thathe/she purchased, is has

Participant is moving in with family or friends and expectsto live there for 90 days or more.

Movedin with family or friends housing homeless for Transitional people Movedin with familyor friends
Psychiatrichospital

Transitional

l.

is Participant movingintoa unit funded a transitional by housing progamfor homeless people (e.g., transitional housing funded through theSupportive Housing Proeram).
Participant is moving in with family or friends and expectsto live there lessthan 90 davs. Participantis moving to a psychiatrichospital.

J.
Institution
t.

1a 1J

HUD4OI r8

Tenure

Destination

Emergency Shelter Other

m n.
o

or alcohol otherdrug Inpatient faciiitY treatment Jail/Prison

shelter Emergency housing Other supportive

facility. or alcohol drugtreatment to earti.lp*-i, moving an inpatient

P arfi ni nenf i c mnvi nq to a i ai l or ori son

pEUPTE snellerror nolrrsrcss Participantls movlng to an emergency

not that housing does correspond intosupportive P"rt"tp^"t " -.ving (a-h) categories andis not transitional housing to anyofthe pernanent (i), 81 people such Section I housing.* as for housinq homeless
latti.ipant is moving to a place not meant for human habitation,such building' as a car, park, sidewalk,or abandoned to Participantis moving to aplace that doesnot correspond any ofthe (a-P). above catesories

p. q.
Unknou.n

not Places meantfor human habitation

specify) (please Other Unknown

where about ifyou areunsure be should used category Thisresponse and has is theparticipant movingor if theparticipant disappeared there is. he/she is no wavto find outwhere

*H{JD encouragesprograms to lintit the use of the "Other Supportive Housittg" APR responsecategory. Progratns should report (i) respectit'ely. destinations toiourr,r[ ilrot are permanetlt or transitional in APR categories (a) through (h) or in categories tlrough O, Exits to entergencyshelters should be reported in category fu)'

who lgft during the operatingyear (from 2, columns 1 and 2), how many receivedthe 15. Supportive Services. Of thoseparticipants receivedfor chronically during their time in the project? Also, pleaseplacethe supportiveservices foliowing supportiveservices and all may have receivedmultiple services homelessparticipantswho Ieft during the operatingyear in the secondcolumn. Participants shouldbe reportedin the table. services All
A

Chronic

Outreach
Casemanagement Life skills (outsideof casemanagement)

services Alcoholor drugabuse

iviental heaith ser,'ices
a I

services HIV/AIDS-related
Other health careservices Education

h.

placement Housing
J
tK.

Employment assistance

Childcare
Transportation Legal

l.
m.

specify) Other(please

l4

HUD-401l8

year Technical objectives thisoperating (fromyourapplication, for list Goals. Underobjectives, yourmeasurable 16. OverallProeram yourprogress meeting objectives. the describe in below. UnderProgress, goaislisted ofthe three Submission, APR)for each or year. for objectives thenextoperating speciffthemeasurable Year'sObjectives, UnderNextOperating a. ResidentialStability Objectives: Please see attached.

Progress:

NextOperating Year'sObjectives:

b.

IncreasedSkills or Income

Please see attached. Objectives:

Progress:

NextOperating Year'sObjectives:

Greater Self-determination

Please see attached. Objectives:

Progress:

NextOperating Year'sObjectives:

17. Beds. SHP recipients answer S+C 17a. recipients answer SRO 17b. recipients answer (SHP-SSO 17c. projects do not completethis question)
a. SHP. How manybedswereincludedin theapplication approved l/ls projectunder'CunentLevel' andunder'New Effort'? for How manyof these New Effort bedswereactually placeat the endof the operating in year?

CurrentLevel New Effort NewEffortin Place Number Beds: of b. S+C. Howmanybeds dwellingunitswere and beingassisted project with fundsat theendof the operating year? (Include bedsfor all participants, otherfamilymembers, caregivers.) and Number Beds: of 18 Number DwellingUnits: 18 of c. SRO. How manydwellingunitswerebeingassisted the endof the operating at year? (Include unitsoccupied "in place"non-homeless by persons qualifyfor assistance.) who Number DwellineUnits: of

15

HUD-401l8

PRA 2OO4 c A 01c 4 0 1 0 0 1 Reporting Period: 6ll106- 5l3ll07 Residential Stab iliUt ; 70"/oof tetants will remain in S+C housing for at least one year. Objectives: Progress: Exceeded/. 78% oftenantsremainedin S+C housingfor at leastone year. Next OperatingYear's Objectives: 70o/. of tenantswill remain in S+C housing for at least one year. who havenot paid rent on time or who havebeen formally notified 100o/o tenants of regardingany other leaseviolation wili be offeredsupportiveservices. Progress: Achieved. 100% of tenantswho have not paid rent on time or who have been formally notified regardingany other leaseviolation were offered supportiveservices. 100% of tenantswho have not paid rent on time or who have Next OperatingYear's Objectives: been formally notified regarding any other lease violation will be offered supportiveservices. Objectives: 85%o crisesthat would have resultedin hospitalization of and,ior eviction will be resolved without the utilization of involuntary servicesor loss of housing for tenants. Achieved.85% of crisesthat wouid have resultedin hospitalization Progress: and,/or eviction were resolved without the utilization of involuntary servicesor loss of housing for tenants. Next OperatingYear's Objective: 850/o crisesthat would haveresultedin hospitalization of and/or eviction will be resolved without the utilization of involuntary services for or loss of housi-ne tenants. Objectives: Increased Skills or Income: 809/c tenantswithout any income will establishincome fiom employment and/or public of assistance which they are eligible during their lust year of residency. for Progress: Not Achieved. 70%. of tenants without any income will establish income from employment and/or public assistancefor which they are eligible during their first year of residency. Next OperatingYear's Objective: 80o% tenantswithout any income will establish of income from employrnent and/or public assistancefor which therr at. eligible during their frrst year ofresidency. Objectives: 50o/o tenantswill participate in organized educationaland/or skill-building activities. of Not achieved. 29% of tenants will participate in organized educational and/or skillbuilding activities, of Next OperatingYear's Objectives: 50olo tenantswill participatein organized educational and/or skill-buildins activities. Objectives: Progress: Gr eater Self D eter m in atio n : will be successful obtainingor maintainingemployment. in Objectives: 15% of tenants Progress: Achieved.15olo tenants were successful obtainingor maintainingemplo;,ment. of in Next OperatingYear's Objectives: At least35% wlll participatein tenantmeerings. Objectives: 70%o tenantswill develop an individualizedserviceplan, which establishes of goals and objectives and identifies activifies leading to their accomplishrnent,within ther fust 90 days ofresidency, Exceeded.89% of tenantsdeveloped an rndividualizedserviceplan, which establishes goals and objectives and identifies activities leading to ther accomplishment,within their first 90 davsofresidencv.

Progress:

Next Operating Year'sObjective: 70% of tenantswill developan individualizedserviceplan, which establishes goalsandobjectives identifiesactivitiesleadingto their and accomplishment, within their fust 90 daysof residency. Objectives: 35Yo tenants participate resident of will in meetings druingthe operating year. Progress: Exceeded.58% tenants participated resident of in meetings dwing the operating year. Next Operating Year'sObjective: 35%o tenants participate resident of will in meetings duringthe year. operaung

Information Part II: Financial

Services. 18. Supportive was (SHP), exhibitprovides for services spent during to information HtlD on how SHPfunding supportive this For Supportive Housing "Other". Include HMIS costs under supportive services. year. Entertheamount SHPfundingspent these on of the operating the fromall match requirement. Specify valueofsupportive services the services this For Shelter PlusCare(S+C), exhibittracks supportive year, (S+Cgrantees persons duringthe operating should keep thatall homeless received that as sources canbe counted match services.) source, and amount, typeofsupportive documentation file, including on of received homeless persons provides services by information HUD on thevalue supportive to duringthe ForSection SRO,this exhibit 8 year. operating

Supporfive Services Outreach b.

Case manasement

Dollars

management) Life skiils (outsideof case

d. Alcohol and drug abuseservrces Mental health services f.
g

$ 16,812 $ 66,674

AlDS-related services Other health care services Education Housing placement

h.

J
t.

Employment assistance Child care

Transportation

Legal

n.

Other(please specify) n) TOTAL (Sumof a through

$ 83,486 $ 83,486

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

t6

HUD-401l8

19. Supportive Housing Program: Leasing, Supportive Services,Operating Costs,HMIS Activities and Administration year. expansion For operating these charts each mustcomplete Program Housing under Suppofiive the receiving funding A1lgrantees for and homeless facility,onlythepeople expenditures theadditional a pre-existing of projects: if SHPgrantfunds for theexpansion are to Documentation resources is notrequired be of used or as application anygrantamendments. expansion beincluded, in theoriginal may by any made with thisreport should kepton file for possible be inspection HtD andAuditors.Do not include expenditures submitted but wasexecuted. before SHPsrant the
during the operatingyear for eachactivity Summaryof Expenditures. Enter the amountof SHP grant funds and cashmatch expended This tableshould up bothhorizontallv and verticallv. The SHP supDortive add services total shouldbe the sameas the SHP supportive servicesin CashMatch Total Expenditures

Services Supportrve OperatingCosts HMIS Activities

Note: Pa).rnents principalandinterest any loanor mortgage not be showr asan operating may expense. of on Sources of Cash Match. Enter the sources cashidentified in the CashMatch column, above,in the following categories.Use additional of sheets,as necessary.

Amount
Grantee/projectsponsor cash

b.

Local govemment(pleasespecify)

State government (pleasespecify)

.l

Federalgovemment(pleasespecify) Community Development Block Grant (CDBG)

(please Foundations specifu)

f.

(pleasespecify) Privatecashresources

Occupancy charge/ fees

Total

17

HUD-401 I8

20.Supportivel{ousingPrograrn:Acquisition,Rehabilitation,andl{ewConstruetion

funds SHP received f,o-lTouisitton'*h?bl1Lt1i:l:.Tff:':::::ci:::.Tni::il*"i:jffi?:iffi'Jil:fiL?t'#tl that grantees Ar1 tobe isnot provided requlredsubmitted ;"*-***1"**::**:i: *"0' were :l;.ffift;ffi' #:"i1fi?;#1.ffiffiilffi: ll1'"; HLID*d At possibl.iltp."tion by
for with this repoft but shouldbe keP! q fi1e
during the operatingyear for eachactivtty' grant funds and cashmatch expended summary of Expenditures. Enter the amountof SHp SHP Funds Total Expenditures

lii,*ffi1:T.TiTTii;:,:*:#:t?til1HH;""'F;;l"yl'::*:::*::*:';:::'*:1,T#?:

New construction

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

Amount
Grantee/project sPonsorcash

specify) (please iocal government

State government (pleasespecify)

d.

Federal government (pleasespecify)

CommunttybtelopmentBlock Grant(CDBG)

sPecifY) Foundations(Please

t.

specify) (please cashresources Private

OccupancYcharge/fees h. Total

18

HUD-40118

FOR HMTSACTIWTIES ONLY

21. For SupporliveHousins (SHP) - HMIS Activities was spentduring the operating year. Enter This exhibit providesinformation to HLID on how SHP-HMIS funding for suppofiiveservices the amountof SHP-HMIS funding spenton theseactivities.

CentralServer(s) PersonalComputers and Printers

Software/ User Licensing Software Installation Support and Maintenance Supporting Software Toois

Trainine bv Third Parties Hostins/ Technical Servtces Programming: Customization m Interface Programming: Data Conversion Secwity Assessmentand SetuP Online Corurectivity (Internet Access Facilitation Disaster and Recovery
." 't. . i

Project Management / Coordination

TechnicalAssistanceand Training Administrative Support Staff

...
OperationalCosts

t9

HUD-40118