/

OMB Approval 2506-0145 No. (exp.1t/30/2009)

U. S. Department of Housing and Urban Developnient Office of CommuniryPlaruring

en ,'l T- ) pr r pln^- ^- t v I lulJ ar r ullr

Annual Progress Report (APR)

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

HUD-401 18

includiltg the time for reviewir,ginstructions, to Public reporting bur6en for this collection ofinformation is estimate<i average33 hours per response, gatheringand maintaining the data needed,and completingand reviervingthe collectionof information. This agencymay searchingexisting data sources, nor conduct or sponsor, and a personis not required to respondto, a collection ofinformation unlessthat collectiondisplaysa valid OMB controi number.

General Instructions Purpose. The Annual Progress Report (APR) is a reporting tool that HUD usesto track progran progressand assistance funding. accomplishments inform the Deparfment'scompetitiveprocessfor homeless and assistance Filing Requirements. Recipientsof HIID's homeless srants must submit 2 A.PR'S to HUD within 90 davs aller to the end of each operating year. One copy of the report must be subnufted the CommunityPlanningand Development for (CPD) Division Director in the local HUD Field Office responsible managingthe grant. The other copy must be submitted to HUD Headquarters, Deparlmentof Housing and Urban Development,Attn: APR Data Editor, Room 7262, 451 7il' Sueet, SW, Washington, DC. 20410. Failure to submit an APR will delay receivinggrant funds andmay resultin a determination of lack of capacity for future funding. An APR must be submrtted for each operating year in which HUD funding is provided. Granteesthat received SHP funding for new constmction, 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. APR must be A separatereport must be submitted for each HUD grant received. For ShelterPlus Care (S+C), a separate submitted for eachS+C component. report covering that period must be submitted(seeExtension below). For thosegrantees receivingan extension,a separate must collect and maintaininformation on eachparticipantin orderto completean APR. Optional Recordkeeping. Grantees worksheetsare attached. The worksheetsmay be used to record information manually or to design a computerizedsystemto store and tabulatethe information. The worksheetsshould not be submitted to HLrD with the APR. Organization of the Report. The APR is organized in the following rutnner: persons self-sufficiency, in to the Part I: Project Progress.This portion of the report describes progress moving homeless documenting servicesreceived, listing project goals, and accounting for beds/units. receivingfundingunderSHP, S+C, Part II: Financial trnformation. This portion of the report is completedby all grantees and SR.O. number everypage sequentially.Mark any questions that do Final Assembly of Report. After the entirereport is assembled, not apply to your programwith "N/A" for not applicable. (See SpeciaiInstructionsfor SSOProjectsbelow.) fype is definedbelow. Note that a client's client/household Definitions of Client/I{ousehold Types. Each client/household type should be basedon the client's age and/or household composition at the program enty date closestto the start ofthe operating year. at of Families - A family is a househoidcomposed two or more relatedpersons, leastone of who is a child accompanied by an adult or ajuvenile parent. by by not accompanied children, includingpregnantwomennot accompanied other Singlesnot in Families - Persons children and unaccompaniedyouth, are singlesnot in families. When two adults or two unaccompaniedyouth present Clients'householdstafusshouldbe togetherforservices,eachpersonshouldbecountedinsinglesnotinfamilies.. detemined basedon their household composition at the program entry date closestto the start of the operatingyear. This means that pregnantwomen expectedto give birth during their program stay should still be counted as singlesnot in families. of Adults in Families - Within a family, an adult is any person 18 yearsof age or older. For the purposes APR reporting, the deterririnationof whether a person is an adult in family should be madebased on their age and householdcomposition at the program entr,vdate closest to the start of the operating year. by Children in Families - Children in Familiesare defined as chiidrenunderthe ageof 18 accompanied one or more adults (parent,relative or guardian). Children in famrliesalso includeboth a juvenile parentand the parent'schild(ren). of of For the purposes APR reporting,the determination whethera personis a child in family shouldbe madebasedon their ageand householdcompositionat the program entry dateclosestto the start of the operatingyear, For example, 2 HUD- 10116

clients who are less than 18 years of age on the fust day of the operatingyear or at program entry (if they enteredduring year. rhe nnerarino vear) shouldbe counted as children evenifthey tum 18 during the courseofthe operating Persons in Families - Personsin families includesadultsin familiesand children in families.

terns are applieddifferently Other Key Definitions. The following terms are used in the APR. As indicated,in somecases, dependingon whetherthe funding is from SHP, S+C, or SRO. personas "an unaccompanied homeless individual Chronically homelessperson * HIID definesa chronicallyhomeiess r,vitha disabling condition who has either been continuously homeiessfor a year or more OR hashad at leastfour (4) chronicallyhomeless, personmusthavebeen on a in episodes homelessness the past three (3) years." To be considered of (i.e., not in transitional housing) during these stays. the streetsor in an emergencyshelter HUD's definition of a chronically homelesspersonis basedon the foiiowing components: r homeless individual hasthe samecharacteristics Unaccompanied homelessindividual: an unaccompanied (describedabove). of a Single not in a Family r Disabling condition: see the instructions under disabling condition (below) to determinewhethera client is disabled. Did not leave the program - This term refers to clients who were il the program on the last day of the operatingyear. Disabting condition - HLID definesa disablingcondition as:(1) A disabiiity as definedin Section223 of the Sociai Security Act; (2) a physical, mental, or emotional impairrnent which is (a) expectedto be of long-continuedand indefinite dgration, (b) substantially impedes an individual's ability to live independently,and (c) of such a nafure that suchability could be improved by more suitable housing conditions; (3) a developmentaldisability as defined in section 102 of the Developmental Disabilities Assistance and Bill of Rights Act; (4) the diseaseof acquired immunodeficiencysl,ndromeor any conditions arising &om the etiological agency for acquired immunodeficiency slmdrome;or (5) a diagnosable abusedisorder. substance progranr, Entered the program - Enteredthe program refersto the first day a ciient receivesservices.For a residential this date would representthe fust day of residence in the program's housing. For services,this datemay representthe day of program enrollment, the day a service was provided, or the frst date of a period of continuousparticipation in a service (e.g., dai1y,weekly, or monthly). For S+C and SRO programs, the program entry date is the date that the participant startsto receive rental assistance.For for S+C, servicesprovided prior to this point are recognized as necessary outreach/enrollmentand are eligible to count as match. An Extension APR applies to SHP and S+C granteesthat requestedand received an extensionof their grantterm from the HIID field office. The only difference befween 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 nerinrl qnd cirele the operating year for which the repofi is an extension.For example, ifthe granteeis extendingyear 3, rvu Pv r the granteeshould submit an APR as usual for year 3 and submit anotherAPR for the extensionperiod, indicating the page. secondis an extensionand also crrcling year 3 on the signature Grantee meansa direct recipient of the HIID award. program,this date Left the program - Left the program refers to the last day a client receivesservices.For a residential the the the would represent last day of residencein the program's housing. For services, exit datemay represent last day service. If a client leavesthe programtemporarily(e.g., a servicewas provided or the last date of a period of continuous but is expectedto return within 30 days,do noi count that client as having left the program. for a hospitalization) and For S+C nrosrams,the program exit date refers to the datethe participantstopsreceivingrental assistance is not housingwithin 90 days,the person housing. If the parlicipantreturnsto S+C assisted exnecredro rehrrnto S+C assisted housingafter90 days,that as should not be considered exiting from the program. If the personreturnsto S+C assisted person is considereda new participant. The worksheet is designedto capturetlris information.
H U D - 4 0 18 i

in receivedby parricipants the S+C project which, in the aggregate, N{atch for S+C is the value ofsupportive services provided over the life of the project. For SHP,matchis cash must at leastequalthe value of the S+C rental assistance new construction, operations and supportiveservices rehabilitation, porlion of acquisition, usedto provide the grantee's expenses. activitiesfor acquisition, Operating year - For SHP programs,the first operatingyear beginsafter development is copy of the Certificateof Occupancy sentto the local HUD after a and new constructionare complete, rehabilitation, nffiee nnd when ffuefirst participantis accepted rehabilitation, new or into the project. For projectswithout acquisition, cnnqmirtinn the epslafingstart datebeginswhen the granteeaccepts first participant. For dedicated HMIS projects, the rhe nnerrrin' J v q lsgins when any eligible cost included in the approvedproject budgetis incurred. For S+C (SRA, r uu uPlr or ur 6 -,e"1 For S+C/SRO the PRA and TRA components), first operatingyearbeginson the dateHUD signsthe grant agreement. (HAP) and for Sec. 8 SRO, the frrst operating year begins rvith the effective date of the Housing AssistancePa).irnents Contract. To determinewhich operating year to circie on the APR cover page, begin counting from the initial grant operating start date and include renervalgrants. For example, a project receiving an initial grant for three years and a renewal grant fbr two years would circle years 1, 2, and 3 respectivelyon the APR cover sheetfor the rnitial grant and wouid circle 4 and -5 respectiveiy for the renewal grant. For any future renewal grants,the granteewould begrr by circling 6 on the APR cover sheet. Participants - The term participantrefersto Singlesnot in Familiesand Adults in Familiesas definedabove. Participant does not include children or caregivers who live with the adults assisted. Project Sponsor meansthe organization responsiblefor carry.ingout the daiiy operation of the project, if the organization is an entity other than the grantee.

SSO grantees shouldcompleteall questions, Special Instructions for Supportive Service Onlv (SSO) Proqrams. unless a written agreementhas been reached w.iththe field office concerning which questionscan be answeredusing estimates, or in rare instances, skipped. Below is an exampleof how information could be derivedin a large, single-service SSO project: A grantee/sponsor staff member could be assignedto collect information from the organizationshousing the participants. The staff person would contact theseindividual organizationsto request information regarding the personsin that facility that use the service. For participants living on the street,the grantee/projectsponsormay provide estimates. Information could be collected for each participant or for participants receiving servicesat a point-ln-time. If estimatesor point-in-time counts are used, the method used must be described in the APR and the documentationkept on file. As with all projectsfundedunder HUD's homelessness ur.irturr.e grants,grantees operatingSSOprojectsare expected to complete all APR questionsthat are applicable to them. Note that all projects have been awardedfunds as a result of personsobtain/remain permanent respondingto the program goalsof assistinghomeless in housingand increase their skilis and income. The APR documentstheir progress in meeting these goals. In sorne circumstancesfield offices and granteesmay sign a written agreementconceming questionsthat can be answereduiing estimates, in rare instances, or skipped. Seethe specialinsffuctionsbelow for reportingon specialtypesof projects,suchas medical,dental,and other single,shortto ouh'each only projects,projectsproviding services children only, and transportation, duration serviceprojects. SSO programs are a third priority for local HMIS implementation, foilowing emergencyshelters,transitional housing programs, outreach prograills, and permanentsupporlive housing programs. Once SSO progran$ are included in the HMIS, SSO grantees will be abie to answerall APR questions using their HMIS ciata. SSO grantees that are not yet parlicipatingin HMIS will need provided above. to coilect datato answerthe APR questions the specialinstructions using Outreach Only Projects. Projectswhich are solely devotedto sheetoutreachand connection housingand serv'ices to are not lequired to lrack participants beyond their contactwith personson the street. It is sufficientfor theseprojectsto enter
HUD-40118

giventhat for questions 5-9 are a1lowed, information on questionsi-10 (skipping questions11-13 and 17). Estimates participantsmay be reluctantto answerpersonalquestions. Answering the questionswill demonstratethat the grantee is serving the appropriate number of peopie, providing basic demographic information for Congress,demonstrating that homelesspersonsare being served,demonshatingthe Qpes of housingparticipantsare connected and the lype ofservices they are receiving. to, Hotline Frojects. llotline servicesare similar to outreach only projects, but contactbetweengranteeandparlicipantis often ofvery shoft duration - people enter and leave the program nearly simultaneously. It is sufhcient for theseprojects to answer questions1-5 (skipping4), 10, and 14-19 (skipping 17). Projects Providing Services To Children Only. Projectsthat provide child care,after school care,counseling for children, etc. make an important contribution toward moving a family out of homelessness.While the main focus of the project is providing servicesto the children, it is the adults who are reported on in questions6- 16 of the APR. Like all other proj ects, this fype is also targeted toward getting the families into housing and increasingthe families' incomes. Granteesmay skip question9; all other questions should be answered(except 17). Transportation, Medical, Dental, and Other Single, Short-Duration Service Projects. Somegrantees provide a single service of fairly short duration focused ONLY indirectly on assistinghomelesspersonsto obtain/remainin permanent housing and increasetheir skills and incomes. It is sufficient for theseprojects to enter information on questions1-10 and 1419 (queshon 17 trraybe skipped). However, with transportation services,it is unreasonableto think that someonewould have to give their age,race, and ethnicity to a bus driver to get a ride a few blocks. Fol these sewices, provide a narrative, which gives the number of rides given during the operating year, and provides estimates on the above statisticsbased on the population that utilizes the service. Snecial Instructions For Safe Haven (SH) Proiects. Granteesshouldreport on all participantsservedduring the operating year. Note: this is a change flom prior instructions where granteeswere inshricted to report on the first 25 parlicipants served.

Special Instructions for HomelessManagement Information Svstem (HMIS) Proiects. HMISgrantees

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

HUD-10118

THISPAGE. TO BE COMPLETEDBY ALL GRANTEES

Grantee:

Number: HUD Grantor Project

Cityand Countyof San Francisco Department HumanServices, of

Prniect Snnncnr'

8501030 cAo1
Drnion+ Iu Je vr \l o m a . l r q r ,!.

Center Hamilion Family

Operating Year: (Circle the operatingyear being reportedon)

Dudley Apartments
/ I Reporting Period: (month day year)

nr Dz !-r X+ ns tro Zt !a ns nto n r r n r z ! r : l r e [rs n r6 n tz [ts l ts nzo

Indicateif extension: fl Yes X No Indicate if renewal: X Yes ! No PreviousGrant Numbersfor this project:

from: 1/UI2A06 1

to 1013112007

8201 cAO1 001 cA 01 8 30'1005 cA01 8401035

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

Section8 Moderate Rehabilitation ! Single Room Occupancy (S ec.8S R o)

I fi

Transitional Housing PermanentHousing for llomeless Persons with Disabilities lrurovative Supportive Housing Supportive ServicesOnly HMIS

I n I tr

Tenant-basedRental Assistance(TRA) Rental Assistance(SRA) Sponsor-based Projectbased Rental Assistance(PRA) Single Room Occupancy (SRO)

| | SaIetlaven I I N

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

for supportservices 50 formerlyhomelesssingleadultsand to Hamilton FamilyCenterendeavors providevoluntary with MercyHousing, support In our membersat the DudleyApartment. partnership family 70 formerly homeless physical in and mentaldisabilities; to address servicestaffofferson-sitesocialservices assistresident's managing goals;and supportresidents training and employment in abuse issues; achievevocational addiction and substance workshops, and supportgroups. tenantcouncil, socialactivities, theireffortsto buiidcommunity-through
Nanre & Title of the Person who can answer questions about this report Phone: (include areacode)

Benton Lesley
Ad d r e s s :

(415)861-8640 x211
Fax Number: (include areacode)

CA St 172 6th San Francisco 94103 ilycenter.org iltonfam Address lbenton@ham E-mail

(415)861-8647

I hereby certify that all the information staied herein is true and accurate.
and/orciviipenalties.(18U.S.C. 1001, Convictionmayresultincriminal Warning: HUDwillprosecutefalseclaimsandstatements. 101 0.10 12 : 3l U.S. C.3729. 3802\ & Signature Date: Name & Title of AuthorizedGranteeOfficial:

SHP GrantsManager Mikyung Kim-Molina,

*hYt
'"/

!!"' 1 "0 t'

i lt i l n . t

H U D - +0 1 1 8

4"J,M*
Name and Title ofAuthorized Project SponsorOfficial:

" ' /rt/,r

Signature& Date:

Executive Director BethStokes,

HUD-4018 I

(EXCEPT HMIS) BY PARTI. TOBE COMPLETED ALL GRANTEES

SSoGLINTEES,PLEASESEESPECIALINSTRUCTIqNSoNPAGE3oFTHEAPR

Part I: ProjectProgress
1.

from the most recentcoc a given point in time. (This inforrnationcomes ProjectedLevel of Personsto be served at
Number of SinglesNot in Families

_v

1Catl0n.

Numberof Adultsirr Families

Number of Children i n Fami l i es

Numbel of Fami l i es

a.

Level Projected at to Persons be served a glven polnt In tlme

50

40

20

2,

PersonsServedduring the operatingyear'

Number of SinglesNot in Families Number of Adults in Families Number of Children in Families
4A

Numbel of Farnilies
1'7

a.

Number on the first day of the operatlng year Number entering program during the operatlng year year Number who left the progtam during the operatrng year Number in the program on the last day of the operatlng (a +b -c)=d

52 12
lo

20
o

b.
c.

6
to

48

19

18

* af3vl rnstructionstooo:'-11: .l:.-T:"'y:1,1:;.::"1T:,f,.Sj:r,1..,, rlpes Generar 3JJ3:i,:"Jli'iitri.nfiro,,.hold inthe Note that this table doesnot accountfor changesin clienl4-rousehold that^* l:nl:l may type pamilies.
Families,Adults in Families,and children in a rypebasedon the ciient's .u"h client should be assigned single client/household occur during the courseofthe operatingyear. Instead, lnthisway,eachclientiscountec attlteprogram""riiorrclosesttothestartiftheoperatittgyear. ageanci/orhouseholdcomposition only oncein thc tabie. Usethefollowinggraphicandexplanationstodeterminewhoshouldbecountedinrowsa-d:

on in Client program firstday ol the year,leffduring operating year count 2a and2a. ln

C ient in program on first day of operaiing Yeaf and last day ofoperaiing Year:counl in 2a and 2d.

.#
a# C|ent Enlered and lefr progErn before slad of operaling year do not count In question 2

and enlered lefl Client pr ogr ardur ir gope- ati ng in count 2b and2c' Year:
Client entered Program dufng op".ating year and slill in program on lasl day ofYear: count in 2b and 2d.

First day otlhe operating year

Last day ofthe operaling year

row includesall clieniswho enteredthe programbeforethe first day ofthe Number on the first clay of the operating year: This operatingyearanddidnotleavetheprogramuntilafterthefirstdayoftheoperatingyeal. b. first the year: This row.includesall clients who entered programon or afterthe Number entering the program during the operating multiple programentrydates'use the of last-d"ay the operatingyear. For clients with <iayof the operatingy.ur, ,ip to and inc'iuciing"the the more than once even ifhe/she entered programmore than ttre start ofthe operatingyear.Do not count the client entry date closestto once during the oPeratingYear' all clientswho left the program on or afterthe first day of the Number who left during the operating year: This row includes usethe exit date year. For clientsrvith multiple programexit dates, operatingyear,up to and including thelast day ofthe operating HUD-40118

closestto the end ofthe operatingyear. Do not count the client more than once even ifhe/she exited the prog1am more than once during the operatingyear. d' Number in the program on the last clay of the operating year: This row includesall clients who were in the program as of the first day ofthe operatingyear or who enteredduring the operatingyearand who did noi leave during the operatingy.ur. Th. nunber of clients or families in the programon the last day ofthe operatingyear is calculated basedon the responses rows 2a through 2c. For to each coiumn, add the numberof clients or families in rorv 2a to the numberof clients or families in iow 2b and subtractthe number of ciientsor familiesin row 2c. Therefore, : 2a + 2b - 2c. 2d

3.

Project Capacity.
Number of SinglesNot in Families Number of A dul ts i n Fami l i es Nun.rber of C hi l dreni n Families N umber of Fa mi l i es

a.

Number on the last day (from 2d, columns 1 and 4) Number proposedin application(from 1a, columns 1 and 4) CapacityRate (divide aby b) : %

48

r lg i. ' . '
4Bo/o ,' ;'i

to

b.
c.

50
96%

' i i t,.., .s9".;,,.. 2 0 {,Q,; 1

B0%

Explanatory Notes: Row b refers themostrecent to coc application whichtheprogram reporting. for is 4. Non-homelesspersons. This questionis to be completed SectionS SRO projects. for

Howmanyincome.eligiblenon-home1esspersonswerehousedt,ytt'.sn@

5'

Age and Gender. Of thosewho entered the project during the operatingyear, how many people are in the follorving age and gendercategories?
Single Persons(from 2b, column 1
a.

Ase
62 and over

Male

Female
z

1
z +

b.
d.

5l -61

1
z U

3 1 -s 0
r 8-30
17 and under

0
U

0
U

Persons Families in (from2b,columns & 3) 2

f.
g

62 and over

h. i
t.

I
m.

5l -61 31-50 18-30 l3-17 6-t2 l -5 UnderI

0
U

0
z

0
U

0
2
z

E xplana tory No tes: This questionrefersonly to Singlesnot in Families and Persons Familieswho enteredthe program during the operaiing in year. Only clients who meet thesecriteria can be countedin this table. The total numberofclients reportedunder Single personsshould be equalto the nunber reponed in question2b, column 1. The total number of clientsreportedunderPersonsin Familiesshould be equal io the sum of cclurnns2 and 3 in question2b. Answer questlons 6 - 10 only for participants who entelgd the project during the operating year (from 2b, colur-nns | & 2).

Thetermparticipanrmeans Suglesnot in Families Adultsin Families. does include and It not children caregivers. or NOTE: Thetotalfor questions , 8 and10belowshould thesame; 7 be respond each those , to of questions all parlicip]nts.Someof for the questions listedthroughout APR will be asking the information individuals for who areghrsnicallv [ .
HU D - 4 0 1 8 i

6a. Veterans Status. A veteranis anyonewho has ever been on activemilitary duty status. were veterans? How many participants

13

homelessindividual with a disablingcondition who has eitherbeencontinuously 6b. Chronically homelessperson. An unaccompanied in of year or more OR has had at leastfour (4) episodes homelessness the pastthree(3) years. To be considered for homeless a shelter(i.e. not transitionalhousing)during or a chronicaliyhomeless personmust havebeen on the streets in an emergency Instructions see underthe Ceneral of thesestays. For furtherdiscussion the definitionof chronichomelessness, Other Key Defrnitions above. individuals? were chronicallyhomeless How manyparticipants

7.

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

b.

2 15

Explanatory Notes: Each participantshould be listed in only one category. The total number ofparticipantsin this table shouldequalthe numberofparticipants in question columns1 and2. 2b,

8.

Race. How many participants are in the following racial categories? American Indian /Alaskan Native

b.
d.

Aslan

B I ack/African American

0 2
I

NativeHarvaiianiOther Pacifi Islander c White

American Indian/Alaskan Native & White

Asian& White
Black/AfricanAmerican & White American Indian/AlaskanNative & Black/Afi'icanAmerican Other Multi-Racial (Hispanic or Latino)

h.
I

12 0 0 0
n

Explanatory Notes: to a Each participantshould be listed in oniy one category, A participantwhoseracedoesnot correspond categories throughi should be in countedin j, Other Multi Racial. The total number of participantsin this table shouldequalthe number of participants question2b, the categories generate APR response to categories. columns I and 2. If using HMIS data,you may combine HMIS race response

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

2 1
J

b.
A

abuse Alcohol
Drug abuse

1 1

diseases HIViAIDS andrelated

Develoomenialdisabilitv Physicaldisability Domestic violence Other (pieasespecify)

0
4 1

f.
o

0 0 0
1

h.

9b. How many of the participantsare disabled? 12

Explanatory Notes:

10

HUD-.{o118

meet HUD's definition of "disabled,"see"Disabling Condition" under Other Key Definitionsin the General To determinewhich participants Instructions. 10. Prior Living Situation. How many participantsslept in the foilowing placesin the week prior to enteringthe project? (For each in participant,chooseone place. The total number of participantsin the "All" column should equalthe number of participants question 2b, slept in the following places. (Chooseone) columns I and 2). Also, indicatehow many chronically homelessparticipants All
a.

Chronic

b. d. f.
g

park, car, bus station,etc.) Non-housing(street, Emergency shelter Transitionalhousingfor homelesspersons Psychiatricfacilityx

A T

facility* treatment abuse Substance

Hospital+ Jail/prison+ Domesticviolencesituation Living with relatives/friends Rentalhousing Other (pleasespecify)

0 1 0
0
A

,0' ,: ,
'0:
- 0:;l
irlii]], :

,'

h.
I

5il'f r,:t

+if a participant lessthan hospital, jail), butwasthere or treatment facility, abuse (psychiatric facility,substance came fromaninstitution in facility, he/she should counted eitherthe be entering treatment the shelter before or 30 daysund,"u, living on thestreet in emergency as category, appropriate. street shelter or Completequestionsl1 - 15 for al1participants who lett during the operating year (from 2c, colurruls1 and 2). The term participant means single personsand adults in families. It doesnot include chiidren or caregivers. The term chronically homeless person means an unaccompaniedhomelessindividual with a disabling condition who has either been continuously in of homelessfor a yearor more OR has had at least four (4) episodes homelessness the past three(3) years.To be considered the streetsor in an emergencyshelter (i.e. not transitional housing) during c|ronically homelessa personmust have been on thesestays. participants left duringtheoperating year, who howmany of 11. Amount and Source Monthly Incomeat Entry and at Exit. Of those place rnonthly the income levelandeach source income?Also,please of income levelandwith each monthly participants wereat each in A chart.Thenumber parlicipants Chart andB of column each of persons thesecond in homeless for source income chronically of s hould t hes a me . be Atl
A. Monthly Income at Entrv No income Chmnic

Atl At Sources Entrv C. Income

a. b. SecurityIncome (SSI) Supplemental Social SecurityDisability Income (SSDI) SocialSecurity d. GeneralPublic Assistance Temporary Aid to Needy Families (TANF)
a4 tl

Chronic

., =r t r '[;,;:i
0 0
I I

r ,;'t.
0
n

.,

'1,

b.
A

s1 150
$151 52 5 0 1 $25 - $500

0 0
0
I

0
0 1

1
o

s501 sr,000 f.
g

4E
A

$1001- 5 0 0 $1 S $1501- 2 0 0 0 + $2001

h.

2 0

0 0 0

f
b'

StateChildren'sHealth InsuranceProgram(SCHIP)

Benefits Veterans
EmpioymentIncome Unemployment Benefits VeteransFlealth Care Medicaii Food Stamps

h. i J
l.

0 0 2 2
n
tl

0 0
U

0 0
1

(please specify) m.. Other

n. No FinancialResources

0 0 0

i1

HUD-:101 18

All B. Monthly Income at Exit No income

Chronic at D. Income Sources Exit

All

Chrunic

a.

1
n

b.
c

s1-150
s 151 $25 0 $251- $500 $50r- $1,0 0 0

0
1 12 6
1
4 I

0 0 0
1 o

SecurityIncome (SSI) Supplemental

11

b.
d

(SSDI) Income Disability SocialSecurity SocialSecurity

GeneralPublic Assistance TemporaryAid to Needy Families(TANF)

0 0
1
6

0 0
1

d.
tr

sr001$1500
s $1501-2 0 0 0 + 52001

h.

0 0 0

f.
I

Program(SCHIP) StateChildren's Health Insurance VeteransBenefits Employrnent Income Unemplovment Benefits

0 0
z

0 0

h.

0 0 0 0
1

0 0 0
1

J
L

Veterans Health Care

Medicaid
Food Stamps

specify) Other(please
No Financial Resources

0 0 0 0

Explanatory Notes: the Table A: Monthly income at enffy refersto the participant'smonthly income on the day he/sheentered program(i.e., on the program entry date or as closeas possibleto that day). You should not report on income receivedbefore enteringthe programor incomereceived during the programstay. Table B: Monthly income at exit refersto the participant'smonthly income on the day heisheleft 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. the of Table C: Income sourcesat entry refersto the participant'ssources income on the day he/sheentered program(i.e., on the program entry date or as closeas possibleto that day). You should not report on sourcesofincome receivedbeforeenteringthe programor income with no income at the time of programentry should be reportedin categoryn, No Financial receivedduring the program stay. Participants Resources. of Tabie D: Income sourcesat exit refersto the participant's sources income on the day he/sheleft the progam (i.e.,on the programexit date with no ofincome received during the programstay. Pariicipants or as close as possibleto that day). You should not report on sources n, incomeat the time of program exit should be reportedin category No Financial Resources.

12a. Of thoseparticipantswho lgft during the operatingyear (from 2c, columns 1 and 2), how many were in the projectfor the following persons who !9.! during the operatingyear in the second lengthsof time? Also, pleaseplacethe length of stay for chronically homeless column. AII Lessthan I month Chronic

b.
c. d. f.

1 to 2 months 3 - 6 months ? months 12months l3 months- 24 rnonths

0
J

0 0
I

o R

0
1

h,
I

25m on th s -3 v e a rs 4y ear s -5 y e a rs 6y ear s -T y e a rs 8 years 10 years Overl0 years

0
o

0
12

0 0
HUD-101 l8

Explanatory Notes: Computeeachparticipant'slength ofstay using the participant'sprogramentry dateand programexit date. Ifthe particrpant has only one programexit date during the operatingyear,calculatelength ofstay by subtracting programenlry date from the pro$am exit date. Ifthe the participanthas multiple program exit datesduring the operatingyear,calculate lengthof stayfor eachprogramstay(by subtracting the the programentrv date from the programexit date for eachprogram stay)and add themtogether producea cumulativelength ofstay. Each to pafiicipantshould be associated with only one length ofstay category. The total numberofpanicipants in the f,rrst coiumn ("All") should equalthe number of patticipantsin question2c, columns 1 and 2_ l2b' Length of Stay in Program. For thoseparticipantswho did not leave during the operating year (from 2d, columns 1 and 2), how long have they been in the project? Also, pleaseplace the length ofstay for chronically homelesspersonswho did not leavedurins the operatingyear in the secondcolumn. AII
a.

Chronic

Lessthan 1 month

n
n n 1

b.
c.

I to 2 months
J - 6 months 7 months- 12 months 13 months- 24 months 2 5mo nth s - 3y ear s 4yea rs-5 y ear s 6 ye ars-Ty ear s Syea rs- l 0y ear s

0
A

d.
e.

11
1a
JI

1 10 0 0 0

f.
g

h.

Over10 years

Explanatory Notes: Computeeachparticipant's length ofstay using the participant'sprogram entry dateand the last day ofthe operatingyear. To calculate length of stay,subtractthe program entry date from the last day of the operatingyear. Eachparticiiant shouldbe associated with only one length of stay category. The total number of participantsin the first column ("A11")shouldequalthe number of participants question in 2d, colulTlnsI anc.z.

13. Reasonsfor Leaving. Of thoseparticipantswho left the project during the operating year (from 2c, columns i and 2), how many left for the following reasons? If a participant left for multiple reasons,include onlv the primary reason. The total number particrpants of in the first column ("A11")should equalthe number of participantsin question2c, columns 1 and 2. Also, pleaseplace the p.imary reasonfor chronically homelesspersonswho left the project during the operating year in the secondcolumn All Left for a housing opportunity before completing program Chronic

b.
c.
d.

Completed program Non-paymentof rent/occupancy charge Non-compliance with project Criminal activity / destructionof property / violence Reachedmarimum time allowed in proiect Needscould not be met by project

0 2
0 I

0 0 0
I I

f
g

0 2
0
J

0
z

Disagreement rules/persons with

Death Other (pleasespecify)

0
A I

j
1-

Unknown/disappeared

1 1

13

HUD-40i l8

1 year the who participants !g[ during operating (from2c,columns and2), howmanyleft for thefoliowing 14. Destination. those Of year persons who left dunngtheoperating in thesecond place destination ofchronicallyhomeless the Also,please destination? column. All Chronic (no subsidy) (a-h) Rentalhouseor aparfment PERMANENT 0
b. PublicHousing Section8 d. ShelterPlus Care HOME subsidized house or aDartment
U

0 0 0 0
1

n
U

or Other subsidized house aparfment

6.

0 0
0

Homeownership Moved in with family or friends Transitionalhousingfor homelesspersons

(i-j) TRANSTTTONAL
J

Moved with familyor friends in

Psychiatric hospital(other hospital) facility Inpatientalcohol or other drug treatment Jail/prison Emergency shelter

1 0 0
1 I

0
4 I I

INSTITUTION(k-m)

tK.

m.

(n) EMERGENCY SHELTER oTHER (o-q)

n. o.
v'

supportive housing Other

Places not meantfor human habitation(e.g. street) Other ipleasespecify)death

2 0 0
1 8

4
I

0
1
1 1

q.

UNKNOWN

Unknown

Explanatory Notes: provided.The response categories Identify eachparticipant'sdestinationupon leavingthe progtamusing the categories combine "destination"(e.g.,rentalhouse or apartment, public housing,homeownership,etc.) and "tenure" (e.g.,permanent, transitional,etc.). response, and be sure to look at all ofthe response Considerboth destination and tenureto determinethe most appropriate categories before making a selection. The table belorv provides a briefdescriptionofeach responsecategory. Enter the numberof participantsunder eachdestinationcategoryin either the frrst column of the tableor in both columns if the participantis chronicallyhomeless. Only one reasonfor leaving shouldbe recordedper participant.The total number of participantsin the first column ("All") should equalthe number of participantsin question2c, columns I and2.

Tenure
Permanent
h

c.
d.

Destination Rental house or apartment(no subsidv) Publichousins Section8 Plus Care Shelter

Description Participant is moving to an apartmentor house without any subsidy. Participantis moving to a public housineunit Participantwill use a housing choicevoucher(formerly known as a Section 8 voucher)to rent a houseor aDartment. Participantis moving to a unit funded by the ShelterPlus Care prosram (e.s..TBA. SRA. PRA. Section8 SRO).

house or HOME subsidized apanment

f. Other subsidizedhouseor apartment

Participant movingto a unitwith rental is provided the assistance by (tenant-basedproiect-based HOME pro.qram or assistance).
Participantis moving to a unit subsidized someprogramother than by public housing,housing choicevoucherprogram(formerly Section8), ShelterPlus Care.or HOME. Particpant is moving to a unit that he/shehas purchased, Participantis moving in with family or friendsand expects live there to for 90 davs or more.

h. Transitional

Homeownership Moved in with familv or friends

for Transitionai housing homeless people Movedin with familyor friends

Participant movinginto a unit funded a transitional is by housing program homeless people (e.g., for transitional housing funded through the Supoortive Housine Proeram).
Participantis moving in with family or friends and expects live there to lessthan 90 davs. is Participant movins to a psvchiafric

Institution

k.

Psvchiatrichosoital

14

HUD-401 l3

T en ure

Destination

Description

I.
m Emergency Shelter Other
n. o.

In p a ti e n tl c o h o l r o th e d rug r a o treatment facilitv

Jail/Prison Emergencyshelter Other supportivehousing

Participant moving an inpatient is to alcohol drugtreatment or facility

P a r t i c r p a l t s m o v i n gt o a l a i l o r p r i s o n i Participantis moving to an emergency shelterfor homeless people Participantis moving into supportivehousingthat doesnot correspond to any ofthe permanent housingcategories (a-h) and is not transitional housingfor homeless people(i), suchas Section81t housine.* Participantis moving to a place not meantfor humanhabitation,such as.acar, par\, sidewalk,or abandoned building. Participantis moving to a placethat doesnot correspond any ofthe to categories above(a-p). This response category should be usedifyou are unsureabout where the participantis moving or ifthe participanthas disappeared rhere and is no way to find out where he/sheis.

p.
q Unknown

Placesnot meant for human habitation

Other(please specify)
Unknown

*HUD encouragesprogratns to limit tlze use of the "Other Supportive Housing" APR responsecategory. Programs should reporl destinations to ltousing that are perntanent or transitional in APR categories (a) through (h) or in categories (i) through Q), respectively. Exits to emergencyshelters should be reporled in category fu).

15. Supportive Services. Ofthose participantswho left during the operatingyear (from 2, columns 1 and 2), how many receivedthe following supportiveservicesduring their time in the project? Also, pleaseplacethe supportiveservices receivedfor chronically homelessparticipants who lgft during the operatingyear in the secondcolumn. Participants may have receivedmultiple services and all servicesshould be reportedin the table. Ail
a.

Chronic

Outreach Case management Life skills (outsideof casemanagement)

b.

22 21
o z

7 1 1 1

d.

Alcohol or drug abuseservices Mental health services

f.
b'

HIV/AIDS-related services
Other health care services

4 I

0 1
U

h
I

Education placement Housing Emplo;nnent assistance

Child care Transportation Legal Other (pleasespecify)

z o

1
z

j
1,

1
n

l.
m.
n

1 12

0 0 0

t5

HUD-40118

Technical year for ob1ectives thisoperating (fromyourapplication, Irst objectives, yourmeasurable Goals.Under 16. Overallprogram the y0ur in describe progress meeting objectives. Progress, goals below.Under listed of or Submission,ApR)for each thethree
I Tn,.Jar NIevr oncrqrino Year's Objectives, specify the measurable objectives for the next operating year. vPr r qt'i r 5

Res ident ial b i l i ty S ta housingfor at leastone year will retain permanent A,. Objective. S0% of residents maintainedtheir housingfor at leastone year. or ObjectiveAchieved. 46 of 54 households, 85o/o Progress.. in this is the number of househoids the past year that have fit into all of HUD's eligibiiity (The number54 is usedbecause and requirements: they havecertificateof homelessness, verificationof disability.Tenantsare also excludedfrom our count if in Program.We usedthe total numberof tenants questions1- 15 they signeda Declinationof Serviceswith the Supporl Services becausethe Dudley Apartments Support ServicesProgram does outreachto and will work with all tenantsin the building regardlessof their eligibility for HUD funding. This is per the agreementbetweenMercy Housing and Hamilton Faruly Center.)

housingfor at leastone year will retainpermanent Next OperatingYear's Objectives:80%of residents voluntary supportiveservices 50% of residentswill access B, Objecttue.'

voluntarysupportservices this in Progress;6lTo, or 36 of54 tenantswho did not sign a declinationofsewices, accessed year. pastfiscal

voluntary services NextOperatilg Year'sObjectives;50% of adultswill access programsand activities. will participatein after-school C. Objective:30% of schoolaged-children chiidren that have lived at the Dudley Aparlmentsin this fisca1 Progress;Objectiveachieved.82Voor 14 of 17 school-aged programsand activities. year havepar-ticipated after-school in programsand activities. childrenwill participatein after-school of Next OperatingYear'sObjectives:40olo school-aged residency. children not in schoolwill be enrolledin schoolwithin 45 days of establishing D. Objective:90% of school-aged Progress;Objectiveachieved.100% or all 17 schoolagedchildren in the past fiscal year were enrolledin school. childrennot in schoolwill be enrolledin schoolwithin 45 d2r'c nf NextOperatingYear's Objectives;90% of school-aged residency. estabiishing

will participatein communitymeetingand/orpeer social activities E. Objective:70% of residents participatedin peer social activities. Progress:ObjectiveAchieved. 40 of54 clients,or 740/o, rvill participatein communitymeetingsand/orpeer socialactivities. )\,lext OperatirtgYear'sObjectives:70% of residents F, O bjec t t v e. . 8 0 % o fth e te n a n ts w h o re s p o n dtotenantsati sfacti onsul veysw i l l i ndi catethatsew i ceshavebeenhelpf ul, or , good to exceilent. rviil ratetheprcgrarn Progress: eitheragreedor stronglyagreedthat theybenefitedfrom a list of Objectiveachieved.12 out of 14, or 86ohof tenants 14 that all tenantsfrll out surueys. tenants Staff doesnot mandate providedby Hamilton. The SupportServices services collection. choseto fill out this survey in the week that rvas allotted for survey 16 HUD- 401 18

who to satisfaction surveys indicate servrces wili NextOperating Year's % that Objectives:80 of thetenants respond tenant goodto excellent. have been helpful, will ratetheprogram or

Increased Skillsor Income G. Objective: 53 % of adults will increasetheir income by obtaining part -or-full time work within one year of entering the prograrn,or will enroll in vocational training program to enhancetheir readinessfor emplolnnent. Progress: ObjectrveAchieved. 77o/o i0 of 13 tenantsthat identified employ'rnent a goal this year r.vere or as able to obtain employrnentor employrnenttraining. Next Operating Year's Objectives: 53% of adults will increasetheir income by obtaining part-or-full time work within one year of entering the progranl or will eruoll in a vocational fraining program to enhancetheir readinessfor emplol.rnent H. Abjective: 80 % of residentswho are determined eligible for mainstreampublic benefits will receive assistance applying in for appropriatebenefits. Progress:ObjectiveAchieved. l00Tq or J out of 7 clientswho requested assistance accessing in mainsfream benefitsworked with a CaseManager to accomplishthis goal. Notes may be found in their casefiies. Next Operating Year's Objectives;80%of residentswho are determined" eligible for mainstreampublicbenefitswill receive assistance applying for appropriatebenefits. in

GreaterSelf-determination I' Obiective: Within 60 days of housing entry, 55%o adults who accesssupport serviceswill develop and individuaiized of serviceplan, which,establishes goals and objectives and identifies activities leading to their accomplishmentand will report success within one year ofdeveloping the plan. Progress: Objective Achieved. Of the t householdsthat enteredin the past fiscal year, 7 or TSYocreated service plan and a each of them successfullyfollowed through with their plan. (The t householdscounted in this objective are those tenantsthat enteredthis year, frt the HUD eligibitity requirementsand also acceptedsupport services.Of the 17 total householdsto enter this year, 8 either declined services or did not fit HUD eligibility requirements.) In the coming year we plan to work with the Property Management at the Dudley Apartments to recruit for more tenantsthat fit the HUD Supportive l{ousing eligibility requirementswhich will increasethe number of new tenantsthat we will report on f or t he A P R. Itlext Operating Year's objectives: Within 60 days of housing enfry,55%o adults who accesssupport serviceswill develop and of individuaiized service plan, which establishes goals and objectives and identifies activities leading to their accomplishment and will report successwithin one year of developing the plan.

J. Objec t iv e: 80% o fre s i d e n ts w i l l re c e i v e re fe rral stoandassi stancew i thaccessi ngongoi ngheal thcarea ndor r em ainin improved heath each year, comparedwith their stafus at program entry. Progress;Objectiveachieyed, tenantsthat requested A11 assistance accessing in health care,or 5 out of5, in the past year were provided with this assistance. addition, staff held weekly groups for the residentsin an effort to help them deal with In mentalhealthissuesand stress.Thesenumbersinclude all participants.

I7

H U D - .1 0 1 1 8

In the coming year the Dudley Apartments Program plans on providing more preventativehealth outreachto the community. In this way, more tenantswill be reached than only thosewho specifically ask for he1p. based on improvedhealtheachyear.Health is assessed The Dudley ApartmentsProgramdoesnot have a methodto assess needthat clientsexpress casemanagers. to with accessing will receivereferralsto and assistance ongoing Next OperatingYear'sObjectives;80% of residents healthcareor remain in improved health each year, comparedwith their statusat program entry

projects do 17b. recipients answer (SHP-SSO 17c. 17a. recipients answer SRO 17. Beds. SHP recipients answer S+C not completethis question)
a. SHP. How manybeds were included in the applicationapprovedfor this project under 'Current Level' and under 'New Effort'? many of theseNew Effort bedswere actually in placeat the end of the operatingyear? New Effort in Place New Effort Current Level q q 12O Number of Beds: S+C. How many beds and dwelling units were being assistedwith project funds at the end of the operating year? (Include beds for all participants, other family members,and care givers.) Number of Beds: Numberof Dwelling Units: c. at SRO. How many dwelling units were being assisted the end of the operatingyear? persons (Include units occupiedby "in place" non-homeless who qualify for assistance.) Number of Dwellins Units:

b.

18

HUD- 40r l8

JAN-0 4- 2008

13: 31

D H S ' O .C .M

Prolrans l-rqmifluusind Hoineless and

141555928?4

01/84/7flA8A7:35

5679 P.O0Z fi733 P.EL?/DO3

0L
Part ll: Financial Information
18. Supportivc Scrvices-

,fr{.w| r\ a '

, -7n

ForSupaqrfiveHouslnq {SHP).thls exhlbltprovldesinformallonro HUD on how SHP fundlngfur supportlvsseMcs was spent during tho oparatlng 1Far. Enter lhe amount of SHP fundlnS spor( on thess supportive servic4s- hclude HMIS cg$F under 'othed. For5,[gtlefElgqQere,lSr-Q). this exhibit b-acks[re suppodivc services mzttctrrequirement.Specifythe value of suppcrtive sarvlces 17onall sources thqt cen be countod as match thal ali homete6s prsons c8lved durlner m operatlng !'aar. (S+C grantees should keeF documentation on file, including sourcc, arnoullt and type of supFonive services.) For Seclion I SRO. thls exhlblt provides lnbnnatlon to HUD on the valueof supporflve cervleesreceived by homele* per:sons durlng the operatlng )Ear,

Suppoftive Servlces
Outeach Case managoment Lifo skills {outside of case managemit)
Alcohol and dnrg abuse services
A

Dqllais

$163.311

Mental health serwicos AID$rBlated senrriccs

s.

Othcr health care servrces Educalon Housing placement I

J.

Employment ass'stance
Child carc

k.

Transponation m.
Legal

n,

Other(pleasespecify)
HMISAdmlnist|a(er

$0.00

stEs,311 TOTAL (Suln of a through n) . t:;,;1..iii51J,:il_,;;.f:'',.,.';_.i:l"i:'-'; ;j,: .ii.,;::l :r.a:i:.ii:i:,t :: : :t,,,'j:l.. .t''i: i i'it, il,:,:l -.._,,,.;:,,.,it-.iurii:;:ll,l;:ii Cumulativc amount of rnatch providgd to date fDr tho Shclter Plus Care Proqram qnder thls grant

IlltD40l r8

JAN- 04- 2008 13:3 1 D H S ' O.C .M Fromlllousin6 and Homeless Programs 14155592834

416 aE 1 5673

P. 003

E7/04/2BBE D7:35

fr733 P.0t13/003

Coets,HM|S Servlces, Operafing Actlvitiesand 19- Supportive Supportive HoustngProgram:Leasing, Admihistration

Afl grantees receivlngfunding under the Supportiva HouslngProgranr musl comFletethaso chafts each operating ycar. For expanslon projects; lf SHP grant funds are forthe extansion of a pro-sxistjng hometess facility, only the pople and erpenditurcs fur the additional etpansion may be includod. as in th6 odginal application or any grant arnendments. Documcnbtion qf resources used is not reguirad to be sqbmittod with Orisreport but should be kept on file br posslble iaspoetion by HUD and Auditors. Do not include any o<pendituresmada bfsre thS qHF grant\rras executed.

Summaryof Erpenditurea..Enterthe arnountof SHPgrahtfundsand cashrnatcherpended yearfor durlntfi operatlng t0talshouldbe the same eaci activity,Thistableshovldadd up boih horizontally vertcalfy. TheSHPsupportive servicss and
as tho SHP
serv|ces In

1 6 S,3 1 1

Nglo: Paymtlnhof prlnctpal'and 8s eteotE. htereBtdn any loen or mo.lgaFcrtlry not be 3ho$rn an opoErdng Sour.coe o.f Cqsh ltlatch. Enter the sourcas of cash ioendfieoin the Cgsh Match column. abovo, in the following calegories. Use addlflonal shoob, as necessary.

Amount
h

Grantee/prnject sponsorsh (Flea.se Localgovemment epeclff)

state government(PleasesPedfy)

6.

Fedoral govemment (plcase specify)

Cornmunity Davlopment Bhck Gr{nt (CDBG)

c.

(please Foundations specrfy)

i:!,r',4iarF

:fl

Privle cash rgsor,rrcs (please spoctfy) Public Donations

Donatlons
u.
h.

Occupancy charge / feos

Total

s4at,38B

s [IUD.101l

TN TALF. O O 3

20. SupportiveHousing Program: Acquisition, Rehabilitation,and New Construction A)l grantees received that SHPfundsfor acquisition, rehabilitation, newconstruction complete or must these charts theyearoneAPR in only. Thisexhibitwill demonstrate HUD thatthegrantee contributed to has enough cash at least to equally match amount SHPfunds the of spent acquisition, for rehabilitation, newconstruction. or Documentation matchingfunds that wereprovided not required be submitted is to
ion by HUD and Auditors.

with this ieport but shoulci kept on file for possible be r

Summary of Expenditures. Enter the amount of SHP grant funds and cashmatch expended during the operatingyear for eachactiviry

SHPFunds
a.

CashMatch

Total Expenditures

Acquisition Rehabilitation New construction Total

b. c d.

Cash Matclt. Enter the sources cashidentified in the Cash Match column, above,in the following categories. Use of additionalsheets, necessary. as

Amount
a.

Grantee/proj sponsorcash ect (please Local government specify)

b.

c.

Stategovernment(pleasespecify)

,l

government please specify) Federal Community DevelopmentBlock Grant (CDBG)

(pleasespecify) Foundations

Private cashresources (pleasespecify)

Qccupancycharge/iees Total

h.

'j1

HUD-4018 1

FOR HMIS ACTIWTIES OIVLY

21. For Supportive F{ousing(SHP) - H}'[IS Activities was spentduring the operating year. Enter This exhibit providesinformationto HUD on how SHP-HMIS funding for supportiveservices the amountof SHP-HMIS fundingspenton theseactivities.

HMIS Activities

.
CentralSewer(s)

.,

PersonalComputers and Printers Networking

Software/ User Licensi Software Installation Support and Maintenance SoftwareTools

Trainine bv Third Parties / Tecbnical Services

Data Conversion Security Assessmentand SetuP On-line Connectivity (Intemet Access) Facilitation Disasterand Recovery

Project Management/ Coordination Data Analysis Techdcal Assistanceand Tra Administrative Support Staff Subtotal

,:,..
Costs Space OperationalCosts

,...',

22

HUD-40118

Describeany problemsand/or changesimplementedduring the operatingyear,

1. On the lastday of our operating yearwe had 16 families our program, in whilefull capacity 20 families. is Over the courseof the past year, Hamilton had to giveup one familyunitat the Dudley Apartments because was it the onlyADA unitin the building and a singleadultwas in need of a transfer the ADA unit.Overthe past 3 to years,unitsslatedfor Hamiltonfamilieshave been givento singleadults.Hamilton has procured few on the a generalpopulation units at the Dudleyfor families, not enoughto make up the difference 20 units for but to families. this pointwe are operating At with 18 unitsfor families. willworktowardprocuring full 2O units We the in the comingyear. Of the 18 familyunits,2 were unoccupied because the rooms had not been turnedover from the previous tenants. We will try to expediate this process, however MercyHousing has the responsibility nrakingunits of readyand at timesthis processhas been delayed. 2. This yearHamilton Family Centerincreased focuson the Housing the Firstphilosophy the DudleyApartments. at The staff emphasized HousingRetentionin their case management services. This year case managersat the Dudley Apartmentsprevented49 evictionsby meetingwith clients and creatingpaymentplans. Harnilton Family Centerwas granted monies from the Mayor'soffice on Housingthis pasi year specifically prevent to evictions singleadults,in addition the fundswe already for to received familyeviciion for prevention.

Technical Assistanceand Recommendations Basedon your experience during the last year, are there any areasin which you needtechnicaladvice or assistance? so, please If describe.

L)

HUD-40118

Report PersonsServedWorksheet - HUD Annual Progress The of or with personal protected (PPI)onthisformis done theknowledge consent theciients' Information of collection the
PPI is only usedfor the following purpose: Program rn Accurate completion of the Annual progress Report (APR) for the Continuum of Care (CoC) HomelessAssistance which the client is eruolled.
and Report. Instructions to This worksheetis optional and is intendedto help you collect information needed completethe Annual Progress not submit this worksheet to HUD. Codesfollow. Do
Number of Months in Project(calculate) l2a Number of Months in Project-Participant did not leave (calculate) 12b

On)y) ( Y/N ) 4

PersonsServed Worksheet (continued)

Collection of the Protected PersonalInformation (PPI) on thrs form is done wrth the knowledge or consentof the clients. The PPI is only usedfor the following purpose: Program in Accurate completion of the Annual ProgressReport (APR) for the Continuum of Care (CoC) HomelessAssistance which the client is enrolled.

Do not sutrmit this worksheet to IIUD Ethnicity Veterans Chronically No

Status (Y,O{) oa Homeless (YN) 6b

'7

Race (code) 8

SpecialNeeds (code) 9a

SpecialNeeds (code) 9b

Prior Situation (code) l0

Monthiy lncome At Project Entry I la

Monthly hcome
Ar Drnieni F wi+

I!

1l b

(
I

.)^

H U D - 4 0 I1 8

25

HUD-40118

Persons Served Worksheet (continued) (PPI)on thisiorm is donewith theknowledee consent theclients.The or of Personai Information Collection theProtecteci of PPIis onlyused thefollowingpurpose: for Accwate completi.on theAnnualProgress of of Report(APR)for theContinuum Care(CoC)Horneless Assistance Program in whichtheclient enrolled. is
Do not submit worksheet HUD this to
Reason Leaving for Program (code) l3

Instructions Codes Persons and for Served Worksheet

T he u se o f th is wor k s heet is opt ional. I t was des i g n e d to help you co llect inf or m at ion on par t ic ipant s n e e d e d to comp lete the An nual Fr ogr es s Repor t . I f t he workshe et is u pd ate d 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 equ i r e d f or comp letio n will be c ont ained in t he wor k s hee t . D o not s ub mit this wo r k s heet wit h t he APR. F or pro jects th at se r v e f ar nilies , 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 an d ge nd er o f thes e c hildr en. O nly nam e, relation sh ip, d ate of bir t h, and age on t he wor k s h e e t

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 he 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 r e f e r t o t h e q u e s t i o n s o n t h e A P R f o r m . I f an y 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 . P a r t i c i p a n t N u m b e r . T h i s c o l u m n a l l o w s y ou 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 or to assign a case number. One number should be assigned to each adult.

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will not be r epor t ed t o N ame . Name s of per s ons H UD. The u se o f n am es is f , or y our r ec or d k eepin g conve nie nce. Rela tion sh ip. En t er t he appr opr iat e r elat ions hip . E xamp les includ e: Self , Head of hous ehold, Spo u s e , ch ild. E ntry Date . Ente r dat e par t ic ipant ent er ed t he pro- ie ct. Usu ally this will be t he dat e of ac t ual phy sica l mo ve -in for a hous ing pr ojec t . E xit Da te. En ter d at e par t ic ipant lef t t he pr ojec t . Usua lly th is will b e t he dat e t he par t ic ipant physically moved o ut f or a hous ing pr ojec t . Do n o t inclu de a pa rticip ant who t em por ar ily lef t t he pr o j e c t and is e xp ected to r et ur n in les s t han 90 day s ( e. g . , h o spita l izati on ). 4. Income -elig ible Non- hom eles s in SRO . The S R O p rog ram allo ws as s is t anc e t o unit s oc c upied b y Section 8 in co m e- eligible per s ons r es iding a t t h e SRO prio r to re habilit at ion. For SRO pr ojec ts o nly, ind ica te w het her t he par t ic ipant is an iricome -elig ible , non- hom eles s per s on ( Y) or n o t (N). SHP a nd S+ C pr ojec t s s hould s k ip t his i t e m .

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

5a. Da te o f Birth . Ent er dat e of bir t h inc ludine J ^, , ,, ^- , I mo - ^- + L nrn , oa y, an o y ear . 5b. Ag e. En ter a ge at ent r y . 5c. Gen de r. En ter appr opr iat e let t er f or gender . M-Ma le F- Fe m ale. 6a. Ve tera ns Sta tus . I ndic at e if t he par t ic ipant i s a vete ran . Plea s e not e: A v et er an is any one w h o h as ever be en o n ac t iv e nt ilit ar y dut y s t at us fo r th e Unite d Sta t es . 6b. Ch ron ica lly ho m eles s per s on. I ndic at e t he nu mbe r ofp articipant s t hat ar e c hr onic ally ho me le ss. 7. Ethn icity. En t er appr opr iat e let t er f or et hnic gro up . a. Hispa nic or Lat ino b. Non -Hisp an ic or Non- Lat ino Ra ce . Ente r a ppr opr iat e let t er f or r ac e. a. American Ind ian or Alas k an Nat iv e b . Asian c. Bla ck or Afric an- Am er ic an d . Na tive Ha waiian or O t her Pac if ic I s lander e . Wh ite f. Ame rica n Ind ian/ Alas k an Nat iv e & W hit e g. Asian & Wh it e h. Bla ck/Africa n Am er ic an & W hit e i. American Ind ian/ Alas k an Nat iv e & Black/African Am er ic an j. Othe r Multi-R ac ial

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

1 l a . G r o s s M o n t h l y I n c o m e a t P r o j e c t E n t r y. E n t e r t h e a m o u n t o f g r o s s m o n t h l y i n c o me 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 r e n t r y i n t o t h e p r o j e ct. l 1 b . G r o s s M o n t h l y I n c o m e a t P r o j e c t E x i t . En te r the gross monthly income the participant is receiving when exiting rhe project. I l c . I n c o m e S o u r c e s R e c e i v e d a t P r o j e c t E n tr y, Enter all types of assistance the participant is receiving at entry to the projecr. a. Supplemental Security Income (SSI) b . S o c i a l S e c u r i t y D i s a b i l i t y I n s u r a n c e ( SSD I) c. Social Security d. General Public Assistance e. Temporary Aid Needy Families (TANF) f. StateChildren's Health Insurance Program(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

8.

9a. Sp ecial Ne ed s. Ent er t he let t er ( s ) f or t he cate go ry(ie s) that des c r ibe t he par t ic ipant ' s d isa bility(ies). ( You m ay double c ount ) .

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I I d.In co me Sou rce s Rec eiv ed at P r oj ec t Ex it . Ente r a ll typ es of inc om e t he par t ic ipant is receiving at pro jec t ex it . ( Us e c odes as in 1 1 c . ) t 2a Le ng th in Stay in Pr ogr am . Calc ulat ed it em . (See Entry Date and Ex it Dat e abov e. ) t 2b. I-en gth o f Siay in Pr ogr am . ( Par t ic ipant did no t lea ve du ring ihe oper at ing y ear . How lon g h ave th ey b ee n in t he Pr ojec t ?) 13. Rea so n for L ea v ing Pr ojec t . Ent er t he pr im a r y rea so n why 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 an d are not ex pec t ed t o r et ur n wit hin 9 0 d ays. a. L eft fo r a h ous ing oppor t unit y bef or e
!v,,,P,!,,,,D ^^-^lotinn tha .,,nrn F, -gram

15.S u p p o r t i v e S e r v i c e s . E n t e r a l l t y p e s o f
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 v e d d tr 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 r s c m a n a g e m e n t) d. Alcohol or drug abuse services e. Mental healrh services f. HIV/AIDS-related services g. Othcr health care scrvlces h. Education i. Flousing placement . ..1E m p l o y m e n t a s s i s t r n c e k. Child care
I Trancnnrfation

m. Legal n. Other (pleasespecify)

b. Comp lete d p r ogr am c. Non -pa yme nt of r ent / oc c upanc y c har ge d. Non -co mplia nc e wit h pr ojec t e . Crimin al act iv it y / des t r uc t ion of pr oper t y / viole nce f. Rea ch ed maxim um t im e allowed in pr ojec t g . Nee ds cou ld not be m et by pr o. lec t h . Disa gre eme nt wit h r uies / per s ons i. Dea th j. Othe r (p lea s e s pec if y ) k. Un kn own /di s appear ed

14. De stin atio n, E nt er t he des iinat ion of t hos e lea vin g the pro jec t Pe rman en t: a . Ren tal hous e or apar t m ent ( no s ubs idy ) b . Pu blic H ous ing c. Section 8 d. She lter Plus Car e e. HOME s ubs idiz ed hous e or apar t m en t f. Othe r s ubs idiz ed hous e or apar t m ent g. Home owner s hip h. Mo ve c i in wit h f am ilY or f r iends Tra n siti o na l: i. Tran siti onal hous ing f or hom eles s per s o n s j. Mo ve d i n wit h f am ilY or f r iends Institutio n: k. Psychia t r ic hos Pit al. l. Inp atie nt alc ohol or dr ug t r eat m ent f a c i l i t y m. Ja il/pri s on Emerg en cy: n . Emerg enc y s helt er Oth er: o . Othe r suppor t iv e hous ing. p. Places not m eant f or hum an habit at io n {e.g ., stre et ) q . Oth er ( pleas e s pec if Y) Un kn own l r. Un kn ow n

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