(exp.11/30/2009) No.

OMB Approval 2506-0145

U. S. Department of Housing and Urban Development Office of Community Planning and Develooment

G@PV

Annual Progress Report (APR)

fbr Supportive Housing Program Shelter Plus Care and Section8 Moderate Rehabilitation for SingleRoom Occupancy Dwellings (SRO) Program

HUD-40118

33 Public reporting burden for this collection ofinformation is estimatedto average hoursperresponse,including the time for reviewing instructions, Thi on . s earch i n g e x i s t i n g d a t a so u r ce s,g a th e r in g a n d m a in ta in in g thedataneeded,andcompl eti ngandrevi ew i ngthecol l ecti onofi nformati sagenc y may not conduct or sponsor, and a person is not required to respond to, a collection ofinformation unless that collection displays a valid OMB control number.

GeneralInstructions ,':.
Purpose. ThE Annual ProgressReport (APR) is a reporting tool that HtlD usesto track program progress and accomplishmentsand inform the Department's competitive processfor homelessassistance funding. Filing Requirements. Recipientsof HUD's homeless grants must submit 2 APR,S to IILID within 90 davs after assistance the end of each operatins vear. One copy of the report must be submrttedto the Community Pianning and Development (CPD) Division Director in the local HL1D Field Office responsiblefor managing the grant. The other copy must be submitted to HIID Headquarters, Departmentof Housing and Urban Development, Attn: APR Data Editor, Room ji62,45l :'t'Sffeet, SW, Washington, DC. 2A410. Failure to submit an APR will delay receiving grant funds and may result in a determination of lack of capacity for future funding. An APR must be submitted for each operating 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 frst operating year and every year throughout the 20 years. A separate report must be submitted for eachHUD grant received. For Shelter Plus Care (S+C), a separateApR must be submitted for each S*C component. For those granteesreceiving an extension, a separatereport covering that period must be submitted (seeExtension below). Recordkeeping. Granteesmust collect and maintain information on eachparticipant in order to complete an ApR. Optional worksheetsare attached. The worksheetsmay be used to record information manually or to design a computerized system to store and tabulate the information. The worksheetsshould not be submittedto HIID with the ApR. organization of the Report. The APR is organized in the followrng nurnner: Part I: Project Progress. This portion of the report describes progressin moving homeless the personsto self-sufficrency, documenting servicesreceived, listing project goals, and accountingfor beds/units. Part II: Financial Information. This portion of the report is completed all grantees by receivingfunding under SHp, S+C, and SRO. Final Assembly of Report. After the entire report is assembled, number every page sequentially. Mark any questionsthat do not apply to your program with "N/A" for not applicable. (See Special Instructions for SSO Projects below.) Definitions of Client/Household Types. Each clienttrousehold fype is definedbelow. Note that a client's clien;4rousehold type should be basedon the client's age and"/or household composition at the program entry date closest to the start ofthe opet'aling year. Families - A family is a householdcomposed two or more relatedpersons,at leastone of who is a child accompanied of by an adult or a juvenile parent. Singles not in Families - Personsnot accompaniedby children, including pregnantwomen not accompaniedby other children and unaccompaniedyouth, are singles not in famrlies. When two adults or two unaccompaniedyouth present togetherforservices,eachpersonshouldbecountedinsinglesnotinfamilies.. Clients'householdstatusshouldbe deterrninedbased on their household composition at the progam entry date closestto the start of the operating year. This meansthat pregnant women expectedto give birth during their program stay should still be counted asiingles not in families. Adults in Families - Within a family, an adult is any person 18 years of age or older. For the purposesof APR reporting, the determination of whether a person is an aduit in family should be made basedon their age and household composition at the program entry date closest to the start ofthe operating year. Children in tr'amilies - Children in Families are defined as children under the age of 18 accompaniedby one or more adults (parent, relative or guardian). Chiidren in famrlies also include both a juvenile parent and the parent's childlren;. For the purposesof APR reporting, the determination of whether a person is a chiid in family should be made based on their age and household composition at the program enhy date closestto the start of the operating year. For example,
HUD-40118

clients who are less than 18 years of age on the first day of the operating year or at program entry (if they enteredduring the operating year) should be counted as children even ifthey turn 18 during the course ofthe operating year. Persons in Families - Personsin families includes aduits in families and children in families.

Other Key Definitions. The following terms are used in the APR. As indicated, in some cases,terms are applied differently dependingon whether the funding is ffom SHP, S+C, or SRO. Chronically homelessperson - HIID definesa chronicallyhomeless person as "an unaccompanied homelessindividual with a disabling condition who has either been continuousiy homelessfor a year or more OR has had at least four (4) episodes homelessness the past three(3) years." To be consideredchronicallyhomeless, personmust havebeen on of in a the sheetsor in an emergencyshelter(i.e., not in transitionalhousing) during thesestays. HUD's definition of a chronically homeless personis basedon the following components: r Unaccompanied homelessindividual: an unaccompanied homelessindividual has the samecharacteristics of a Singlenot in a Family (describedabove). r Disabling condition: seethe inskuctions under disabling condition (below) to determinewhether a client is disabled. Did not leave the program - This term refers to clients who were in the program on the last day of the operating year. Disabling condition - HUD definesa disablingcondition as: (1) A disability as defined in Section223 of the Social Security Act; (2) a physical, mental, or emotional impairment which is (a) expectedto be of long-continued and indehnite duration, (b) substantially impedes an individual's ability to live independently, and (c) of such a nature that such ability could be improvedby more suitablehousingconditions;(3) a developmental disability as definedin seciion 102 of the Developmental Disabilities Assistanceand Bill of Rights Act; (4) the diseaseof acquired immunodeficiency s1'ndromeor any conditions arising from the etiological agency for acquired immunodeficiency s1'ndrome; (5) a diagnosable or substanceabusedisorder. Entered the program - Enteredthe programrefers to the first day a client receivesservices.For a residentialprograrn, this date would representthe first day of residencein the program's housing. For services,this date may representthe day of program enrollment, the day a service was provided, or the first date of a period of contiluous participation in a service (e.g.,daily, weekly, or monthly). For S+C and SRO proglarns, the program entry date is the date that the participant startsto receive rental assistance.For S*C, servicesprovided prior to this point are recognized as necessaryfor outreach,/enrollment are eligible to count as and match. An Extension APR applies to SHP and S+C granteesthat requestedand received an extensionof their grant term from the HIID f,reidoffice. The only difference between an APR for the extension period and the regular APR (besidesthe amount of time covered) is the signaturepage. Granteesshould circle "yes" to indicate the APR is for an extension period and circle the operating year for which the report is an extension.For example, if the granteeis extending year 3, the grantee should 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 signature page. Grantee meansa direct recipient of the HUD award. Left the program - Left the program refersto the last day a client receivesservices.For a residentialprogranl this date would represent last day of residence the program's housing. For services, exit datemay represent last day the in the the a servicewas provided or the last date of a period of continuousservice. If a client leavesthe program temporarily(e.g., for a hospitalization) but is expectedto return within 30 days, do not count that ciient as having left the program. For S+C programs, the program exit date refers to the date the parlicipant stops receiving rental assistanceand is not expectedto retum to S+C assistedhousing. Ifthe participant returns to S+C assistedhousing within 90 days, the person shouldnot be consideredas exiting from the program. If the personreturnsto S+C assisted housingafter 90 days,that person is considereda new participant. The worksheet is designedto capture this information.
HUD-40118

receivedby participantsin the S+C project which, in the aggregate, Match for S+C is the value of supportiveservices rnust at least equal the value of the S+C rental assistance provided over the life of the project. For SHP, match is cash usedto providethe grantee's portion ofacquisition, rehabilitation, new construction, operationsand supportiveservices expenses. Operating year - For SHP prograrrls,the first operating year begins after development activities for acquisition, rehabilitation, and new construction are complete, after a copy of the Certificate of Occupancy is sentto the local HIID office, and when the first participant is acceptedinto the project. For projects without acquisition, rehabilitation, or new construction,the operating start date begins when the granteeacceptsthe first parlicipant. For dedicatedHMIS projects, the operatingyear begins when any eligible cost included in the approved project budget is incurred. For S+C (Sna, PRA and TRA components),the first operating year begins on the date HUD signs the grant agreement. For S+C/SRO and for Sec. 8 SRO, the fust operating year begins with the effective date of the Housing Assistancepa)rrnents(HAp) Contract. To determinewhich operating year to circle on the APR cover page, begin counting from the initial grant operating srarr date and include renewal grants. For example, a project receiving an initial grant for three years anda renewal grant for two years would circle years 1, 2, and,3respectivelyon the APR cover sheet for the initial grant and would circle 4 and 5 respectively for the renewal grant. For any future renewal grants,the granteewould begin by circling 6 on the ApR cover sheet. Participants - The term participant refers to Singlesnot in Families and Adults in Families as defined above. pafticipant does not include children or caregiverswho live with the adults assisted. Project Sponsor meansthe organization responsiblefor carrying out the daily operation of the project, if the organization is an entity other than the grantee.

Special Instructions for Supnortive Service Only (SSO) Programs. SSO grantees should completeall questrons, unless a written agreementhas been reachedwith the field office conceming which questionscan be answeiedusing estimates, or in rare instances,skipped. Below is an exampieof how informationcould be derivedin a large,single-service SSOproject: A grantee/sponsor staff member couid be assignedto collect information from the organizalisns housing the participants. The dtaff person would contact theseindivi dual organtzations requestinformation regarding the persons rn thaifacrlity that use to the service. For participants living on the street,the grantee/projectsponsormay provide estimates. Information could be collected for eachparticipant or for parlicipants receiving servicesat a point-in-time. If estimatesor point-in-time counts are used, the method used must be describedin the APR and the documentationkept on hle. As with all projectsfundedunderHUD's homelessness grants,grantees assistance operatingSSO projectsare expectedto complete all APR questionsthat are applicable to them. Note that all projects have been awarded funds as a result of responding to the program goals of assistinghomelesspersonsobtain/remainin permanenthousing and increasetheir skills and income. The APR documentstheir progress in meeting thesegoals. In some circumstances field offices and granteesmay sign a written agreementconcerning questionsthat can be answeredusing estimates,or in rare instances,skipped. Seethe special inskuctions below for reporting on special tlpes of projects, such as outreachonly projects, projects providing servicesto children only, and fransportation,medical, dental, and other single, shortdruationserviceprojects. SSO programs are a third priorify for local HMIS implementation, following emergencyshelters,transitional housing prograilN, outreachprograms, and permanentsupportive housing programs. Once SSO progranN are included in the HMIS, SSO grantees will be able to answerall APR questionsusing their HMIS data. SSO granteesthat are not yet participating in HMIS will need to collect data to answerthe APR questionsusing the special instructionsprovided above. Outreach Only Projects. Projectswhich are solely devotedto streetoutreachand connectionto housirg and servicesare not required to track pafticipants beyond their contact with personson the sheet. It is sufficient for theseprojects to enter
HUD-40r l8

for questions 5-9 are allowed,given that infonnation on questions1-10 (skipping questions11-13 and 17). Estimates questions. personal to parlicipants may be reluctant answer Answering the questionswili demonstratethat the grantee is serving the approprratenumber of people, providing bastc demographic hformation for Congress,demonstrating that homelesspersonsare being served, demonstratingthe types of housing participants are connectedto, and the type of servicesthey are receiving. Hotline Projects. Hotline servicesare similar to outreach only projects, but contactbetweengranteeand padicipantis often of very shorl duration - people enter and leave the program nearly simultaneously. It is sufficient for theseprojects to answer questions1-5 (skipping4), 10, and 14-19(skipping 17). for Projects Providing Services To Children Only. Projectsthat provide child care,after schoolcare,counseling 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 reporled on in questions6-16 of the APR. Like all other projects, this tlpe is also targeted toward getting the families into housing and increasingthe families' incomes. Granteesmay skip question9; ali other questions shouldbe answered(except I 7). provide a Transportation, Medical, Dental, and Other Single, Short-Duration Service Projects. Somegrantees single service of fairly short duration focused ONLY indirectly on assistinghomelesspersonsto obtainhemain in permanent housing and increasetheir skills and incomes. It is sufficient for theseprojects to enter information on questions 1-10 and 1419 (question 17 may be 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 fewblocks. For these services,provide a narrative, which gives the number of rides given during the operating year, and provides estimates on the above statisticsbasedon the population that utilizes the service. shouldreport on all parficipants ser-ved during the For Safe Haven (SH) Proiects. Crrantees Special Instructions operating year. Note: this is a changefrom prior instructions where granteeswere instructed to report on the first 25 participantsserved.

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

shouid frll out the cover sheetof the APR. Part II Financial Information, and the HMIS Activities section.

HUD-401 l8

THIS PAGE. TO BE COMPLETEDBYALL GRANTEES

Grantee:

HUD Grantor ProjectNumber:

of Services Department Human of Cig andCounty SanFrancisco,

Prniect Snnn cnr'

cAO1c501040
Project Name:

Tenderloin Housing Clinic

year OperatingYear: (Circle operating beingreported the on)

Tenderloin Housing Clinic

Reporting Period : (month/day/year)

!r lz nr !+ ns Xo lt ns fls nro nrr n r z n r : n r+nrs [ro ni z nrs nrs nz o

Indicate extension: n Yes X No if if Indicate renewal: X Yes ! uo Previous Grant Numbers thisproiect for

from: 07/0'1106 06/30/07 to:

cAOc301 039

cAo1 c401 051

cAo1 c201 034

cA01 01 1 c1 0 3

Check the component for the program on which you are reporting.

Supportive Housing Program (SHP) Ll I I ransltlonalHousmg Housing for Homeless Permanent Persons with Disabilities Safe Haven Innovative Supportive Housing SupportiveServices Only HMIS

Shelter PIusCare (S+C) n X I tr (TRA) Tenant-based RentalAssistance (SRA) Assistance Sponsor-based Rental (PRA) Project-based RentalAssistance (SRO) Single RoomOccupancy

Section ModerateRehabilitation 8 tr SingleRoomOccupancy (Sec. SRO) 8

n n n n

(One twosentences a descriptionpopulation, number served accomplishments and or with year) Summary theproject: of of thisoperating year,this projectprovidedup to 90 unitsof permanent housing homelesssingleadults. All to Duringthis operating participants were from the streetsor emergency and are livingwith at leastone specialneed related of the shelters substance use,of HIV/AIDS. to mentalhealth,
questions aboutthis report Name& Title ofthe Person who cananswer
Phone: (include area code)

Support Manager Colleen Carrigan, Services

Address: City andCountyof SanFrancisco

415-59s-3976
Fax Number: (include areacode)

'126 Hyde Street, Francisco, 94102 San CA

4Is-345-9740

org E-rnail Address leen@thclinic. col

I hereby certify that all the information stated herein is true and accurate. (18 false and in Warning:HUDwill prosecute claims statements. Conviction result criminal may and/or penalties. U.S.C. civil 100i,
1 0 1 0 1 0 121 U. S . C. 7 2 9 .3 8 0 2 . 3l 3'
Name & Title of Authorized Grantee Ofhcial: Signature& Date:

Stephen Adviento, Shelter PlusCareProgram Grants & Analyst

Name and Title of Authorized Project Sponsor Official:

Signature &

-/*fr
HUD-40118

Randy Shaw, Executive Director

PART I. TO BE COMPLETED BY ALL GRANTEES(EXCEPT

HMIS)

INSTRUCTIONS PAGE3 OF THEAPR ON PLEASE SEESPECIAL SSO GRANTEES, Part I: Project Progress
1.
a

Projected Level of Personsto be served at a given point in time. (This information comesfrom the most recentCoC
tcatlon.
Number of SinglesNot in Families Number of Adults in Families Number of Children in Families Number of Families

Proiected Level
a.

Persons be servedat a givenpoint in time to

90

2.

Persons Served during the operating year.

Number of SinglesNot in Families Number of Adults in Families Number of Children in Families Number of Families

Number on the first day of the operating year b. c. d. Number entering program during the operating year Number who left the program during the operating year

84

22 22
84

Numberin theprogramon the lastday of the operating year ( a+ f - s ' l: 6

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

Client program llrsldayof in on yar,lefrd!ringlhe operating yeaf: counltn2aand2c.

Clienl in program on firsl day of operating yeaf and last day ofoperaling year: counl in 2a and 2d. H H Client entered and leff program before slart of operatrngyear: do not count In queslion 2 Client entered and leff program duf ng operatlng yea| count in 2b and 2c.

pr C l i enl er ed ogr am i ng enl dur y ear oper ati ng ands l i l li n program lasldayofyeer: on c ouni n 2b and2d i

Fist day ofthe operarng year

Lasl day ofthe operating year

Number on the first day ofthe operating year: This row includesall clientswho enteredthe programbefore the first day ofthe operating year and did not leave the program until after the first day of the operating year. b. Number entering the program during the operating year: This row includesall clients who enteredthe program on or after the first day ofthe operatingyear,up to and including the last day ofthe operatingyear. For clients with multiple program entry dates,use the entry date closestto the startofthe operatingyear.Do not count the client more than once even ifhe/she enteredthe programmore than once during the operating year. Numtler who left during the operating year: This row includesall clientswho left the program on or after the first day of the operatingyear, up to and including the last day ofthe operatingyear. For clientswith multiple program exit dates,use the exit date HUD-40118

cl0sestt0 the end of the operatingyear.Do not count the client more than once even if helsheexited the programmore than once during
fho nnpr at i- a. , - . .

d'

N um ber int hep ro g ra m o n th e l a s td a y o fth e operati ngyear: Thi srow i ncl udesal l cl i entsw how erei ntheprog r am asof t hef ir st dayofthe operating or who entered year during operating andwho did not leave the year duringtheoperating year.Thenumber of clients families theprogram thelastdayofthe operating is calculated or in on year based thJresponses rows2a through For on to 2c. each column, thenumber clients families row 2ato thenumber clients families iow 2b andsubtract number add of or in of or in the of clients families row 2c. Therefore, 2a+ 2b - 2c. or in 2d:

3.

Project Capacity.
Number of SinglesNot in Families Number of Adults in Families Number of Children in Families Number of Families

Number on the last day (from 2d, columns 1 and 4)

84

b.
c.

Number proposed application in (from 1a,columns and4j 1

Ca pa city Rate(d iv ide aby b) : %

90
93%
%

Explanatory Notes: Row b refersto the mostrecentcoc application which theprogramis reporting. for 4. Non-homelesspersons. This questionis to be completedfor Section8 SRO projects.

Howmanyincome-eligib1enon-homelesSpersons*"'"ho,''"d

5'

Age and Gender. Of those who entered the project during the operating year, how nany people are in the followrng age and gendercategories? Single Persons (from2b, columnt)
a. 62 and over
I

Male

Female

b.
d.

5 1-61
JI-)U

5
11

3
1

I 8-30
l7 and under

Persons Families (from2b. columns & 3) in 2

f
o

62 and over

h.

51 ot 3l - 50

r8 - 30
L

13-17 6-12 UnderI

m.

Explanatory Notes: Thisquestion refers onlyto Singles in Families Persons Families not and in who entered program the duringtheoperating year.only clients whomeetthese criteria be counted thistable.Thetotalnumber can in persons ofclientsreported underSingle should equal the be to number reported question column1. Thetotalnumber clients in 2b, of reported under Persons Families in should equai thesumof be io columns and3 in question 2 2b. Answer questions6 - 10 only for participants who entered the project during the operating year (from 2b, columns1 & 2). The term participant meansSinglesnot in Familiesand Adults in Famrlies. It doesttot itrrtua" children or caregivers.NOTE: The total for questions , 8 and 10 below shouldbe the same;respondto eachof thosequestions all participlnts. ,7 for Someof the questionslisted throughout the APR will be asking information for individuals who are chronicallv homeless.

HUD-401 18

6a. Veterans Status. A veteranis anyonewho has eter been on active military duty status.

participants veterans? Hoi,v many were

I 1

6b. Chronically homelessperson. An unaccompanied homelessindividual with a disabling condition who has eitherbeen continuously ho mele ssfora y ear or m or eO Rhas hadat leas t f ou 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 eT os .e c o n s i d e r e d ar b chronicallyhomeless personmust have beenon the streetsor in an emergency a shelter(i.e. not transitionalhousing) during thesestays. For further discussionof the definition of chronic homelessness, Other Key Definitions under the GeneralInstructions see above.

How manyparticipants werechronically homeless individuals?

I 13-l

7.
a. b.

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

8
14

Explanatory Notes: Eachparticipant should listedin only onecategory. totalnumber be The ofparticipants thistableshould in equal number the ofparticipants in question colunrns and2. 2b, I

8.
a.

Race. How manyparticipants in thefollowing are racialcategories?

American Indian/Alaskan Native
Aslan

b. c. d.

Black/African American Native Hawaiian/Other Pacific Islander

White I
o

3 2 5

h.
1.

American Indian/Alaskan Native & White Asran & White Black/Afiican American & White American Indian/Alaskan Native & Biack/African American Other Multi-Racial

ll

Explanatory Notes: Each participantshouldbe listed in only one category. A participantwhose race doesnot correspond categories through i should be to a countedin j, Other Multi Racial. The total number of participantsin this table should equal the number of participantsin question2b, columns 1 and 2. If using HMIS data,you may combineHMIS race response categories generate APR response to the categories.

9a. Special Needs. How many participantshave the following? Participantsmay have more than one. Ifso, count them in all applicablecategories.For eachcondition, also indicatethe number that were chronically homeless. All Chronic q a. Mental illness o 1 b. Alcohol abuse 5 Drug abuse 6 5 d HIV/AIDS and relateddiseases 2 f
g

h.

Develoomentaldisabilitl Physicaldisability Domesticviolence Other (pleasespecify)

2
z

1
4 I

A Explanatory Notes: To determine whichparticipants meetHUD's definition "disabled," "Disabling of see Condition" under OtherKey Definitions theGeneral in Instructions. 9 HUD- 40118

9b. Howmany thepanicipants disabled? of are

10. Prior Living Situation. How many participantsslept in the following placesin the week prior to enteringthe project? (For each participant, choose one place. The total number of participants in the "A11" column shouid equal the number of pafiicipants in question 2b, columns 1 and 2). Also, indicatehow many chronically homeless participantsslept in the following places. (Chooseone) All b. d. (street, park,car,bus station, Non-housing etc.) Emergencyshelter Transitionalhousine for homelessDersons Psychiatricfacility* Substanceabusetreatment facility* Chronic 4
o
.t
-a -.-il

5 t4 3

.\

i.
h

Hospital*
Jail/prison* Domesticviolence situation Living with relatives/fri ends Rentalhousing Other (pleasespecify)

l' :r
",
.- l

t.

*lf a participant came from an institution (psychiatric facility, substanceabusetreatment faciiity, hospital, or jail), but was there less than 30 days and was living on the street or in emergencyshelter before entering the treatment facility, helshe should be counted in either the streetor sheltercategory,as appropriate.

Complete questions 1 1 - 15 for all participants who left during the operating year (from 2c, columns I and 2). The terrn participant means shgle persons and adults in families. It does not include children or caregivers. The term chronically homeless person means an unacconlpanied homeless individual with a disabling condition who has either been continuously homeless for a year or more OR has had at least four (4) episodes of homelessness in the past three (3) years. To be considered chrorucally homeless a person must have been on the streets or in an emergency shelter (i.e. not hansitional housing) durrng these stays.

1 1. Amount and Source of Monthly Income at Entry and at Exit. Of thoseparticipants who left during the operatingyear,how many participants were at eachmonthly income level and with eachsourceof income? Also, pleaseplace the monthly iniome level and each sourceofincome for chronically homelesspersons in the secondcolumn ofeach chart. The number ofparticipantsin Chart A and B should be the same. AII A. Monthly Income at Entry No income Chonic C. Income SourcesAt Entrv Supplemental SecurityIncome (SSI)

l-'.-4'1:i
z

4
4

;. 1' :
1

Atl

Chronic

b.
c.
A

$1- 150 $151 $2s 0 1 $25 - $500

b.

SocialSecurity Disability (SSDI) Income

Social Security

2 10
8

z
A

General PublicAssistance
Temporary Aid to Needy Families (TANF) StateChildren's Health Insurance Program(SCHIP) Veterans Benefits EmployirnentIncome Unemployrnent Benefits Veterans Health Care Medicaid Food Stamps

10

s501 sr,000 s1001$1500

$1501- 0 0 $20 + $2001

f
g

c.
h

h.
l.

2
1

1 1

J
t,

m.. n.

Other (pleasespecify) No Financial Resources

z

l0

H U D - 4 01 8

AII

Chronic
ltliil, ":::rt:; .,lr.,':ilrif'

Alt
D. Income Sources Exit at

Chronic
i

B. MonthlyIncome at Exit
a.

No income

a.

Supplemental SecurityIncome (SSi) Social SecurityDisability Income (SSDI) Social Security z

b. c d.

$ 1-1s 0

b. 1
6

1 1

s151 5250 $251- 0 0 $s $501 $1,0 0 0 $1001- 5 0 0 $r

z z
z

d.
9.

GeneralPublic Assistance TemporaryAid to Needy Families (TANF) StateChildren's Health InsuranceProgram(SCHIP)

I
z

f
o

I
g

$r501s2000
+ $2001

Veterans Benefits
EmploymentIncome Unemploy'rnentBenefi ts Veterans Health Care Medicaid Food Stamps Other (pleasespecify) No Financial Resources

h.

h
I

k. I
m. n.

Explanatory Notes: Table A: Monthly income at entry refers to the participant'smonthly income on the day he/sheenteredthe program(i.e., on the program entry date or as closeas possibleto that day). You should not report on income receivedbefore enteringthe program or incomereceived during the program stay. Table B: Monthly income at exit refersto the participant'smonthly income on the day he/sheleft the program (i.e., on the programexit date or as close as possibleto that day). You should not report on income receivedduring the pro$am stay. Table C: Income sources entry refersto the participant'ssources income on the day he/sheenteredthe program(i.e., on the program at of entry date or as closeas possibieto that day). You shouldnot report on sourcesof income receivedbefore enteringthe programor income received during the program stay. Participants with no income at the time of program entry should be reported in category n, No Financial Resources. Table D: Income sources exit refersto the participant'ssources at ofincome on the day heisheleft the progratn(i.e., on the programexit date or as close as possibleto that day). You should not report on sources incomereceivedduring the program stay. Participants of with no income at the time of program exit should be reportedin categoryn, No Financial Resources.

12a. Of thosepafticipantswho Ieft during the operatingyear (from 2c, columns 1 and2), how many were in the project for the following lengthsof time? Also, pleaseplace the length of stay for chronically homelesspersonswho left during the operatingyear in the second column. AII Chronic

b.
c. d.

Lessthan I month 1 to 2 months 3 - 6 months 7 months 12months l3 months - 24 months 2 5mo nt hs - 3y ear s 3 years-4.0years 4 ye ars- 5y ear s 6 ye ars- Ty ear s 8 years- 10 years Over I 0 years

2
o

I
g

0
1
z

1 1
z

G(a). h.

1
z

Explanatory Notes: Computeeachparticipant'slength ofstay using the participant'sprogram entry date and program exit date. Ifthe participanthas only one programexit dateduring the operatingyear, calculatelength ofstay by subtractingthe program entry date from the programexit date. Ifthe participanthas multiple program exit datesduring the operatingyear, calculatethe length ofstay for eachprogram stay(by subtractingthe

1l

HUD-40118

progf1m entry datefrom the program exit date for each ptogram stay) and add them together to produce a cumulative length of stay. Each participant should be associatedwith only one length of stay category. The total number of participants in the frrst column ("A11") should equal the number of participants in question 2c, columns 1 and 2. 12b. Length of Stay in Program. For thoseparticipantswho did not leave during the operatingyear (from 2d, columns 1 and 2), how long have they beenin the project? Also, pleaseplace the length ofstay for chronically homelesspersonswho did not leave during the operatingyear in the secondcolumn.

AII
b. c. d f. h. Lessthan I month I to 2 months
z

Chronic

I 7
z

3 - 6 months
7 months - i2 months 13 months- 24 months 25 mon ths - 3y ear s

B
44 II

1 6 4
z

4y ear s - 5 y e a rs
6 ye ars-Ty ear s 8 years - 10 years
t+

Over10years

18

Explanatory Notes: Compute eachparticipant'slength ofstay using the participant'sprogram entry dateand the last day ofthe operatingyear. To calcutare length of stay, subtract the program entry date from the last day of the operating year. Each particiiant should be asiociated with only one length of stay category. The total number of participants in the first column ("All") should equal the number of participants in questron 2d, columns1and2.

13. Reasons for Leaving' Of those participants who lgft the project during the operating year (from 2c, columns 1 and2),how many left for the following reasons?If a participant Ieft for multiple reasons, include q4lythe primary reason. The rotal number of partrcrpants in the first colunm ("All") should equal the number of participants in question 2c, columns I and2. A1so,please place the primary reason for chronically homelesspersons who left the project during the operating year in the second coiumn. All
a.

Chronic

Left for a housing opportunity before completing progrzLrn Completed program

b.
u,
I

Non-paynent renVoccupancy of charge

Non-compl iancewith project Criminal activity ldestruction of property / violence f. Reachedmaximum time allowed in oroiect Needscould not be met by project Disagreementwith rules/persons Death J.
t.
I

2
1

Other (pleasespecify) (left independently) Unknown/disappeared

11

t2

HUD-401 18

14. Destination. Of thoseparticipantswho left during the operatingyear (from 2c, columns 1 and 2), how many ieft for the following destination? Aiso, pleaseplace the destinationofchronically homelesspersonswho !e during the operatingyear in the second c o lumn ' At Chronic PERMANENT (a-h) Rental house or apartment (no subsidy) I b.
c

Public Housing Section8

d.

Shelter PlusCare
HOME subsidized house or apartment Other subsidized house or aDartment Homeownership Moved in with family or friends Transitionalhousing for homeless persons Moved in with family or fiiends Psychiatrichospital Inpatient alcohol or other drug treatment facility Jail/prison Emergencyshelter

f.
o

h.

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

j
1-

I
m. EMERGENCY SHELTER (n)

4
z
I

1 1 1

OTHER(o-q)

o.

Othersupportive housing
Placesnot meant for human habitation (e.g. street) Other (pleasespecify) Unknown (Deceased)

Y.

2
6

UNKNOWN

Explanatory Notes: Identify eachparticipant'sdestinationupon leaving the programusing the categories provided. The response categories combine "destination" (e.g.,rental house or apartment,public housing,homeownership, etc.) and "tenure" (e.g.,permanent, transitional,etc.). Consider both destination and tenure to determine the most appropriate response,and be sure to look at all ofthe responsecategoriesbefore making a selection.The table below provides a briefdescription ofeach response category. Enter the number of participants under each destination category in either the first column of the table or in both columns if the participant is chronically homeless. Only one reason for leaving should be recorded per participant. The total number ofparticipants in the first column ("All") should equalthe number of participantsin question2c, columns I and 2.

Tenure
Permanenl b

Destination
Rental house or apartment (no subsidv)

Description Participant is moving to an apartment or house without any subsidy. Participantis moving to a public housing unit Participantwill use a housing choice voucher(formerly known as a Section 8 voucher) to rent a house or apartment. Participantis moving to a unit funded by the ShelterPlus Care program(e.g.,TBA, SRA, PRA, Section8 SRO). Participantis moving to a unit with rental assistance providedby the HOME program (tenant-based project-based or assistance). Participant is moving to a unit subsidizedby some program other than public housing,housing choicevoucherprogram(formerly Section8), ShelterPlus Care, or HOME. Participantis moving to a unit that he/shehas purchased Participantis moving in with family or fnends and expects live there to for 90 days or more. Participantis moving into a unit funded by a transitionaihousing program for homelesspeople (e.g.,transitionalhousing fundedthrough the SupportiveHousins Proeram). Participant is moving in with family or fnends and expectsto live there less than 90 days. Participantis moving to a psychiatrichospital.

Public housins Section 8 PlusCare Shelter HOME subsidized house or apartment

d.

f.

Other subsidized house or aDarfment

g.

Homeownershio
Moved in with family or friends Transitionalhousing for homeless people

h. Transitional

J. Institution
1.

Moved in with family or friends Psvchiatrichospital

13

HUD-40118

Tenure
m n.

Destination
tnpatient alcohol or other drug treatment facilitv

Description
Farticipant is moving to an inpatient alcohol or drug treatrnentfacility'

Jail/Prison
Emergency shelter

is Participant movingto a iail or prison.

Participant is moving to an emergency shelter for homelesspeople. Participant is moving into supportive housing that does not correspond to any ofthe permanent housing categories(a-h) and is not transitional housins for homelessoeoole(i). such as Section 8i i housins.* Participant is moving to a place not meant for human habitation, such as a car, park, sidewaik,or abandoned buildine. Participantis moving to a place that doesnot correspond any of the to cateqories above(a-p). This response categoryshouldbe used if you are unsureabout where the participant is moving or ifthe participant has disappearedand there is no way to find out where he/sheis.

Emergency Shelter Other

Other supportive housing

Y'

q. Unknown

Placesnot meant for human habitation Other (pleasespecify) Unknown

*HUD encouragesprograms to limit the use of the "Other Supportive Housing" APR responsecategory. Programs should report destinations to housing that are perntanent or transitional in APR categories (a) through (h) or in categories (i) through (j), respectively. Exits to emergencyshelters should be reported in category @).

15. Supportive Services. Ofthose participants who left during the operating year (from 2, columns 1 and2), how manyreceived the following supportive servicesduring their time in the project? Also, pleaseplace the supportive servicesreceived for chronically homelessparticipants who left during the operating year in the second column. Participants may have received multiple servicesand all servicesshouldbe reportedin the table. All z
zz
I

Chronic

Outreach b. Casemanagement Life skills (outside of casemanagement) d. Alcohol or drug abuseservices Mental health services f.
b.

8 1
o

lo

HIViAIDS-related services
Other health care services Education Housing placement Emnlovment assistance
J

h.

4
z

1.

Child care Transportation

m.
n

Legal

Other(please specify)

14

HUD-401 l8

objectivesfor this operatingyear (from your application,Technical 16. Overall Prosram Goals. Under objectives,list your measurable Submission,or APR) for eachof the three goals listed below. Under Progress, describeyour progressin meeting the objectives. Under Next OperatingYear's Objectives,specify the measurable objectivesfor the next operatingyear. z. Residential Stability

Objectives: Attachment 16 B. See

Progress:

Next Operating Year'sObjectives:

b.

Increased Skills or Income

Objectives: Attachment 16 B. See

Progress:

Next Operating Year'sObjectives:

c.

Greater Self-determination

Objectives:See Attachment B. 16
Progress:

Next Operating Year'sObjectives:

17. Beds. SHP recipients answer S+C 17a. recipients answer SRO 17b. recipients answer (SHP-SSOprojects do llc. not complete this question)
a. SHP. How many bedswere included in the applicationapproved for this project under 'Current Level' and under 'New Effort,? How many of these New Effort beds were actually in place at the end of the operating year? Current Level New Effort New Effort in place Number of Beds: S*C. How many beds and dwelling units were being assisted with project funds at the end of the operatingyear? (Include beds for ail participants, other family members, and care givers.) Number of Beds: 84 Number of Dwellins Units: 84 c. SRO. How many dwelling units were being assisted the end of the operatingyear? at (Include units occupiedby "in place" non-homeless personswho qualify for assistance..l Number of Dwelline Units:

b.

15

HUD-401l8

Part II: Financial Information

18. Supportive Services. For SupportiveHousing (SHP), this exhibit providesinformation to HUD on how SHP funding for supportiveservices was spentduring the operating year. Enter the amount of SHP funding spenton thesesupportiveservices. Include HMIS costsunder .,Other',. For ShelterPlus Care (S+C), this exhibit tracks the supportiveservices match requirement.Specifythe value of supportiveservices fiom all sourcesthat can be countedas match that all homeless personsreceivedduring the operating year, (S+C granteeishouldkeep documentation file, including source,amount,and type of supportiveservices.) on For Section8 SRO, this exhibit provides information to HUD on the value of supportiveservices receivedby homeless personsduring the operating year.

Supportive Services
a.

Dollars

Outreach Casemanagement Life skills (outside of casemanagement) Aicohol and drug abuseservrces Mental health services

$4,968.60 $34,780.19 $9,937.19 (DHS) $35,705.75 (DHSportion $57,090.26 was $52,'121.66)

b.
a

d.

I
6.

AIDS-relatedservices Other health care services Education Housing placement

h.

J
1.

Employmentassistance Child care Transportation

$7,452.90

m. n.

Legal Other (please specify)

1). Residential Management Skills 2). Benefits Advocacy 3). Representative Payee/MoneyMgmt. 4). Food/Clothing/ Donation Distribution
o. TOTAL (Sum of a through n)

$64,380.85 $17,389.53 $64,380.85 $4,968.60

$301,054.72

Cumulative amount of match provided to date for the Shelter Plus Care Program under this erant

lo

HUD-401 18

Operating Costs,HMIS Activities and Administration 19. Supportive Housing Program: Leasing,SupportiveServices, year. expansion All grantees receiving funding under Supportive the Housing Program mustcomplete these charts each operating For projects: lf SHPgrantfundsarefor theexpansion a pre-existing of homeless facility,only thepeople expenditures theadditionai and for expansion be included, in theoriginal may as application any$ant amendments. or Documentation resources is not required be of used to submitted thisreportbut should kepton fi1efor possible with be inspection HLrDandAuditors.Do not include expenditures by any rnade before SHPerant the wasexecuted. Summaryof Expenditures. Enter the amount ofSHP grant funds and cashmatch expendedduring theoperating yearfor each activity. Thistableshould up bothhorizontally and vertically. The SHP supportiveservicestotal should be thesame rheSHPsupportive add as services Question in 18.
SHP Funds
a

Cash Match

TotalExpenditures

Leasing SupportiveServices

b.

Operating Costs
d. HMIS Activities Administration I Total

Not e: Paymentsofprincipal and interest on any loan or mortgage may not be shown as an operating expense.

Sourcesof Cash Match. Enter the sources cashidentified in the Cash Match column, above,in the following categories.Use additional of sheets, necessary. as

Amount
a

Crantee/project sponsorcash Local govemment (pleasespecify)

b.

c.

State govemment (please specify)

d.

Federalgovernment(pleasespecify) Community DevelopmentBlock Grant (CDBG)

Foundati ons (pleasespecify)

Private cashresources (pleasespecify)

Occupancy charge fees /

Total

h.

17

HU D - 4 0 1 1 8

20. Supportive Housing Program: Acquisition, Rehabilitation, and New Construction All grantees received that SHPfundsfor acquisition, rehabilitation, new conskuction or mustcomplete these charts the yearoneApR in only. This exhibitwill demonstrate HUD thatthe grantee contributed to has enough cashto at leastequallymatchthe amount SHp funds of

spent for acquisition, rehabilitation, or new construction. Documentation that matching funds were provided is not required to be submitted with this report but should be kept on file for possiblei ion by HIID and Auditors. Summary of Expenditures' Enter the amount of SHP grant funds and cash match expendedduring the operating year for each activrty. SHP Funds Acquisition b. c d. Rehabilitation New construction Total Cash Match Total Expenditures

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

Amount
2

Grantee/projectsponsor cash Local government (please specify)

b.

State govemment (please specify)

d.

Federal government (please specify)

Community Development (CDBG) Block Grant

tr,

Foundations(pleasespecify)

Privatecashresources (pleasespecify)

Occupancycharge/fees Total

h.

18

HU D -40118

FOR IIMIS ACTIWTIES ONLY

21. For Supportive Housine (SHP) - HMIS Activities This exhibit providesinformation to HUD on how SHP-HMIS funding for supportiveservices was spentduring the operating year. Enter the amount of SHP-HMIS fundine spenton theseactivities.

HMIS Activities Only

Dollurs :
l

CentralServer(s) Personal Computers and Printers Networking Security Subtotal

Softwure
Software i User Licensins Software Installation Support and Mahtenance SupportineSoftwareTools Subtotal

Semices
Training by Third Parlies Hostins / TechnicalServrces Programming: Customization Programming:SystemInterface

Proqramming.: Data Conversron Security Assessmentand Setup On-line Connectivity (Internet Access) Facilitation Disasterand Recovery Subtotal Project Management/ Coordination Data Analysis Programming Technical Assistanceand Trainins Administrative Sunport Staff Subtotal SpaceCosts Operational Costs Total

t9

HUD-40118

Describe any problems and/or changes implemented during the operating year.

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

20

HUD-40118

PersonsServed Worksheet - HUD Annual Progress Report

Collection of the Protected PersonalInformation (PPI) on this form is done with the knowledge or consent of the clients. The PPI is only used for the following purpose: Accurate completion of the Annual ProgressReport (APR) for the Continuum of Care (CoC) Homeless AssistanceProgram in which the client is enrolled. Thisworksheet optional is intended helpyou collectinformation is and to needed complete AnnualProgress to the Report. Insfructions and Codes follow. Do not submitthis worksheet HUD. to
Relationshtp Number of Months in Project (calculate) l2a Number of Months in Project -Participant did not leave (calculate) 12b

New Partrcipant (Y/N)

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

PersonsServed Worksheet (continued)

Collection of the Protected PersonalInformation (PPI) on this form is done with the knowledge or consent of the clients. The PPi is only used for the following pulpose: Accurate completion of the Arurual ProgressReport (APR) for the Continuum of Care (CoC) Homeless AssistanceProgram m which the client is enroiled.

Do not submitthis worksheet HUD to

No. Veterans Status (Y,N) 6a Chronically Homeless

(Yn{)
6b

Ethnicity (code) 7

Race (code) 8

SpecialNeeds (code) 9a

SpecialNeeds (code) 9b

Prior I i vi no Situation (code )

Monthly Ingome At Project Entry l 1a

Monthly income At Project Exit l 1b

! (
I

10

21

HUD-40118

22

HUD-40118

Persons Served Worksheet (continued) Coilectionof theProtected Personal Information (PPI) on this form is donewith theknowledge consent the clients. The or of PPI is only used thefollowingpurpose: for Accurate completion the AnnualProgress of Repofi(APR) for the Continuum Care(CoC)Homeless programin of Assistance which the client is enrolled.
Do not submit this worksheet to HUD
Reason for Leaving Program (code) 13

Instnlctions and Codes for Persons Served Worksheet T he use o f this wo rk s heet is opt ional. I t was des i g n e d to help yo u co llect inf or m at ion on par t ic ipant s ne e d e d to com ple te th e Ann ual Pr ogr es s Repor t . I f t he works he et is up da ted as par t ic ipant s m ov e in and m o v e out of you r pro ject, m os t of t he inf or m at ion r equi r e d f or comp letio n will b e c ont ained in t he wor k s heet. D o not sub mit th is wo rk s heet wit h t he ApR. F or pr oje cts tha t se r v e f am ilies , HUD only r equir e s reporting o n th e n um ber of c hildr en s er v ed, and t h e age and g en de r of th es e c hildr en. O nly nam e, relation sh ip, da te ofb ir t h, and age on t he wor k s he e t
z)

n e e d t o b e c o m p l e t e d f o r c h i l d r e n . A s s i g n t h e a d u l ts a n u m b e r , b u t n o t e a c h f a m l l y m e m b e r . U i e t hi s n u m b e r t o t r a n s f e r t o t h e o t h e r p a g e s o f t h e w o r k s h e et. B e g i n n i n g w i t h n u m b e r 4 , t h e n u m b e r s i n t h e co l u m n s refer to the questions on the ApR form. If any q u e s t i o n s a r e a n s w e r e d w i t h , , O t h e r , , , p l e a s e e n te r th e specific "Other" answer for inclusion in the ApR. Participant Number. This column allows you t o e i t h e r n u m b e r p a r t i c i p a n t s c o n s e c u t i v e l y or to assign a case number. One number should be assigned to each adult.

HUD-401 18

N ame. Name s o f p er s ons wiil not be r epor t ed t o H UD. The u se o f na m es is f or y our r ec or d k eepin g conv en i e nce. Relatio nship . En ter t he appr opr iat e r eiat ions hip . E xample s includ e: S elf , Head of hous ehold, Spou s e , child. E ntry Da te. Ente r dat e par t ic ipant ent er ed t he proiect. Usua lly th is will be t he dat e of ac t ual phys ica 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 oiec t. Usually this will be t he dat e t he par t ic ipant physica lly moved o ut f or a hous ing pr ojec t . Do n o t inclu de a p articipa nt who t em por ar ily lef t t he pr o j e c t and is e xp ected to r et ur n in les s t han 90 day s ( e. g . , hosp italizatio n). 4. In co me-e ligib le 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 Se ctio n 8 incom 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 only, in dicate whet her t he par t ic ipant is an income -elig ible , non- hom eles s per s on ( Y) or n o t ( N), SHP an d S+ C pr ojec t s s hould s k ip t his i t e m .

a. Mental illness b. Alcohol abuse c. Drug abuse d. HIV/AIDS and related diseases e. Developmental disability f. Physical disabilities g. Domestic violence h. Other (please specify) 9 b . E n t e r t h e n u m b e r o f p a r t i c i p a n t s w i t h a d i sa b i l i ty 1 0 . P r i o r L i v i n g S i t u a t i o n . E n t e r t h e l e t t e r th a t b e st d e s c r i b e s w h e r e t h e p a r t i c i p a n t s l e p t i n th e w e e k prior to entering the project. Do not double 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 facility* e, Substance abuse treatment facility* f. Hospital* g. Jail/prison* h. Domestic violence situation i. Living with relatives/friends j. Rental housing k. Other (please specify) *I f a p a r t i c i p a n t c a m e f r o m a n i n s t i t u t i o n b u t w a s t h e r e l e s s t h a n 3 0 d a y s a n d w a s l i v i n g 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 of Birth . Ent er dat e of bir t h inc ludine m o nth , d ay, a nd y ear . 5b. Ag e. En ter a ge at ent r y . 5c. Ge nd er, Ente r appr opr iat e let t er f or gender . M -Ma le F- Fem ale. 6a. Ve tera ns Sta tus . I ndic at e if t he par t ic ipant i s a ve tela n. Ple ase not e: A v et er an is any one w h o Itas e ve r be en o n ac t iv e nt ilit ar y dut y s t at t t s f o r the Un ited Sta Ies . 6b. Chro nically h om eles s per s on. I ndic at e t he nu mbe r o f pa rtic ipant s t hat ar e c hr onic ally h ome less. 7. Eth nicity. Enter appr opr iat e let t er f or et hnic gro up . a. Hisp an ic or Lat ino b . Non -Hisp an ic or Non- Lat ino Ra ce . En ter ap pr opr iat e let t er f or r ac e. a. Ame rica n Ind ian or Alas k an Nat iv e b. Asian c . Bla ck o r Afric an- Am er ic an d . Native Ha waiian or O t her Pac if ic I s lander e. Wh ite f. American Ind ian/ Alas k an Nat iv e & W hit e g . Asia n & Whi t e h. Black/African Am er ic an & W hit e i. American Ind ian/ Alas k an Nat iv e & Black/African Am er lc an j. Oth er Mu lti-Rac ial

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

I l a.Gross Monthly Income at Project Entry. E n t e r t h e a m o u n t o f g r o s s m o n t h l y i n c o m e th e p a r t i c i p a n t i s r e c e i v i n g a t e n t r y i n t o t h e p r o j e ct I l b . G r o s s M o n t h l y I n c o m e a t P r o j e c t E x i t . En te r the gross monthly income the participant rs receiving when exiting the project. 1 I 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 f E n tr y. Enter all types of assistance the participant is
r p n p i .r i n c qf p n r r \/ J l^ !v th a ur! nr^ia^f

8.

9a. Sp ecial Ne ed s. Ent er t he let t er ( s ) f or t he cate go ry(ie s) th at des c r ibe t he par t ic ipant ' s disab ility(ie s). ( You m ay double c ount ) .
1A

a. S uppl emental ecuri tyIncome (S S I) S (SSDI ) b. S oci al S ecuri tyD i sabi l i ty Insurance c. S oci al S ecuri ty d. GeneralP ubl i c A ssi stance e. TemporaryA i d N eedy Fami l i es(TA N F) (SCHIP) f. State Children's HealthInsurance ProgTam g. V eteransbenefi ts h. E mpl oymenti ncome i . U nempl oyment benefi ts j . V eteransH eal th C are k. Medi cai d l . Food S tamps m. Other (pl easespeci fy) n. N o Fi nanci alR esources
H U D - 4 0 1 t8

1 l d.Income So urces Rec eiv ed at Pr ojec t Ex it . Ente r a ll typ es of inc om e t he par t ic ipant r s receiving at p rojec t ex it . ( Us e c odes as in 11 c . ) 12a Le ng th in Stay in Pr ogr am . Calc ulat ed it em . (See Entry Date and Ex it Dat e abov e. ) 12b. L en gth o f Sta y in Pr ogr am . ( par t ic ipant di d no t le ave d urin g t he oper at ing y ear . How lon g ha ve the y b ee n in t he pr ojec t ?) 13. Re ason fo r L ea v ing Pr ojec t . Ent er t he pr im a r y re ason wh y th e par t ic ipant lef t t he pr ojec t . ( Co mple te on ly f or par t ic ipant s who lef t t he pro ject a nd a re not ex pec t ed t o r et ur n wit hin 9 0 da ys. a. Le ft for a ho us ing oppor t unit y bef or e co mple ting the pr ogr am b. Co mple ted pr ogr am c. No n-p aymen t of r ent / oc c upanc y c har ge d . Non -co mplia nc e wit h pr ojec t e . Crimin al a cti v it y / des t r uc t ion of pr oper t y / vio l e n ce f. Rea ch ed ma x im um t im e aliowed in pr ojec t g. Ne ed s cou ld not be m et by pr ojec t h . Disag ree men t wit h r ules / per s ons i. De ath j. Oth er (p lea se s pec if y ) k. Un kn own /disappear ed

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 1 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 ve d d u r i n g lhe time in rhe project. a. Outreach b. Case management c . L i f e s k i l l s ( o u t s i d e o f c a s e m a n a ge m e n t) d. Alcohol or drug abuse services e. Mental health services f. HIV/AIDS-related services g. Other health care servlces h. Education i. Housing placement j. Employment assistance k. Child care L Transportation m. Legal n. Other (please specify)

14. Destina tion . Ent er t he des t inat ion of t hos e lea vin g the pro jec t . Perma ne nt: a . Ren tal ho us e or apar t m ent ( no s ubs idy ) b. Pub lic Ho us ing c. Se ctio n 8 d. She lter Plus Car e e. HOME s ubs idiz ed hous e or apar t m ent f. Oth er subs idiz ed hous e or apar t m ent g . Home ow ner s hip h. Moved in wit h f am ily or f r iends T ran sitio na l: i. Tra nsition al hous ing f or hom eles s per s o n s j. Mo ve d in wit h f am ily or f r iends Institutio n: k. Psychia tr ic hos pit al. l. In pa tien t alc ohol or dr ug t r eat m ent f ac i l i t y m. Jail/p riso n Eme rge ncy: n . Emerg en c y s helt er Othe r: o . Othe r sup por t iv e hous ing. p. Pla ce s no t m eant f or hum an habit at ion (e.9 ., stree t) q. Othe r (p leas e s pec if y ) Un kn own : r. Unkno wn

25

HUD-40118

SPCR THC'06I'07 cAO1c501040 Reporting Period: ll 106-6130107 7

Residential Stability Objectives: At least80% of participantswill remain in housingfor six months. (96Yo) remained Progress:Exceeded.101 of 105participants in housingfor six months. Year's Objectives: At least 80% of participantswill remain in Next Operating housingfor six months. will remain in housing for one year. of Objectives: At least70o/o participants Exceeded.98 of 105 participants(93.3%)remainedin housing for one Progress: yeaf. of Next OperatingYear's Objectives: At least70Yo pafiicipantswill remain in housingfor one year.

IncreasedSkills or Income Objectives:Maintain Memorandum of Understandingor formal referral with five pre-vocationalandlorvocationalprograms,which may include mechanisms Adult EducationalProgram,ConardHouse Goodwill, EpiscopalCommunity Services, TenderloinHousing Clinic Employment,SanFranciscoCommunity VocationalServices, and Day Labor Program,Community Vocational Enterprises, College,SanFrancisco HomelessEmploymentCollaborative. Achieved. During this operatingyear,the CaseManagershave Prosress: with the following pre-vocationaland the formal referral mechanisms maintained Adult Educational vocationalprograms: Goodwill, EpiscopalCommunity Services, Program,SanFranciscoCommunity College,SanFranciscoDay Labor Program, and HomelessEmploymentCollaborative. Community VocationalEnterprises, with the following Additionally, we have developednew referral relationships programs:One-StopCareerCenter,Clean City, Toolworks Vocational Program,and Community HousingProgram Emplol.rnentServices. or Next OperatingYear's Objectives: Maintain Memorandumof Understanding with five pre-vocationaland/orvocationalprograms,which formal referralmechanisms Adult EducationalProgram,San may include Goodwill, EpiscopalCommunity Services, FranciscoCommunity College,San FranciscoDay Labor Program,Community and VocationalEnterprises, HomelessEmploymentCollaborative. We will enterinto to with our local ShelterPlus Carerepresentative updatethis objectiveprior discussions year's APR. to next

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Greater Self-determination Obiectives:At least l0o/oor participantswill eitherobtains/sustain employrnent during the operating year. Progress:Achieved. of the 70 respondents, (r3%) reportedobtainingor 9 sustainingemployrnent during the operating year. Next OperatingYear's Objectives: We will enterinto discussions with our local ShelterPlus Carerepresentative about changingthis objectiveprior to next year's ApR.

ob-iectives: thosethat obtain employment,40oA of will obtain full time (not temporary) employment. Pro8ress:Not Achieved. Of the 9 that reportedobtainingor sustainingemployment during the operating year, 2 (22%) reported having obtainedemployment that was full time (not temporary)employment. However l3o/oof all residents housedduring operating year were able to obtain or sustainemployrnent,either temporary and/or parttime employrnent. Our goal is to keep theseresidentsstabilized and help them maintain their housingwhile helping them access and utilize medical,psychiatricand mental health services. Next OperatingYear's Objectives:We will enterinto discussions with orir local Shelter Plus Carerepresentative aboutchangingthis objectiveprior to next year's APR.

Objectives:At least 35% wlll participatein tenantmeetings Proeress: Exceeded.365 of 924 (40%) participantsattended11 tenantmeetings. We also offeredparticipantsweekly food pantries,holiday partiesand BBQs, and outings to the movies. Next OperatingYear's Objectives:At least 35% will participatein tenantmeetings

Objectives:At least75o/owlll developand acquireskills suchas socialization, relationship-building, literacy, money management,and artistic skills. Proeress:Exceeded.Of the 70 participants that responded, (93%) statedthat they 65 had developedor acquiredskills such as socialization, relationship-building, literacy, money management, and artistic skills. Next OperatingYear's Objectives:We will enterinto discussions with our local ShelterPlus Carerepresentative about changingthis objectiveprior to next year's APR.

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