G@PV

OMB Approval 2506-0145 No. (exp.11/30/2009)

U. S. Department of Housing and Urban Development Office of CommunityPlanning and Development

Annual ProgressReport (APR)

for Supportive HousingProgram PlusCare Shelter
and Section8 Moderate Rehabilitation for SingleRoom Occupancy Dwellings (SRO) Program

HUD-401l8

PuLrlicreporting burden for this collection ofinformation is estimatedto average hours per responseJ 33 inclu<iingthe time for reviewing instructions, s earc h i n g e x i s t i n g d a t a s ou r ce s' g a th e r in g a n d m a in ta in in g th edataneeded,andcompl eti ngandrevi ew i ngthecol l ecti onofi nformati on. hri sagen"y may not conduct or sponsor, and a personis not required to respondto, a collectionofinformation unlessthat collection dispiaysa valid OMB control number.

General fnstructions
Purpose. The Annual ProgressReport (APR) is a r-eporlingtool that Hl,D usesto track +*aeks-program progressand accomplishmentsand inlbrm i*-the Department's competitive Eg-qqs!&{ homelessurti.1un." p-"g**rf,'4d1lc Filing Requirements. Recipientsof HUD's homeless assistance erants must submit 2 ApR,S to HUD within 90 days alter the end of each operating year. One copy of the report must be submrtted tt ,o (CPD) Division Director in the local HtlD Field Office responsiblefor managing the grant. The other copy must U. s,rU-it.a to HUD Headquarters,Department of Housing and Urban Development,Affn: APR Data Ed.itor, p.oomii1z,45l'1th Street, SW, Washrngton,DC. 20410. Failure to submit an APR will delay receiving grant funds and may result in a detennination of Iack 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 hrst operating year and an1*-evellyear i*-x&i<#+hey+rseIJp
^^^ ^" -^*,4!b,

ocratie+throughout the 20 years. this-APR A separatereport must be submitted for each HLD grant received. For Shelter Plus Care ApR must be {S+C), a separate submitted for eachShra+er-Pk**reSr-C component. For those granteesreceiving an extension,a separatereport covering that period must be submitted (seeExtension below). Recordkeeping. Granteesmust collect and maintain infofmation on eachparticipant in order to complete an ApR. Optional worksheetsare attached. The worksheetsmay be used to record information manually or to design a computerizedsysiem to store and tabulatethe information. The worksheetsshould not be submitted to HUD with the ApR. organization of the Report. The APR is organized in the following manner: Part I: Project Progress.This portion of the report describes progressin moving homeless the personsto self-sufficiency, docunenting servicesreceived, -[g;!4gproject goals, and . Part II: Financial Information. and SRO. This portion of the report is completed by all granteesreceiving funding gnder SHp, S+C,

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 Proiects below.)

'wne+l
r.el+h{.a*++ieu-u**l Eu.h cli.tlihorrseh.rl.ltwe ir tlel-rn"dbelor.,. Not. thut a client's clientr'hoLrsehold shoulcl basedon the cliert's age andior householdcomposition.t/ /le progrurr enrn, r/ale r:/ose.r/ rre t-ype be /o st art o-/' operat i il g J gllt. the +ePet*er*i;e-4i{J'ere*+e{ies*"]lo*se&e}48

ehildren

HU D - 4 0 1 1 8

persons.at lelst cineof who is a child accornpalied cir composedo1'tr"'o n'rolerelateci is a I.*nilics - A Jar-nil_*- lrnrrsehold jltleu]tj2algll hy an adult or a by bv not accompanied children.including plegnant women not acconrpanied other Singlesnot in l'amilies - Persons youth. are singlesnot in f-amilies.\l"helt trvo aclultsor {lnvo unaccompanied youth present chililren anclunaccompanied be togetherfor selvices.cachpersonthetr-shoulcl countedina; singles-not in lamilies.n<*ir+far*i]ies.Cllients'irouseholcl basedon their householdcomgositionat the progmm entry date closestto the start of tire statusshouldbe deternrined glqating )'eat'.7 as s inqlc s r tin fa n ri l i c > . nt Adults in Families '- \4rithirta farnily. an adult is any pslrsort year:s age or older. For the purposesof APR repolting. 18 of a the c{etennination rl.'hetlrcr personjs an achlltin famil-\, of shouldbe made basedou iheir ase and llouselloldcomposition at tire programc'ntr_y closestto the siart o1'theoperatingyear. rlate Children in Fanrilies - Children in Fatrilies are definedas childrenrutderthe ase of 18 accompanied one or mor:e by aclults(piLqg,rcbltrc_:u gardii irn. Children in families also include both a For the purposesof API{ reporting. the cleierrnination r,l'hether person is a iuvenile @en). of a child in famil)' should be maiie basedon tlteir age and householdcompositionat the pr:osram entrv date closestto the start of ihe operatingyear. For example.clients*'ho are lesstl-ranI 8 )'ears of age on the flrst da]' of the operatingyear or at prograrnentr)'(.i1'the)i enteredduring the operating)iear)shoulel countecl children eveu if the)z be as tum 18 drLring the r c or r r s e t he op e ra ti n g e a r' . of Personsin Families - Persons families includesadultsin farniliesand childr-en tamilies. in in f*r+li!1es-A-ftlr111_r{**-heu;ee9l*gqglp@ptr,'on$-s-e*s+-efe9f'n&o1]:jsrlrr-at1r]]rqx.g

t*1lx,tpil$l;-'-{! tle!:itd$jie-eltM

l*r+ieip*nlle*e+s;++$i*gles-fiel.i*r4atrlili**nd-Ad{+'1*#{+amilir*-&sde+r'}d-eb{c,-P+*+eipap.t+1{}cs t}te+xhdt$-tssj,st{xl.'

Other Key Definitigns. T'helblloil.ing terns are used in tlie API{. As indicated.in somecases. termsare apoliedciifl'erenrl.r' clepending rvhether fundilg is fiom SIIP. S+C, or SRO. or the person as "an unaccompanied -homeless Chronically homelessperson - HUD dehnesa chronicallyhomeless individual with a disabling condition who has either been continuously homeless for a year or more OR has-had at least of in foru (4) episodes homelessness the past three(3) years." To be consideredchronicallyhomeless, -person must a have been on the streetsor in an emergencyshelter (i.e.-not in transitional housing) during these stays. personis basedon the follo*'ing compsngnll IIUD's clefiniticrn a chr-onicalll'homeless of r homelessindividual hasthe samecharacteristics Unaccornrranied horneless individual: an unaccornpanied above). of a Singlenot in a Famil)'(described e Disabling condition: seethe insfiuctionsunder disablingcondition (below) to determine whethera client is disabled.

f)icl not leave the program .. This ternrrefers to clientsu'ho rverein the prclglamon the last dav of the operatinqyear:. Disabling condition - Hl.iD deflnesa disablingconclitionas: (l) A disabiiit-v ciefined Section223 of rhe Social as in to SecuritvActl (2) a physical.mentai. or emotionaiimpairment-*'hichis (a) expgcteci be o1'long-continued inriefinite and and duration.(b) substantiallvimpedesan individual's abililr''to live independentllz. (c) of such a nahrrethat such abilitv (3) disabiliqvas definedin section 102 of the coriid be improvedb)'rucrresuitablehousingconclitionsl a developntental De',,elopmental Disabilities Assistanceancillill of l{ights Act; (4) the disease acquiredinrmunodeficiencv of s},nclrome or acquiredimmunodeficiencvs--r'ndrome: (5) a diagnosable an.vconditionsarising fiom the etioloEicalasencyti')r: or substance ablrsedisolder. --+Uness;devetepnae*+ ---+l
rc

*+tsaS+ltyinehdt+4+he-ee-eeeu*rerc-ft#-ol.-fferie+

guD-4ol 18

Entered the program - Enteledthe pr this datemay represent dal' this date rvouldrepresent first dalr of residencein the program'shousing. For services. the the of program enr:ollment. da-rr ser-r'ice plovided. or the fir:stdate of a perjod of continuouspalticipntionin a selvice the a u'as (e.g.. daily, r.r'eekly. monthh'). or For S+C and SRO pr:oqranrs. program entr:ydate is the datethat the the participantstartsto receiverental assistance. provided prior to this point are recognizedas necessary For S+C,services for outreach/enrollmentand are elieible to count as -match. An Extension APR appliesto SHP and S+C grantees that requested receivedan extensionof their grant term from and the HUD field office. The only difference between an APR for the extensionperiod and the regular APR (besidesthe amountof time covered)is the signature page. Grantees shouldcircle "yes" to indicatethe 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 granteeshould submit an APR as usual for year 3 and submit anotherAPR for the extensionperiod, indicating the secondis an extensionand also circling year 3 on the signaturepage. l'*mlty nrcansa netme @ Grantee meansa direct recipientof the HUD award. Left the program - Left the programre rvould r:epresent iast <layof r:esidence the prograrn'shousing. For ser:vices, exit date mav repfesent last darthe in tlie the as er v ic er v as p r-o v i d e d o rth e l a s td a te o fa p eri odofconti nuousservi ce.i entl eavestheprogl amtcnrpor ar ilv( . e. _g. . Ifacl lbr a hospitalization) is expectecl return within 30 da)is,do not count that clienr as having left the program. but to Fgr S+C proqrarls. the program exit date refers to tire date {tlr$+Cfrejeersme**s-.;*he*the parlicipant stopsreceiving rental assistance and is not expectedto return to S+C assistedhousing. Ifthe participant returns to S+C assistedhousing within 90 days,-the personshouldnot be considered exiting from the program. If the personreturnsto S+C assisted as housing after 90 days, that person is considereda new participant. The worksheet is designedto capnre this information. Match for S+C me*nrir the value of supportive servicesreceived by participants in the S+C project which, in the provided over the life of the project. For SHP, match aggregate, must at leastequalthe value of the S+C rental assistance nreans-jrcashused to provide the grantee'sportion of acquisition, rehabilitation, new construction, operationsand supportiveservices expenses. Operating year - FoI SHP plograms. -the S++$IlP*+rean&{l*-dete-*henp$rrieip*ntr;begi serier-+h-first operating year begins after development activities for acquisition, rehabilitation, and new conshuction are complete, after a copy of the Certificate of Occupancyis sentto the local HUD office, and when the first participant is acceptedinto the project. For projects without acquisition, rehabilitation, or new consffuction, the operating start date rvhenany ihe cl the beginswhen the granteeaccepts first participant. For declicale HMIS proir--cis. oper"atius .veal'beuits S+C (SRA, PRA and TRA components),the first eligible-cost included in the applg\,9dpt:oie'cib&Lr.i_1:gUfdFor operating year begins on the date HUD signs the grant agreement. For S+C/SRO and for Sec. 8 SRO, the first operating year begins with the effective date of the Housing AssistancePalments (HAP) Contract.

To determine which operating year to circle on the APR cover page,begin counting from the initial grant operating start date and include renewalsgrants. For example, a project receiving an initial grant for three years and a renewal grant for two years would circle years I , 2, and 3 respectively on the APR cover sheetfor the initial grant and would circle 4 and 5 respectively for the renewal grant. For any future renewal grants,the granteewould begin by circling 6 on the APR cover sheet. Palt icip: P ar t ieipanf s - ' I' h e te rm p a rti c i n a n tre fe l s toS i ngl esnoti nfami l i esandA drrl tsi nFanri l i esasdefrnei i above. nr t rvholive rvitl:tltc adultsassisled. doesnot includechiklrenor caregivers

H U D - 4 01 8 1

ipafit

Project Sponsor meansthe organizationresponsible carryingout the daily operationofthe project, ifthe for organization is an entity other than the grantee.

Instructions tbr Supportive Service Onlv (SSO) P*oieetsPrograms. MSpecial SSO granteesshould complete all questions,unless a written agreementhas been reachedwith the field office concerning which questionscan be answered using estimates, in rare instances, or skipped.

Below is an exampleof how informationcould be derived in 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 faciliry that use the service. For participants living on the street,the grantee/projectsponsormay provide estimates. Infotmation could be collected for each participant or for participants receiving services at a point-in-time. If estimatesor point-in-time counts are used, the method used must be described in the APR and the documentationkept on file. As with all projects funded under HUD's homelessness grants, granteesoperating SSO projects are expectedto assistance completeall APR questions that are applicableto them. Note that all projectshave been awardedfunds as a result of responding to the program goals of assistinghomelesspersons obtain/remain in permanenthousing and increasetheir skills and income. The APR documentstheir progressin meeting thesegoals. In some circumstancesfield offices and granteesmay sign a written agreementconcerning questionsthat can be answeredusing estimates, in rare instances, or skipped. Seethe specialinstructions belorvfor reportins on specialt)!es of projects,such as <xttreach onlv projects.projectsproviding senices to children only. and transportation. medical. clental. and other sinsle. shortdrtratiouserviceplojects. gete*'are senrce SSO prosrams are a third priority tbr local HN,IIS implementation. follorving emergenclrshelters.trarsitienal housing programs. outreachorograms.and petmanentsupportivehousingprograms. Once SSOprogramsare included in the iIMIS. SSO qrantees rdll be able to answerali APR cluestions usirg their HMIS data. SSO srantees that are not yet narticipatingin HfuIISrvill need to collect data to arswer the API{ questions usine the specialinstructions provided above. Outreach Only Projects. -Projects which are solely devotedto streetoutreachand connectionto housingand servicesare not required to hack participants beyond their contact with persons on the street. It is sufficient for theseprojects to enter i n fo tmat iononques ti o n s l -1 0 (s k i p p i n g q u e s ti o n sl l -l 3andl 7), sti matesforquesti ons5-9areal l ow ed,gi ven t hat E participants may be reluctant to answer personal questions. Answering the questionswill demonstratethat the grantee is serwingthe appropriate number of people, providing basic demographic information for Congress,demonstratingthat homelesspersonsare being served,demonshating the tlpes of housing participants are connectedto, and the bpe of servicesthey are receiving. Hotline Projects.Hotline servicesare similar to outreach onlv projects, but contactbetweengranteeand. participantis often of very short duration - people enter and leave the program nearly simultaneously. It is sufficient for theseprojects to answer questions (skipping 4),10, and 14-19(skipping17). 1-5 Projects Providing Services To Children Only. Projectsthat provide child care,after school care,counselingfor children, etc. make an important contribution toward moving a famrly 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 projects, this type is also targetedtoward getting the families into housing and increasingthe famrlies' incomes. HUD-401r8

Grantees may skip question9; all other questions shouldbe answered (except 17). Transportation, Medical, Dental, and Other Single, Short-Duration Service Projects. Somegranrees provide a single sewice of fairly short duration focusedONLY indirectly on assistinghomelesspersonsio obtair,/re*uin in permanent housing and increasetheir skills and incomes. It is sufficient for theseprojects to entei information on questions i-to and t+19 (question 17 may be skipped). However, with transportation servicis, it is unreasonable to think that someonewould have to give their age,race, and ethnicity to a bus driver to get a ride a few blocks. For these sewices, provide a narrative, which gives the number of rides given during the operating year, and provides estimates on the abovestatistics basedon the populationthat utilizes the service" . *Grantees SpgtglqC-Sg{-,Nolqth::-lre-diittsq f.ot t D o, i the I!C!.JS

H*f{}j!{d.;.1,T:T*Nie$+ha++&ey-are-3rene++{}N-L}-<*tlr@app}re*rren-*a.s-*pprev*i-ibr
se:ve*

SpecialInstructions f
should fill out the cover sheet of the aPn_ Activities section.

Management Information System(HMIS) pro

lS aetivities=

. . . . l l . . . . . . . . . . . . . . . . . . . . . ---^ ^ ^ * o '

*HMIS grantees na tne HtitS

HUD-40118

PAGE. TOBE COMPLETED TT{IS BYALLGMNTEES

Gmtee:

HLID Grmt or Project Numbe.

Cityand Countyof San Francisco, Depariment HumanServices of

Project Spomor:

126 cAO1DB30
Project Name:

UnitedCouncilof HumanServices
Operating Year: (Circle the oprating yeu beiag reported on)

HopeHouse
Reporting Period: (month/daylver)

trl D2 xE3 f]4 Ds [o Iz trs f]e Dro E rt nrz lr [r+ lrs lr e [ ] 17 Dt 8 nr s Dz o

Indioale ifextension:

Indigate ifrenewai: Preuious Gr*rN

xD yes I No

yes

x!

No

fiorn:6/1/06

to:5131107

cAo1DB30126

Checkthe component the program whichyou arereporting. for on Supportive Housing Program (SHP) n x[ I I I I TransitionalHousing PermanentHousing for Homeless Personswith Disabilities Safe Haven lnnovativeSupportive Housing Supportive ServicesOnly HMIS Shelter Plus Care (S+C) fl I ! f] Tenant-based Rental Assistance (TRA) Sponsor-based Rental AssistanceISRA; Projecrbased Rental Assistance(PRA) Single Room Occupancy (SRO) Section 8 Moderate Rehabilitation fl Single Room Occupancy (Sec. 8 SRo)

Summary ofthe project: (ODeor two sentences a description with ofpopr:latio&numberserved accompl.ishments operating and this year) Hope Houseis a permanent supportivehousingand customizedemploymentprogramfor cbronically homelessindividuals with disabiing conditions. We provide permanent supportivehousingfor 70 individuals who haveexperience chronic homelessness immediatelyprior to cominginto housing.

Nue & Title of tbe Psson who cm ruwer questionsabout this report: Crumdolyn Westbrrclq Chief Exerrive Offrs Address: 2lll JemingsStreet E-mil Addressgwndolynwestbrook@yahoo.com

Phone: (include ue 415 671-l 100

code)

Fu Nmber: {include uea code) (4t s',)822-3436 / 41 5 6'1 | -I | 84

I hereby certify that all the information stated herein is true and accu
Warning: HIID will prosecute false claims aDdstatements.Conviction may result in 1010. 1 2 :3 1U . S . C . 3 7 2 9 10
Nue & Title of
Gmntee Offrcial:

penalties. (18 U.S.C

Simanre &

MikyungKim-Molina GrantsManager
Nme md Title of Authorired Project SponsorOfficial:

-a

efsr4ghl

Signatue & Date:

GwendolynWestbrook,CEO

o8-4i"o i
TIIJD.4O1 I8

gKtra i 4.3lZ+h - i'rou

(EXCEPT T{MTS) tsY.4LL GRANTEES PARTI. TOBE COMPLETED

SSO PLEASE GKANTEES, SEESPECAL INSTRUCTIOI,IS PAGE3 OF THEAPR OI,{ Fart I: Froject Progress
1 .Fro jec t edLev elof P e rs o n s to b e s e ry e d a ta g i v e n poi nti nti me. irformation comes fi'om the most recent CoQ,SWe*il,+application. ) ----SRC-See-+i
Numberof Singles Not in Families
Number of Adults in Families Number of Children in Families Number of Families

a.

Prol'ected Level Personsto be servedat a given point in time

70

70

2.

PersonsServed 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

70
to

b.
c. d.

Numberentering programduring the operating year

Number who left the program during the operating year Number in the program on the last day of the operating year (a+6 -.1:O

22
64

Exrrlanatory notes: SeeDefinitions of Client/HousehoidTilres in the GeneralInstrLrctions above to determinewhich clientsshoulcl countedas Sinql., Not in be FarniLies. Adults in Families.ffrd Children in Familjes. Note that this table doesnot accountfor chanqes clienlihousehold in ii,pe thar nrav occur:du ring the co trrse of t heoper at ingy ear . I ns t ead. eac. h c l i e n t s h o u l d b e a s s i e n e d a s i n g l e c l i e n t / h o u s e h o i c l t v p e b a s e do n 'ti ;.l i .r t'. aeeandlorhouseholdcontpositionattlteproqrantentry;dateclosesttr:tlrcstartoftheoperatirtgt:ear. Inthiswav.eachcljentiscounted orrlvoncc in tlrctab lc. Lisethe follqrving.gtaphicanil e.xplanations deielnine who should be countedjn rorvs a-d: to

Client program llrsldayof in on year , dur ing oper aling lei the year:count 2a and2c. in Clienl program firstday in on of operaling andlasl year year count dayof operaling i n 2a and2d.
+ H Clieni enlered and left
P 'v9 o ,'L cE 'e E :r qr L ul

Client entered and ieff progfam during operatjng year: count in2b and2c. Client eniered Frogram during operaiing year and slill in program on Iasl day of year counl in 2b and 2d.

year do nol countin operating queslion 2

Fict day ofthe operating year

Last day ofthe operating year

a.

Number on the first dav ofthe operating year: This ro$, includesal1clients rvho enteredthe proqranrbefore the first dav ofthe operating)'ear: and did not leavethe program until atler tlre first day oflthe operatingyear. N*ulnbet' entering the prograrn cluring the operati4g year: This rorv includesall cheits u,ho entei'ed pr.oeram or after the first the on 7da,v the operatinqvear. up to and including the last dat' of ihe operatineyear. Fot' clients with nrultiple pro-sram of enhv clatcs. tlre use entrv date closcstto the start ofthe operatin-syear. not court the client nrorc than once er,enifhe/she enteredthe progranrnr.t. th.n Do yeor. oncedurine, operalin!t the HUD-40118

b'

c'

Number rrho left during the operatingr:ear: This row includes clientsrvho left rlrepl'oeram all on or aft.. th. fi.rt dr,,f ,h. operatillg up togqd includin.g lastday of the ooeratins pvir the vear. Fol clienrcrvirlrnrrrllj'rl"nr^.rrqh1 ,4rio. ,r.o irra^*,,r -\'ear'

3.

Project Capacity.

Number of SinglesNot in Families a

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

Number of Adults in Families

Number of Children in Families

Number of Families

64 70
92 Yo

b.
c.

1.,'i
%

ExplanatoryNotes: Rowb refers themostrecent ('o{.'application whichtheprogram reportine. to for is 4. Non-homelesspersons. This questionis to be completedfor Section8 SRO proiects.

Howmanyincome-e1igiblenon-homelesspeIsonS*.'"hou."d

5'

Age and Gender. Of those who entered the project during the operating year, how many people are in the following age and gendercategories?
Single Persons(from 2b, column 1
A ge

Male

Female

62 and over b. d.

5 1-61 31-50

2
4 5

r8-30
I 7 andunder

3
NA NA NA

lglqgl. in Families(from 2b, columns2 & 3)

f.
g

62 and over

NA

h.

5i -61 31 - 50 l 8-30

NA
NA NA

t3-1',7
t.

NA
NA NA NA

NA NA
NA NA NA

6-t2
l-5 Under I

I m.
f ix plan : r t o n ilotes:

crrlLrn rnsa nd -l in qu cs t ion2h. I

HUD-40118

Answer questions - I 0 only for participants who entered the proj ect during the operating year (from 2b, columns | & 2). 6 Th et er m par t ic ipan tm e a n s s i a n d a d u ]* i A< 1 rr]tsi n{ + + ni ti esE aa!]i e5.Itdoesnoti rrcl ude childrenor caregivers.NoTE: The total for questions, 8 and 10 below shouldbe the same;respondto eachof those 7, questionsfor all participants. Some of the questionslisted throughout the APR will be asking information for individuals who are chronically homeless. 6a. veteransstatus. A veteran anyone is who haseverbeenon activemilitary duty How manyparticipants wereveterans? | ? I

6b. Chronically homelessperson. An unaccompanied homelessindividual with a disabling condition who has eitherbeen continuously homeless a year or more OR has had at leastfour (4) episodes for ofhomelessness the past three (3) years. To be considered in chronicallyhomelessa personmust have been on the streets in an emergency or shelter(i.e. not transitionalhousing)during thesestays. For further discussionof the cicfirritionof chronic honrelessness. Other Ke)..Definitions unclerthc Generallnsrructrons see aboveHow many participantswere chronically homelessindividuals?

7.
a.

Ethnicity. How many participants are in the following ethnic categories? Hispanicor Latino Non-Hispanicor Non-Latino

0 16

lixDlanatory Notes: EilchFarticiD.int shoulcibe listeclin onlv one category. 'lhe total numberolpanicipants in thrs tcblr-shttuldegual the nurnberof Orrt'.i'rnt* in question columns1 and 2. 2b.

8.
a.

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

b.
A

Black/African American Native Hawaiian/Other Pacific Islander

0 0 t4 2

White i.
h.
l.

American Indian/Alaskan Native & White

Asian& White
Black/African American & White American Indian/Alaskan Native & Blaci</African Amerrcan Other Multi-Racial

Explanatory Notes: Each participantshould be listed in only one category. A participantwhose racedoes not corlespondto catcgories through i shouldbQ a countedin i, Other N{ulti Racial. The total number oflparticipantsin this table should equal the nnmber ollparticipants qL}estion in 2b, coltlmns 1 and 2. If using HMIS ciata, categories eenerater APll response to the cateqorie t'ou nrat' conrhineHMIS raceresponse s.

10

H U D - 4 01 8

9a. Special Needs. Hor.vmany participantshave the following? Participants may have more than one. Ifso, count them in all applicablecategories.For eachcondition, also indtcatethe number that were chronically homeless. All Chronic 6 a. Mentalillness b. Alcohol abuse 6 c. Drugabuse 10 10 d e. f. HIV/AIDS and relateddiseases Developmental disabilitl Physical disabilit Domesticviolence Other (pieasespecify)

1 l0

10

s.
h.

9b. How manyof theparticipants disabled? l--l are

ZO

Erplanaforv Notes: wlricn e_Octermine I nsinrctio ns10. Prior Living Situation. How many participantsslept in the following placesin the week prior to enteringthe project? (For each participant,!-$ese-il!g!c one place. 'l'he iotal nLrrnbcr ollp]!I!tsbAuj[!-i]ll!llc itll" Eqlurtrnshould c ual thc nulrber of panicipanisjn qirestittn2b, colunrns I and 2). Also, indicatehow many chronically homelessparticipantsslept in the following places. (Chooseonc) Ail 6 Chronic
o

b. c.
d.

f
o

h.
L

k.

Non-housing(street,park, car, bus station,etc.) Emereencv shelter Transitionalhousing for homelesspersons Psvchiatric facilitv* Substance abusetreatmentfacilitv* Hospital* Jail/orison* Domesticviolence situation Livins rvith relatives/friends Rentalhousins Other (pleasespecify)

10

10

xlf a participantcamefrom an institution (nsychiatricfacilit-v, abusetleatmenttacility. hospital.or iail). but was there less than substance 30 days and rvasliving on the streetor in emergency shelterbeforeenteringthe treatmentfacility, he/sheshould be countedin either the slrce!or shelter_category,appropriate. as

Completequestions11 - 15 for all participants who left during the operating year (from 2c, colunns 1 and 2). The term participantmeanssingle personsand adultsin families.It doesnot includechildren or caregivers.The term chronicall-v individual with a disablingcondition who has eitherbeen continuously homeless homelessperson meansan unaccompanied in of homelessfor a year or more OR has had at leastfour (4) episodes homelessness the past three(3) years.To be considered shelter(i.e. not transitionalhousing)during a chronically homeless personmust have been on the sheetsor in an emergency thesestays.

participants left duringtheoperating who year, I 1 Amount and Source Monthly Incomeat Entry and at Exit. Of those of how many of place monthly participants levelandwith each source income? Also,please the wereat each monthlyincome income levelandeach persons thesecond of in column each chart.Thenumber participants ChartA andB of in source income chronicallyhomeless of for be shouici ihe sarne.
All A. Monthly Income at Entrv No income b
c d.

Chrcnic

All

Chronic

Sources Entrv At C. Income

$1- 150

0 0
1

0
0
1 b. c d.

Supplemental SecurityIncome (SSi) SocialSecurity DisabilityIncome(SSDI)

U
o

sr 5i- s2 50 I s2s- ss00

Security Social
Pubiic Assistance General

5 I

5
a HUD-401 18

10

10

i1

$s 01 $1, 0 0 0 f
g

I
z

I
z

TemporaryAid to Needy Families (TANF) f

s10 0 s1500 rs1501s2000

+ 52001

(SCHIP) Children's HealthInsurance State Program

VeteransBenefits EmployrnentIncome UnemplovmentBenefits VeteransHealth Care Medicaid Food Stamps Other (pleasespecify) No FinancialResources

0
0
z
z

0
0 0 0

0 0

0
U

h.

h.
I

J
1-

0 0 0 0

m.. n.

All B. Monthly Income at Exit No income

Chronic

All

Chrcnic

D. Income Sources Exit at (SSI) Supplemental Security Income b.

c. Social SecurityDisability Income (SSDI)

a.

b.

d.
c.

I
q

sl-150 s151 5250 5500 $2s1s501 $1,000 s1001$1500 s1501s2000

+ $2001

Social Security
General PublicAssistance TemporaryAid to Needy Families (TANF)

14 8

14
8

I
q

StateChildren's Health InsuranceProgranr(SCHIP) VeteransBenefits EmployrnentIncome UnemPlo;,rnentBenefits

h.

h.

VeteransHealth Care Medicaid Food Stamps

m.
n

Other (pleasespecify) No Financial Resources

Erplanaton, Notes: T rb_lgA: Mon thll-in c on] eat ent r - y - r ef er s t ot he iic ipa n t 's r n o n t h l y i n c o m e o n t h c d a y h e i scntefedthc pfogram(i.e..on . . o n th c'p r o g l a m Daf h c c n t e f e d t h c p f o g r a m ( i . e thc'proglam progralr entr-t, clateor as closeas possibleto thal da)-). You sirould not report on inconrereceivedbelbre entcrinsthe nrosralr or incorrereceivecl entcrinli incorre receiveci during the trrogramsta! (i.c.. on thc prograrn gI-!!deIS Ttble B: Monthl)z on insonre exit refersto the participant's at rxonthl)'incornc the dav heisheleft thc proqranr noi report on income receiveddurinq the program sta-v. or as close aspossibleto that day). \'oLr shoulcl

of befbreentelinqthe prograrn incornc or entr)'date as clossaspossible that day). You shouldnot reporton sourccs incomgreceived or to r.r,ith incorne the time of proqramentn,shoultlbe reportecl category No Financial in n. receir,ed at dLrring proqram the stav. Panicipants no Ilesources. proi-ranr on Table D: lncomesources erit rcfersto the plrticipirnt'ssources inconrc the day heishc'left progrim (-i.l-,o!_1he thc at of cxit datq P -r orasclo se aspo ssible t ot hat dav )Yous houlc lnot r epor t o n s o u l c e s o f i r r c o m e r e c e i v e d d u r i n g t h e p r o g r a r n s t aa y..t i c i p a n t s r vj th n p . in Resources. incornc the tirnc of proqram at cxit shoulcl reported categor)'n. Financial be No

l2

HUD-'+O1 l8

I 2a. Of thoseparticipants year(from 2c, columnsI and2), how manywerein-theprojectfor the following who lgft duringthe operating lengthsoftime? Also,pleaseplacethelengthofstayforchronicallyhomelesspersonswholeltdurinqthcoperatingyearinthesecon column.
All
a.

Chronic

b.
A u.

f
o

Lessthan I month I to 2 months 3 - 6 months 7 months - 12 months 13 months - 24 months 2 5mo nths - 3y ear s

12

12

4y ear s -5 y e a rs
6yea rs- Tv ear s 8 years- l0 vears

h.
l.

Over10vears
Explanatorv Notes: Contpute each participant'slength of stay using the participant'sprograrnenfDrdate antl proel.anr exit date. Ijlihe particip,rnt has orl}. .r. Droeran-rexitclxiedulingtl-reopelatingvear.calculatelengthofsta-vbvsubtractingtheorograrr:rentrydateliomtheproqramexitcl.t.. Jfth" garticipani has nultiple programexii datesduringthe oneratingvear. calculatethe length of sta-v eachplgsranr stav(by subtracting for thc 0lo9raln ent* date lrom the program exit-datefor eachprogram stay) and add thenrtogetherto producea cumulativelength ofstau. Eo.h pariicipant shoilld be associated with onlv one lensth ot'sta.r'cateqorlr'. total nunrberof participants the jirst column (*AIl") sh.rld The in ecLrai the nurnberof p4rrlicipgnlltinjus$iierl-?c. columns 1 and 2. l2b. Length of Stay in Program. For those participants t'h*t-rilhs did not leave during the operating year (ffom 2d, columns 1 and 2), how ' long have they been in the project? Also, pleaseplace the length of stayfor chronically homelesspersonswho did not leave di,rrins the operatingvear in the secondcolumn. AII Less than 1 month Chronic

b.
d. f h.

I to 2 months 3 - 6 months
7 months - 12 months l3 months - 24 months 25 mon ths - 3v ear s 4 ve ars-5v ear s 6yea rs-T y ear s 8 years- 10 years Over 10 vears

16

16
ZJ

23 25

25

f,-rplanatory n-otes: Compute eachparticioirnt'slength of stay using the participant'sproerantenby date and the last da),of the operatingvear. To calculate lengfhofstav,subtlactther;r'ograrrentrydatefrornihelastclavoftheoperatingycar. Eachrrar-ticipantshor-rltlbcassociatedrvithonl)rone iength ollstay category. The total nunrberof participantsin the flrst coh.rmn jn ("A11")should equal the number of participants question2d. colunrnsI a nd 2 .

IJ

HUD-401 18

13. Reasonsfor Leaving. Of thoseparticipants who left the project during the operatingyear (from 2c, columns 1 and 2), how many left for the following reasons?If a participantleft for multiple reasons, include g4!2the primary reqson. 'l'he total number of p4lLtr'inant-s in the first colunrn("All") should equalthe nurnberof r;aniciglnis in t-luesticin colurnns1 and 2. Also, pleaseplace the primary 2c. reasonfor chronically homelesspersons$'ho left the pleject durins the opclallingvear -in the secondcolumn. AII Left for a housing opportunity before completing program b. Completed program Non-pal,rnent of rent/occupancycharge d Non-compliance with project Criminal actlvity I destruction ofproperty / violence f.
g

Chronic

7
6

^
1

Reached maximum time allowed in prot'ect Needscould not be met by project Disagreementwith rules/persons Death Other (pleasespecify) Unknown/disappeared
+

h.
I

1
4

J.
t.

t4

HUD-101r 8

14. Destination. those participants left duringtheoperating (from2c, columns and2), how manyleft for_the Of who year 1 followrng destination? place destination chronicallyhomeless Also,please the persons of rvholeft duringtheoperating in thesecond -,-ear columnAll Chronic

PERMANENT (a-h)

(no Rentalhouseor apartment subsidy)

Public Housing Section8

b.
c.

10 2 2

10 2 2

d.

Shelter PlusCare
HOME subsidizedhouse or apartment

f
g

Othersubsidized house apartment or

Homeownership Moved in with family or friends Transitionalhousing for homelesspersons

h.

TRANSTTTONAL (i-j)
J

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

INSTITUTION(k-m)
m EMERGENCY SHELTER InI OTHER (o-q) o.
n Y'

Jaillprison

Emergency shelter
Other supportive housing Placesnot meant for human habitation (e.g. street) Other (please specify) Unknown

q.

TINKNOWN

Explanatory Notes: ldcrrtify eerch nlriiciprrnt:s rlestinat:ion upon lear,ingthe program us:ine the categories provided-The response c.t.ta.i.r.ambir. "deslin{ition"(.e.9.. t'entalhouseor aparlment.public housinq. homeorvner"ship. and "tenure" (e.g..Dennanent. etc.l transitiorral. etc.). Considel boih dcstinationancltenureto detcrrninothe rnostaoplopriatercsponse, anclbe sureto looli at all <lfthe response cate_qoris b..fnr* tnaking a seleciior. The table below nrovidesa briefdescriptiou ofeach response category. EIrterthe nunlberof p4rticipantsunderr eachdestinaiioncatesor)'in eiihcr ihe fifst column of thc tablc or in both columns if the participantis qlUo"i.ally h"t". ("All") should eqLral number of parlicipantsin question2c. columns 1 and 2. the

Tenure
Permanenl
a. 11.

c. d.
!

Destination Rental houseor apadrnent(no sr-rbsidv) Publichous ins Section8 ShelterIrlus C'are HC)N"IE sr.rbsiclized houseor apartnlent Other subsidizc:d houseot-apartnre nt

f)escription Particilrantis nroving to an apartmentor houseu,ithout any subsidlr. Participant noving to a public housingunit is Participantwill use a hoLrsing chojce vouche (fcirrncrlvknorvnas a r Section 8 voucher)to rent a houseor apartment. Plnlicipant is moving to a unit funded by the ShelterplLrsCare piosra-m (e.q..TBA. SR4, PRA, Section8 SRO). Particirrant moving to a Lrnit is u,ith rental assistance providcd bv the l:lON.tlE or uogran (tenant-based oroiect-based assisrance r. Pgticipant is moving to a unit subsidjzedby sorre programother than public housing,housinqchoicevoucherprogr.an (ibrrncr.lv Section8). ShelterPlus Care E. Participantis nrovinq to a uDitthat he/shehas purchased. Participantis moving in rvith fanrily or friends and expcctstcl live there for 90 davs or more. Participant rnovinginio a unit fundedbv a transitional is housine proglarn for honreless people(e.g..transitionalhousing ftrndedthrough the SupportiveHousins Prosram).

f.

g. h.

l {onrcou'n ip crsh Movcd rn r.t,ith farnilr'- friends or 'l'ransitional housingfbr homeless peoplg

'iiansitional

I.

J.
I n.stitution
1.

in familyor tl-ientls L!_crved_rvith

Psvchiatrichosoital

Participant nrotingin rvithtamilvor friends expects live the is and to rc lessthan90 davs.
P a l t i s i p a r ri t n r o r i n q1 oi r p s v c h i r t r i c o s p i r l l s h

15

HUD-40i 18

Tcnure

1.
n1

Emersency Shelter Othe r

n. o.

Dcstination Inpatientalcohol or other drirg treatnrent facilitv JailiPrison Etnergenc)i lter she Othcr supportive housing

!C$r'iDfion Participantis nroving to an inpatientalcohol or drug trealntentl'aci1irv. Palticipant is movinq to a iail or prisor.r. Psdicipant is rnoving to an emcl'gencV shelterfbr homelc-ss people. Participantis moving into supportivclrousingtirat cloes n.otcorrespond to anv ofthe permanenthousingcategories (a-h) and is not tr.ansitjonal (i), hoLrsing honreless for Deople suchas Secrion | I housins.* 8 Particioantis moving to a place not nreantfol.human habitation, such as a c:r, park. sjdetvalk"clrabandoned builchns. Participantis moving to a place that doesnot correspon.lto anv ofthe catcgories abovc (a-t). This response cateqorvshould be usedif),ou are unsureabout u,here the participcllLtir moving or if the partit:ipanrt and ba$1llsappeared there is no rvav to find out whcre he/sheis.

Pllc esnot m eantlbr ir Lr m an habitation

s
Unknor.r,n
r.

Other(please suecii.v) Unkuorvn

Uxits to enrerget!!

llu?lters shauld be reported in categot); (rt).

15. Supportive Services. Of those participants who left during the operating year (from 2, columns I and2), how many received the following supportiveservices during their time in the project? Also, pleaseplace the supportiveservices receivedfor chronically homelessparticipantswho Ieft during the operatingyear in the secondcolumn. Participants rnav har,'e receivedmultiple servicesand all servic:es should be reportedin ihe table.

AII
Outreach
L

Chronic
zz zz

22
zz

Casemanagemenl Life skills (outsideof casemanagement)

zz

zz

d.

Alcohol or drug abuseservrces Mental health services HIV/AIDS-related services Other health care services Education Housing placement Employment assistance Child care Transportation

10
15
zz

10
15
zz

f.
G b'

h.
l.

J.
K.

19 22
zz

m. n.

Legal

Other(please specify)

16

H U D - 4 01 8

l6'

Overall Program Goals. Under objectives,list your measurable objectivesfor this operatingyear (from your application,Technical Submission, APR) for eachof the three goals listed below. Under Progress, or describeyour progressin meetingthe objectives. Under Next Operating Year's Objectives, specify the measurableobjectives for the next operating year. ResidentialStability Objectives:

a.

1. Eightypercentof residents remainhousedfor at leastone year, will Progress: 1. Occupancy rate has been achieved.The 22 peoplethat left Hope Househad been housed for over one year.The 70 clientshousedon the first day of the operating year had been housedfor at leastone year or had achievedone year of housingduringthis operating year.The 16 participants entering our programduringthis operating yearwouldnot hive maintained one year of housingduringthis operating year. The totalnumberof participants year includes duringthis operating boththe numberon the firstday, 70, and the number entering or BOtotalparticipants. 16, HopeHousehas maintained of 86 people 81.4% 70 or occupancy the 3'' year in operations. for
Objectives: Tenantswho are delinquentin rent or have other documentedleasedviolations will experience more then two no reculrences subsequent12-month period. in

Progress:
I. Approximately 5 out of 70 residentswho had two or more recurrence with rent delinquent palments, payments were collectedand theseclients were counseled the importanceof paying their rent on time. Of these5 residents, 2 on residents had four delinquentviolation; t had five delinquent violation; 2 had two delinquentviolations. At the end of this reporting period we have limited the number of recurrence by providing extra life skills training with an emphasis financial responsibility. The casemanagers on have continuedto assistindividuals with personalize budgetsto keep residentson track. As of this APR all clients are on track and maintainingtheir inaividual budget objectives.

This goal was achieved. Objectives: 2. Progress: 2. 37 residents were housedwithin 6 months of start-up;a total of 70 were housedwithin 12 months At least30 residentswill be housedwithin 6 months of start-up;70 residents within 12 months.

This goal was achieved.

NextOperating Year's Objectives: Maintainthe same objectivesfor the next projectyear.

b.

Increased Skills or Income Objecti ves:

At least70% of Hope Houseparticipants engagein work relatedactivities. will Fortypercent HopeHouseclients becomeemployed of will within12 monthsof move-in. At least50% of Hope Houseclientswill be linkedwith mainstream community resources to addresshealth,mentalhealthor substance abuse relatedneeds.

ll

HUD-40118

Progress:

49 clients are involved in work-relatedactivitiesthat include volunteeringat a nonprofit agency,or are invoived in work-relatedactivities; theseactivitiesinclude computerclasses, nursing school,ciefschool and life skills classes; in clu d in g r e su m e wr iti ngandi ntervi ew i ngtechni ques.26cl i entsarei nvol vedi nw ork.totai of4gou tof64or A 7 6 .6 0 /o r ewo r kin g d uri ng thi s reporLi ng we peri od.

2. 3.

Approximately 49 of the 64, or 76.5%o Hope Houseclients rvereemployedwithin l2 months of of move in. 45 out of 64, or 70.3%" participantswere linked to mainstreamcommunity resources that address heajth,mental health or substanceabuse related needs. Some ofthe clients became employed soon after they entered the program a n d d id n o t p u r su em a instream servi ces.

Is were achieved.

NextOperating Year's Objectives: Maintain same goals.

c.

Greater Self-determination Objectives:

t.

Basedon clientssurveys90% of clientswill be ableto identify staff personthey are to contact: a lf and when they need repairsmade in theirunitand if they needto register complaint a or grievance.

Progress: 2. Achieved this goal. As notedby surveys completed 63 of the 70 residents, by or 90% of all residents ableto identify staffpersonthey are to contactwhen repairsare needed are the on the residence.
Next Operating Year'sObjectives: Maintain Same goal. Objective:

2. At least50% of residence actively participate the resident's will in council.

Progress:
2. As provedby the tenantassociation's sign-insheetsapproximately of 70 or 54.3%of 38 residents attendedthe resident's councilmeetingmonthly.Those residents that did not attend are employed and hoursof the tenant's councilmeetingsare in conflict with iheirwork hours. Thisgoalwasachievec. Next Operating Year'sObjective: Maintain same goal. the

18

HUD-40118

17. Beds. SHP recipients answer S+C 17a. recipients answer SRO 17b. recipients answer (SHP-SSOprojects do I7c. not complete this question)
a' SHP. How many beds were included in the application approved 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: 70 q 0 S+C. How many beds and dwelling units were being assistedwith project funds at the end of the operatin gyear? (Include beds for all participants, other family members, and care givers.) Number of Beds: Number of Dwelling Units: c. SRO. How many dwelling units were being assistedat the end of the operatingyear'! (Include units occupiedby "in place" non-homeless personswho qualify for assistance.) Number of Dwellins Units:

b.

19

HUD-40118

Part II: Financial Information

18. Supportive Services. For SupportiveHousine(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 tracksthe supportiveservices match requirement.Specifythe value of supportiveservicesfrom all sources that can be countedas match that all homeless personsreceivedduring the operating year. (S+C grantees should keep documentation file, including source,amounr,and type ofsupportive services.) on For Section8 SRO, this exhibit provides information to HUD on the value of supportiveservicesreceivedby homeless personsduring the operating year.

Supportive Services
a.

Dollars

Outreach Case management Life skills (outsideof casemanagement)

Alcohol and drug abuseservices Mental healthservices

f.
6.

AIDS-related services Otherhealthcareservices

h.

Education Housing placement

J
t-

Employment assistance Child care

L
m. n. o.

Transportation
Legal Other (pleasespecify) TOTAL (Sum of a through n)

Cumulative amount matchprovidedto datefor the of ShelterPlusCare Programunder thisgrant

tn

HUD-401 18

submittedwith this report but should be kept on file for possibleinspectionby HUD and Auditors. Do not include any expendiiures made before the SHP grant was executed. Summary of Expenditures. Enter the amount ofSHP grant funds and cashmatch expendedduring the operatingyear for eachactivity. This table should add up both horizontally and vedically. The SHP supportiveservicestotal should be the same as the SHP supportive sefvlcesrn lon SHP Funds
a

19. Supportive Housing Program: Leasing, Supportive Services,Operating Costs, FIMIS Activities and Administration AII grantees receiving fundingunder Supportive the Housing Program mustcomplete these charts each operating year.For expansion projects:If SHPgrantfundsarefor the expansion a pre-existing of homeless facility,only thepeople .*p.nditur., for thl additional and expanslon be included, in theoriginalapplication anygrantamendments. may as or Documentation resouices is not required be of used to

Cash Match

TotalExpenditures

Leasing

$649,294.6e
160,113.58

$649,294.69 160,113.58 $157,804.72 52,105.00

b. c. d.
g-

Supportive Services Operating Costs

HMIS Activities Administration Total

$105,699.72

$18,874.86 773,869.27 $212.218.58

$18,874.86 $986.087.85

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

Sourcesof Cash Match. Enter the sourcesof cashidentified in the Cash Match column, above,in the following categories. Use additional sheets, necessary. as Amount Grantee/project sponsor cash

b.

(please Local government specify)

MayorsOfficeof Community Development

$25,000.00

Stategovernment (pleasespecify)

d.

Federalgovernment(pleasespecify) CommunityDevelopment Block Grant(CDBG) Departmentof Labor

$107.218.58

(please Foundations speci fy)

LeviFoundation

$10,000

f,

Private cashresources (pleasespecify)

Occupancycharge/ fees h. Total

$70,000
$212,218.58 2l
HUD-401 l8

20. Supportive llousing Program: Acquisition, Rehabilitation, and New Construction All grantees received that or must SHPfundsfor acquisition, rehabilitation, newconstruction complete these in charts theyearoneAPR only. This exhibit will demonstrate HUD thatthegrantee contributed to has enough cash at least to equally match amount SHPfunds the of spent acquisition, for rehabilitation, newconstruction. or Documentation matchingfundswereprovided not required be submitted that is to with thisreport should kepton file for possible but be inspection HLD andAuditors. by
Summary ofExpenditures, Enter the amount ofSHP grant funds and cashmatch expendedduring the operatingyear for eachactivity.

SHPFunds
a.

Cash Match

Total Expenditures

Acquisition

b.

Rehabilitation
New construction

d.

Total

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

Amount
Granteeiproject sponsorcash

(pleasespecify) Local government

c.

Stategovemment(pleasespecify)

Federal government (please specify)

Block Grant(CDBG) Development Community

e.

(pleasespecify) Foundations

f.

(please specify) Private cash resources

Occupancycharge/fees Total

h.

22

HUD-40118

FOR HMIS ACTIWTIES OI{LY

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

HMIS Activities Only

Dollars

E
CentralServer(s) Personal Computers and Printers Networking Security Subtotul

Soflwure
Software/ User Licensins Software Installation Support and Maintenance Supporting Software Tools Subtotal

Services
Training by Third Parties Hosting/ Technical Services Programming: Customization Programming: System Interface Programming: Data Conversion Security Assessmentand Sefup On-line Connectivity (Internet Access) Facilitation Disasterand Recovery Subtotal Project Management / Coordination Data Analysis Programming Technical Assistanceand Trainins AdministratjveSupporrStaff Subtotal

HMIS Space Costs

sni

OperationalCosts Total

z)

HUD-40118

Describeany problemsand/or changes implemented during the operatingyear.

Technical Assistance Recommendations and Based yourexperience on during lastyear, there areas whichyouneed the are any technical advice assistance? please in or Ifso, describe. Yes we need technicalassistanceon fund raisingfor this project. To sustainthe projectas a whole, the Department of Laborfunding case management in this for endswithin18 months. We needassistances maintaining program. The programis working'forthe chronically homelesspeoplewe have participating Hope House and we do not in their many, want to lose the progress have made in housingthe homelessand assisting we them with overcoming many issues such as mental illness,physicaldisabilities, substances with abuses and the problemsassociated addiction.

24

HUD-40118

Report Persons Served Worksheet - HUD ArurualProgress (PPi)onthisformis done withtheknowledge consent theclients.The or Collection theProtected of Personal Information of
PPI is only usedfor the following purpose: Accurate completionof the Annual Progress Report (APR) for the Continuum of Care (CoC) Homeless Program in Assistance which the client is enrolled. needed complete AnnualProgress to the Report. Instructions Thisworksheet optional is intended helpyou collectinformation is to and and to Codes follow. Do not submitthis worksheet HUD.
Number of Months in Project (calculate) 12a Number of Months in Project-Participant did not leave (calculate) 12b New Participant (Y /N )

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

Persons Served Worksheet (continued)

Collection of the Protected PersonalInformation (PPI) on this form is done with the lcrowledge or consentof the clients. The PPI is only used for the following purpose: Accurate completion of the Annual ProgressReport (APR) for the Continuum of Care (CoC) HomelessAssistanceProgram in which the client is enrolled.

to Do not submitthis worksheet HUD

No.

Veterans (Y,Ai) Status 6a

Chronically Homeless (Yn\I) 6b

Ethnicity 7

Race (code) 8

SpecialNeeds (code) 9a

SpecialNeeds (code) 9b

Prior Living Situation 10

Monthly Income At Project Entry 11a

Monthly Income At Project Exit 1l b

II (r
I

25

HUD-401l8

26

HUD-40118

PersonsServedWorksheet (continued)
Collection of the Protected Personal Information (PPI) on this form is done with the knowledge consent or ofthe clients.The PPI is only used for the following purpose: Accurate completion of the Annual ProgressReport (APR) for the continuum of Care (CoC) HomelessAssistanceprogram m whrchthe chentis enrolled. Do not submitthis worksheet HUD to
Reason for Leaving Program (code) i3

Instructions and Codes Persons for Served Worksheet

T he use o f th is wo rk s heet is opt ionai. I t was des i g n e d t o help you co llect inf or m at ion on par t ic ipant s ne e d e d to com ple te th e An nu al Pr ogr es s Repor t . I f t he w orksh ee t is u pd ate d as par t ic ipant s m ov e in and m o v e out of yo ur pro ject, m os t of t he inf or m at ion r equi r e d for co mple tion will b e c ont ained in t he wor k s heet. D o not sub mit this wo rk s heet wit h t he APR. F or pr o jects th at se r v e f am ilies , HUD only r equir e s reportin g on th e n um ber of c hildr en s er v ed, and t h e age an d g en de r of thes e c hildr en. O nly nam e, relat ion sh ip, d ate o f bir t h, and age on t he wor k s he 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 refer to the questions on the APR form. If any q u e s t r 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 Ap R . 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 o r to asslgn a case number. One number should be assigned to each adult.

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N ame ._-Na mes o f per s ons will not be r epor t ed t o H UD. Th e u se o f n am es is f or y ounec or d k eeptn g conven i e n ce. R elation sh ip. Enter t he appr opr iat e r elat ions hip . E xamp les includ e: Self , Head of hous ehold, Spo u s e , chi ld. E ntry Da te. En ter dat e par t ic ipant ent er ed t he proiect. Usu ally th is will be t he dat e of ac t ual phys ica l mo ve -in fo r a hous ing pr ojec t . E xit Date . Ente r dat e par t ic ipant lef t t he pr ojec t. U sua lly th is will be t he dat e t he par t ic ipant physicaliy mo ve d o ut f or a hous ing pr ojec t . Do n o t includ e a pa rticip an t who t em por ar ily lef t t he pr o j e c t and is expe cte d to r et ur n in les s t han 90 day s ( e. g . , h ospita liza tion ). 4. In co me-e ligib le Non- hom eles s in SRO . The S R O pro gra m a llows as s is t anc e t o unit s oc c upied b y Section 8 in co m e- eligible per s ons r es iding at t h e SRO prio r to re habilit at ion. For SRO pr ojec ts on ly, in dicate w het her t he par t ic ipant is an in co me-e ligib le, 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 it 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/prisonx 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 but w a s t h e r e l e s s t h a n 3 0 d a y s a n d w a s l i v i n g on th e s t r e e t o r i n a n e m e r g e n c y s h e l t e r b e f o r e e n t er 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. Inslruction Codes for Persons Served Wo r k s h e e t ( c o n t i n u e d ) I I a . G r o s s M o n t h l y I n c o m e a t P r o j e c t E n t r y. E n t e r t h e a m o u n t o f g r o s s m o n t h l y i n c o 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 t e n t r y i n t o t h e p r o j e ct. 1 l b . G r o s s M o n t h l y I n c o m e a t P r o j e c t E x i t . En te r the gross monthly income the participant is receiving when exiting the project. I l c . I n c o m e S o u r c e s R e c e i v e d a t P r o j e c t E n tr y. Enter all types of assistance the participant is receiving at entry to the project. a. Supplemental Security Income (SSI) b . S o c i a l S e c u r i t y D i s a b i l i t y I n s u r a n c e ( SSD I) c. Social Security d. General Public Assistance e. Temporary Aid Needy Families (TANF) f. StateChildren's Health InsuranceProgram(SCHIP) g. Veterans benefits h. Empioyment income i. Unemployment benefits j. Veterans Health Care k. Medicaid 1. Food Stamps m. Other (please specify) n. No Financial Resources

5a. Date o f Birth . Ent er dat e of bir t h inc ludine mon th, da y, an d y ear . 5b. Age . 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- Fem ale. 6a. Ve tera ns Sta tus . I ndic at e if t he par t ic ipant i s a vete ran . Ple ase not e: A v et er an is any one w h o lta s e ye r be en on ac t iv e m ilit ar y dut y s t at us f o r th e Un ited Sta tes . 6b. Chro nically h om eles s per s on. I ndic at e t he nu mbe r o f p arti c ipant s t hat ar e c hr onic ally h ome less. 7. Eth nicity. Ente r appr opr iat e let t er f or et hnic gro up . a. Hisp an ic o r L ar ino b . No n-Hispa nic or Non- Lat ino Ra ce . En ter a ppr opr iat e let t er f or r ac e. a . American In dian or Alas k an Nat iv e b. Asian c. Bla ck or Afric an- Am er ic an d. Native Ha waiian or O t her Pac if ic I s lander e. Wh ite f. American In dian/ Alas k an Nat iv e & W hit e g. Asia n & Wh it e h . Black/African Am er ic an & W hit e i. Ame rica n Ind ian/ Alas k an Nat iv e & BIack/African Am enc an j. Oth er Multi-R ac ial

8.

9a. Spe cia l Ne ed s. Ent er t he let t er ( s ) f or t he ca teg ory(ies) th at des c r ibe t he par t ic ipant ' s d isa bility(ies). ( You m ay double c ount ) .

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I l d.In co me So urces R. ec eiv ed at pr ojec t Ex it . En ter a ll typ es of inc om e t he par t ic ipant is receiving a t pr ojec t ex it . lUs e c odes as in 1 I c . ) l2a Le ng th in Stay in pr ogr am . Calc ulat ed it e m . (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 n ot le ave du ring t he oper at ing y ear . How lo n g h ave the y be en in t he pr ojec t ?) 13. Rea so n for Le av ing Pr ojec t . Ent er t he pnm a r y rea so n wh y th e par t ic ipant lef t t he pr ojec t . (Comp lete on ly f or par t ic ipant s who lef t t he p roje ct a nd a ie not ex pec t ed t o r et ur n wit hin 9 0 d ays. 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 . Non -pa yme nt of r ent / oc c upanc y c har ge d . No n-comp lianc e wit h pr ojec t e . Crimina l activ 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 olec t g. Ne ed s cou ld not be m et by pr ojec t h . Disa gre eme nt wit h r ules / per s ons i. Dea th . .1 Othe r (ple ase s pec if y ) k . Un kn own /disappear ed

t5 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 i t y p e s of
s u p p o r t r 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 ei ve d d u r i n g the time in the projecr. 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 g e m e n t) d. Alcohol or drug abuse services e. Mental health services f. HIV/AIDS-related services g. Other health care services h. Education i. Housing placement j. Employment assistance k. Child care l. Transportation m. Legal n. Other (pleasespecify)

14. Destina tion . E nt er t he des t inat ion of t hos e lea vin g the p roj ec t . Perma ne nt: a . Ren tal ho us e or apar t m ent ( no s ubs idy ) b . Pub lic H ous ing c. Se ctio n 8 d . She lter P lus 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 i n wit h f am ily or f r iends T ra nsition al: i. Tra nsition al hous ing f or hom eles s per so n s j. Moved in wit h f am ily or f r iends I nstitutio n: k. Psye hia tr ic hos pit al. i. In pa tien t aleohol or dr ug t r eat m ent f ac i l i t y m. Jail/p riso n Eme rge ncy: n . Eme rge nc y s helt er Oth er: o . Oih er su ppor t iv e hous ing. p. Pla ce s no t m eant f or hum an habit at ion (e .g., stre et) q . Oth er (p leas e s pec if y ) Un kn own : r. Un kn own

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