PROGRAM REQUEST FORM

WORKFLOW MANUALS

New Program Request Form (2021) (Updated 19Mar21)

Complete Santa Clara Workflow Revised CCP Workflow & Manual – Case Managers (Revised 09-26-17)

HUD HMIS SYSTEM STANDARDS

CSJ RRH Workflow Training (Revised 03-07-18)

HMIS Standards

RRH Workflow Training (Final 11-19-18)

2017 HMIS Data Standards – Manual

The Health Trust (THT) Workflow Training (Revised 01-17-2020)

2017 HMIS Data Standards – Data Dictionary

CLIENT INTAKE FORMS & GUIDES

GENERAL HMIS FORMS

Client Consent To Data Collection And ROI (Revised 03-11-2020)

Partner Agencies List

Client Consent and Coordinated Assessment: What can I enter into HMIS?

HMIS Privacy Statement Rev. 6.2020

Client Consent PR-VI-SPDAT: What can I enter into HMIS?  Client Consent and the VI-SPDAT: What can I enter into HMIS?

HMIS Standard Operating Procedures (SOP’s) Rev. 7.2020

FORMS & DOCUMENTS FOR AGENCY ADMINISTRATORS

HMIS Client Grievance Form Rev. 7.2020

SCC HMIS Partner Agency Privacy and Data Sharing Agreement (version 2021-02-16)

VI-SPDAT 

Technical Administrator and Security Officer Agreement (version 2015-09-25) 

VI-SPDAT for Single Adults (Updated 10May2021)

Electronic End User Agreement (Version 2020-01-29)

VI-SPDAT for Families with Children (Updated 10May2021)

SCC HMIS Quarterly Compliance Certification Checklist (V. 2020-09-02)

VI-SPDAT for Youth (Updated 10May2021)

 

JD-VI-SPDAT for Justice Dischargees (Update 10May 2021)

SCC HMIS Quarterly Compliance – Self Certification

HOMELESS PREVENTION ASSESSMENT TOOL (HPAT) This Assessment Replaces the PR-VI-SPDAT

Santa Clara County Agency Admin. Meeting Attendance Policy (Updated January 2020)

HPAT English fillable PDF Form

SPDAT FORMS

HPAT English Version Form

SPDAT-v4.01-Single-Print

HPAT Spanish Version Form

F-SPDAT 

HPAT Vietnamese Version Form

 

VI-SPDAT Additional Resources

Please use the following documents as guidance for the VI-SPDAT
When should I do a VI-SPDAT (PDF)
FAQ for Service Providers who do not administer the VI-SPDAT (PDF)
FAQ for Victim Service Providers (VSPs) who administer the VI-SPDAT (PDF)
FAQ for Providers who administer the VI-SPDAT (PDF)

Program Specific Forms

HUD Continuum of Care Program (CoC) (Updated 30January2020)
Intake Form (PDF,DOC) Status Assessment Form (PDF,DOC) Exit Form (PDF,DOC)
Homeless Prevention Services Program (HPS) (Updated 30January2020)
Intake Form (PDF,DOC) Status Assessment Form (PDF,DOC) Exit Form (PDF,DOC)
HHS Runaway and Homeless Youth Program (RHY) (Updated 30January2020)
Intake Form (PDF,DOC) Status Assessment Form (PDF,DOC) Exit Form (PDF,DOC)
SAMHSA Projects for Assistance in Transition from Homelessness (PATH) (Updated 30January2020)
Intake Form (PDF,DOC) Status Assessment Form (PDF,DOC) Exit Form (PDF,DOC)
VA Programs (SSVF, GPD) (Updated 13May2021)
Intake Form (PDF,DOC) Status Assessment Form (PDF,DOC) Exit Form (PDF,DOC)
UPLIFT (Updated 30January2020)
Intake Form (PDF) Status Assessment Form (PDF) Exit Form (PDF)

(CE) Minimum Screen Forms

(Updated 10March2020)        
Intake Form (PDF,DOC) Exit Form (PDF,DOC).
   
FEMA Intake Forms (Updated 25September2020)
Intake Form (PDF, DOC) Exit Form (PDF, DOC) Intake Form Minor (PDF, DOC)
Clarity HMIS: HUD-CoC Congregate NCV Program Intake (Back Data Entry)  
Intake Form (PDF,DOC) (Updated 27May2020)
   

Housing Problem Solving Documents

DSW Flow Chart (PDF)

HMIS Surge Data Collection Form (PDF, DOC)

Housing Problem Solving Services Form (PDF, DOC)

Participant Acknowledgement (PDF)

W9 Form (PDF)

HPS Summary Form Participant Check Request (PDF, DOC)

Housing Problem Solving Minimal Intake Form (PDF, DOC)

Housing Problem Solving Exit Form (PDF, DOC)

 

Current Living Situation (CLS) Assessment

Who Should Use Current Living Situation Assessment?

(Updated 19September2019)

Coordinated Entry (CE) Night by Night Shelter (NBN) Services Only
Safe Parking                    UPLIFT Programs               Forms (PDF,DOC)

Translated Forms

Click here for Spanish forms

Click here for Vietnamese forms

Click here for Chinese Forms 

Other Tools and References

Domestic Violence, Sexual Assault, and Human Trafficking Pre-Screening Tool and Referral Guide

How to Exit Clients from a Program

How to Create an Anonymous Client Profile

When a Client Requests a Name Change

SCC ROI FAQ Sheet

SCC ROI Completion – Instructions Guide

CCP Reports User Guide

How To Fix Common Annual Assessment Errors

SCC Helpful Reports Guide

Victim Services Screening Tool and Training

When Should I Do a VI-SPDAT

Work Readiness Assessment HMIS Workflow

Work Readiness Assessment Paper Form