This copy is a sample. What's new HMIS documentary Digital Learning - New HMIS Portal Latest Technical note released on: Wed, Dec 04, 2019 for Version 8.6.7 When does client consent end? Resources and assistance to support HUD's community partners. A list of agencies participating in HMIS that may have access to your information if you sign this authorization is at . Agencies should refer first with their own data privacy agreements, then any data sharing arrangements theymay have. Meeting Attendance Policy, FAQ for Service Providers who do not administer the VI-SPDAT, FAQ for Victim Service Providers (VSPs) who administer the VI-SPDAT, FAQ for Providers who administer the VI-SPDAT, Housing Problem Solving HMIS Quick Guide (, HPS Summary Form Participant Check Request (, Housing Problem Solving Minimal Intake Form (. Giving That Gives Back DCED Library Homeless Management Information System (HMIS) - Intake Form. The Homeless Management Information System, or HMIS, is an electronic data management system that provides vital insights on homelessness to our agency partners, while helping Calgary Homeless Foundation allocate resources for highest impact and outcomes. Tourist Development Forms. Please have the following readily available as you complete this form: Increased visibility of HMIS information is designed to ensure a safe and confidential method for sharing data. We serve as the community coalition to address homelessness and housing vulnerability. Client Informed Consent FY 2021-2022. See our Training page for more details on how to sign up for HMIS trainings. View our Bed and Unit Number Calculation Guide. Authorized Power of Attorney or Proxy notarized letter from Client along with signed HMIS consent form. Vice President, Data Analytics. EGMS (LAHSA staff) EGMS All . Housing Extension. HMIS Documents | The Housing and Homeless Coalition of Central New York HMIS Documents For assistance with HMIS, email HMIS@unitedway-cny.org E-Forms: User License Request Form New User Ethics Agreement Policies and PDF Forms CNY HMIS Policy and Procedures - Updated 2018 HMIS Agency Partnership Agreement - Updated 2017 Resources. Request in-depth assistance with implementing a HUD-funded program. The Service Prioritization Decision Assistance Tool (SPDAT) was developed by OrgCode Consulting as an assessment tool for frontline workers to prioritize which homeless clients should receive assistance first and to determine when clients have sufficiently stabilized so that assistance is no longer needed. The information they collect helps to run programs, improve services, and better understand your needs. Welcome to the Housing Contract Administration Partner Agency Portal. Beginning at 8:00 p.m. the system will be unavailable to allow the HMIS Team to install updates. HMIS Administrative Documents - Use and Bookmark our ServicePoint link hmisncceh.servicept.com! We want to see that homelessness is rare in King County, racial disparities are eliminated, and if one becomes homeless, it is brief and only a one-time occurrence. Search for a specific grantee and view itsawards, contact information, and reports, and more. Hours of Operation Our office hours are Monday-Friday from 8:00 am to 5:00 pm. HMIS. EIN # 84-1705573 Explore featured publications and browse regulations, policy guidance, toolkits, and other resources. People New. Online Application. Institute for Community Alliances Client Informed ConsentEach client must sign this form to consent to, or deny, the collection of his or her personally identifying information; form should be available in other languages as needed. Data sharing is a comprehensive term used differently in each community where it is implemented. The Housing and Homeless Coalition of Central New York (HHC) serves the City of Syracuse, the County of Onondaga, the City of Auburn, the County of Cayuga and the County of Oswego. ES, HP, TH, & SSO Annual Assessment for Children under 18, 2021 CNY HMIS Exit RHY Assessment for Adults & HoH, 2021 CNY HMIS Exit RHY Assessment for Child of Parenting Youth, 2021 CNY HMIS TH, RRH and SSO Exit Assessment Child Only, 2021 CNY HMIS TH, RRH and SSO Exit Assessment, HUD ESG & CoC TH, RRH, and PSH Assessment SPANISH, CNY HMIS ES and SO Entry Assessment for CHILDREN HoH-SPANISH All, Permanent Supportive Housing HMIS Workflow, List of HMIS Providers (Updated 5-14-2021). Client Consent to Data Collection & ROI (2020), Online Fillable Client Consent to Data Collection and ROI (2020), Department of Veterans Affairs Release of Information, Consent Refused Data Entry Guide (updated 6Sept2019). If you have any further questions, please contact ourHelpdesk! Forms & Documents for Agency Administrators, Santa Clara County CoC Continuous Data Quality Improvement Process, VI-SPDAT (Replaces H1K Vulnerability Index), Justice Discharges VI-SPDAT (JD-VI-SPDAT), SPDAT Forms (Replaces Self-Sufficiency Matrix), Homeless Prevention Assessment Tool (HPAT), Homeless Prevention Services Program (HPS), HHS Runaway and Homeless Youth Program (RHY), SAMHSA Projects for Assistance in Transition from Homelessness (PATH), Clarity HMIS: HUD-CoC Congregate NCV Program Intake (Back Data Entry), Santa Clara County Community Queue Referrals - Standard Location Practices, Domestic Violence, Sexual Assault, and Human Trafficking Pre-Screening Tool and Referral Guide, How to Create an Anonymous Client Profile, How To Fix Common Annual Assessment Errors, Victim Services Screening Tool and Training, How to ask well-being questions in PSH Enrollment, Bed and Unit Inventory (BUI) Update Form (2021), 2022 HMIS Data Standards- Data Dictionary, HMIS Standard Operating Procedures (SOPs), SCC HMIS Partner Agency Privacy and Data Sharing Agreement, Technical Administrator and Security Officer Agreement, SCC HMIS Quarterly Compliance Certification Checklist, SCC HMIS Quarterly Compliance Self Certification, Santa Clara County Agency Admin. I have the right to . Next Steps: Call 410-686-2867. Browse the library of grantee reports and plans, organized by program. - Click HERE to download the videos PowerPoint slides. Visit the FY 2022 HMIS Data Standards Changes page. It allows the Agency to use HMIS, assigning rights to user licenses. Intergovernmental Review-EO 12372. Browse the library of grantee reports and plans, organized by program. Please contact mnhmis@icalliances.org if you need assistance filling out this form. Information collected in the HMIS database is protected in compliance with the standards set forth in the Health Insurance Portability and Accountability Act (HIPAA) and the U.S. Department of Housing and Urban Development HMIS Data Standards. 2023 US Department of Housing and Urban Development, 2004 HUD Data and Technical Standards Notice. HMIS data specifically designed to support planning, management, and decision making based on on Grading of facilities, various indicators at Block, District at State as well as National Level. Visit the FY 2022 HMIS Data Standards Changes page. 2003-2021 Bitfocus, Inc. All rights reserved. Provider Request Form (PRF) This form allows the Institute for Community Alliances (ICA) to configure data collection appropriately for agencies in the database. Capacity Building. 6. Funding. For Agencies/Projects Not Currently Set Up in HMIS: For Agencies/Projects Currently Set Up in HMIS: Data and Performance Management Meeting Materials, Article: HMIS Requirements for New Agencies. For more detailed information about the responsibilities an agency has regarding data privacy, please review theData Privacysection of theMinnesota HMIS Policies. Please send all requests for changes to support@bitfocus.com. 446 Since its inception in 2004, BTG has utilized the HMIS to collect client-level data, as well as data on the provision of housing and services to at-risk and homeless individuals and families. In place of the client signature, the words "Verbal Consent" must be written or typed. HMIS Client Informed Consent Client Release of Information and Informed Consent IMPORTANT: Do not enter personally identifying information into HMIS for clients who are: 1) in DV agencies or; 2) currently fleeing or in danger . I can receive a copy of this Consent and the Client Information Sheet I may refuse to sign this Consent. Client Consent and Data Privacy Notice documents are on the Administrative Documents page. 1 MB Download. A Client Consent to Data Collection and Release of Information (ROI) must be completed for each client who consents to have their personally identifying information (PII) entered into the King County HMIS System. This is an example of an informed consent agreement. If I refuse, I will not lose any benefits or services. The HMIS (Homeless Management Information System) is a local web-based information technology system that San Diego's Continuum of Care (CoC) uses to capture and report on client, project, and system level information regarding homeless services utilization, performance and outcomes. Homeless Management Information System (HMIS) - Intake Form. There was a problem submitting your feedback. Online Fillable Client Consent to Data Collection and ROI (2020) Client Revocation of Consent (2019) (Click here to also access this form in other languages). The Vulnerability Index Service Prioritization Decision Assistance Tool (VI-SPDAT) was developed by OrgCode Consulting and is a triage survey administered to homeless individuals and families that helps to determine acuity of need and prioritization of BTG's housing resources and supportive services. Additionally, make sure theData Privacy Noticeis available to clients at intake, even if an intake is being conducted over the phone. Funding. There are well-defined data collection procedures and limitations. ICA's . Explore featured publications and browse regulations, policy guidance, toolkits, and other resources. HMIS -Homeless Management Information System. *, If a project will operate in more than one Continuum of Care (CoC), you will need to complete one form for EACH CoC of service.*. San Diego uses the software Clarity (distributed by . Client Consent and the VI-SPDAT: What can I enter into HMIS? Disclaimer: All peer approved resources shared on the HUD Exchange have been provided by the organization that developed them. the GA HMIS as described in this consent form. Data sharing is a comprehensive term used differently in each community where it is implemented. Client Informed Consent is a blanket document that indicates the client wishes to share all identifying information . Register for upcoming training, webinars, conferences, and more. We work with and for the homeless and formerly homeless or other interested consumers and stakeholders. The Baltimore City Mayor's Office of Homeless Services serves as the HMIS Lead Agency for the Baltimore City Continuum of Care. A In general, HMIS standards do not stipulate what form of consent must be obtained to share data within HMIS. HMIS. Dependent children under 18 in household, if any (Please print first and last names): . Capacity Building. sg+QN y]ZU(_,iOw0*'% |xw/"402wu1*y@R,) ?cmJ*J@ d@4FET~2ZREKdW^8>+V$lL)'+F7e;xtbYiyRn^a$Vh|oF TheHMIS Privacy and Security Standardsthat were established in 2004 by HUD still provide the basic framework for data privacy. and they may reflect local laws and policies. all ages. Ask a basic policy or reporting system question. Copyright 2020 Institute for Community Alliances. Household DHS HS Entry - Housing and Supportive Services, Household DHS HS Interim - Housing and Supportive Services, Household DHS HS Exit - Housing and Supportive Services, Single DHS HS Entry - Housing and Supportive Services, Single DHS HS Interim- Housing and Supportive Services, Single DHS HS Exit - Housing and Supportive Services, Household DHS HS Entry - Emergency Shelter, Household DHS HS Exit - Emergency Shelter, Instructions: Last Updated August 15, 2022, DHS-HS HMIS User Guide for Housing and Supportive Services, DHS-HS HMIS User Guide for Emergency Shelter, Maia Uhrich: Housing and Support Services, Household LTHSSF Entry: Doc | Fillable PDF, Household LTHSSF Interim: Doc | Fillable PDF, Household LTHSSF Exit: Doc | Fillable PDF, Single LTHSSF Interim: Doc | Fillable PDF, Household SOR Entry - Street Outreach Projects: Doc | Fillable PDF, Household SOR Entry - Services Only Projects: Doc | Fillable PDF, Household SOR Interim: Doc | Fillable PDF, Single SOR Entry - Street Outreach Projects: Doc | Fillable PDF, Single SOR Entry - Services Only Projects: Doc | Fillable PDF, Instructions: Last Updated August 17, 2022, Household ESP Entry - Emergency Shelter & Street Outreach Projects: Doc | Fillable PDF, Household ESP Entry - All Other Project Types: Doc | Fillable PDF, Household ESP Interim: Doc | Fillable PDF, Single ESP Entry - Emergency Shelter & Street Outreach Projects: Doc | Fillable PDF, Single ESP Entry - All Other Project Types: Doc | Fillable PDF, DHS-OEO ESP HMIS User Guide for Rapid Rehousing and Homelessness Prevention, DHS-OEO ESP HMIS User Guide for Emergency Shelter and Street Outreach, Katelyn Warburton, State Program Administrator: katelyn.warburton@state.mn.us, Rabya Hassen,Homeless Grant Program Manager: Rabya.N.Hassen@state.mn.us, Household THP Interim: Doc | Fillable PDF, Instructions: Last Updated August 12, 2022, Annie McCabe, Homeless Grant Program Manager: Ann.E.McCabe@state.mn.us, PATH Street Outreach (SO) Entry-Exit Form: Doc | Fillable PDF, PATH Street Outreach (SSO) Entry-Exit Form: Doc | Fillable PDF, RHY Single Entry/Exit Combined - BCP-Prevention/TLP/MGH Programs: Doc | Fillable PDF, RHY Single Entry/Exit Combined - BCP-Emergency Shelter Programs: Doc | Fillable PDF, RHY Single Entry/Exit Combined - Street Outreach Programs: Doc | Fillable PDF, Family and Youth Services Bureau (FYSB)Website, Household HUD CoC Entry: Doc | Fillable PDF, Household HUD CoC Interim: Doc | Fillable PDF, Household HUD CoC Exit: Doc | Fillable PDF, Single HUD CoC Interim: Doc | Fillable PDF, Household ESG Entry - Emergency Shelter & Street Outreach Projects: Doc | Fillable PDF, Household ESG Entry - All Other Project Types: Doc | Fillable PDF, Household ESG Interim: Doc | Fillable PDF, Single ESG Entry - Emergency Shelter & Street Outreach Projects: Doc | Fillable PDF, Single ESG Entry - All Other Project Types: Doc | Fillable PDF, Instructions: Last Updated November 2, 2022, HUD-ESG HMIS User Guide for Homelessness Prevention and Rapid Rehousing, HUD-ESG HMIS User Guide for Emergency Shelter and Street Outreach, HUD- ESG HMIS User Guide for Night-by-Night Emergency Shelter , Household HOPWA Entry - Emergency Shelter & Street Outreach Projects: Doc | Fillable PDF, Household HOPWA Entry - All Other Project Types: Doc | Fillable PDF, Household HOPWA Interim: Doc | Fillable PDF, Singles HOPWA Entry - Emergency Shelter & Street Outreach Projects: Doc | Fillable PDF, Singles HOPWA Entry - All Other Project Types: Doc | Fillable PDF, Singles HOPWA Interim: Doc | Fillable PDF, Hennepin County Single YHDP Entry/Exit Combined, Household VASH Entry/Exit Combined: Doc | Fillable PDF, Household VASH Interim: Doc | Fillable PDF, Single VASH Entry/Exit Combined: Doc | Fillable PDF, Household FHPAP Entry: Doc | Fillable PDF, Household FHPAP Interim: Doc | Fillable PDF, Household FHPAP Entry/Exit Combined: Doc | Fillable PDF, Single FHPAP Entry/Exit Combined: Doc | Fillable PDF, Street Outreach Single FHPAP Entry/Exit Combined: Doc | Fillable PDF, Instructions: Last Updated September 27th, 2022, Minnesota Homeless Prevention Assessment Tool (M-PAT) Guide, Household HSWH Interim: Doc | Fillable PDF, Instructions: Last Updated November 7, 2022, Homework Starts with Home HMIS User Guide, Videos: Homework Starts with Home Data Entry Demo, Household LTH Interim: Doc | Fillable PDF, High-Priority Homeless Form Instructions (video), Instructions:Last Updated August 15, 2022, Household MN Universal Entry - Emergency Shelter and Street Outreach Projects: Doc | Fillable PDF, Household MN Universal Entry - All Other Project Types: Doc | Fillable PDF, Household MN Universal Interim: Doc | Fillable PDF, Household MN Universal Exit: Doc | Fillable PDF, Single MN Universal Entry - Emergency Shelter and Street Outreach Projects: Doc | Fillable PDF, Single MN Universal Entry - All Other Project Types: Doc | Fillable PDF, Single MN Universal Interim: Doc | Fillable PDF, Single MN Universal Exit: Doc | Fillable PDF, Hennepin Single Adult Shelter Instructions: Last Updated November 1st 2022, HCC Shelter Training: Checking-in a Client with an ASC Reservation, HCC Shelter Training: Managing Clients in ShelterPoint, Hennepin Single Adult Shelters (for both night-by-night and extended stay programs), General ShelterPoint Instructions: Last Updated January 7th, 2022. HMIS. This consent form expires in three (3) years, meaning that any data collected after that time will require an updated consent form before that data will be shared. information has been misused, I can contact my HMIS systems administrator at (206) 444-4001 x2. View Minnesota's HMIS Data Standards Guide. Homelessness is solvable, and by acting together as a community, all people can have a home. The posting of these documents on the HUD Exchange is not intended as an endorsement of the documents by HUD or any of its contractors. 2023 US Department of Housing and Urban Development, Client Consent Form: Informed Consent (Sample), HMIS Client Consent Form: Informed Consent Agreement (Sample). The Statewide HMIS Data Committee and HMIS Lead recently approved the use of a new HMIS consent to share form. Homeless Programs Reporting ScheduleCheck out this resource for information on upcoming report deadlines. 5 0 obj If you have any questions, please submit a request and a Training and Development Specialist or KYHMIS Specialist will respond. View brief descriptions of HMIS Project Types. All people have a home. All questions must have an answer in order to save - please choose N/A where needed. The client is not guaranteed to receive assistance by consenting to share data. HUD FAQ Policy. A current list of Partner Agencies is at Meet SAP BusinessObjectsThis video introduces SAP BusinessObjects, a software program used to build and store the reports that help make HMIS data actionable. Find point of contact information for HUD's grantees. Client/server system: Architecture in which the client and server computers are connected via a LAN or `RQ$7;k+g?Ew?J?=T'{z%QqRdO}EI;a[mq]l[ BTG Client Informed Consent Form (Jun 2018) BTG Authorized Agency List (Apr 2021) Powered by Help Scout. 2021 CNY HMIS Entry DV Bonus Assessment, 2021 CNY HMIS Entry TH, HP & SSO Programs for Adults & HoH, 2021 CNY HMIS Entry Assessment for Adults & HoH Cayuga County Emergency Shelters, 2021 CNY HMIS Entry Assessment for Adults & HoH Tompkins County Emergency Shelters, 2021 CNY HMIS Entry Assessment for Children under 18, 2021 CNY HMIS Entry SO ONLY Assessment for Adults & HoH, 2021 CNY HMIS ES Entry Assessment for Adults & HoH, 2021 CNY HMIS HHS RHY Entry Assessment Child of Parenting Youth, 2021 CNY HMIS HHS RHY ES & SO Entry Assessment HoH or Single Youth, 2021 CNY HMIS HHS RHY TH & HP Entry Assessment HoH or Single Youth, 2021 CNY HMIS PSH Entry Assessment for Adults & HoH, 2021 CNY HMIS PSH Entry Assessment for Children under 18, 2021 CNY HMIS RRH Entry Assessment for Adults & HoH, 2021 CNY HMIS HHS RHY Annual.Update Assessment HoH or Single Youth, 2021 CNY HMIS HHS RHY Follow-up Assessment HoH or Single Youth, 2021 CNY HMIS PSH Update Annual Assessment for Adults & HoH, 2021 CNY HMIS SO ONLY Update Annual Assessment for Adults & HoH, 2021 CNY HMIS Update Annual Assessment for Adults & HoH, 2021 CNY HMIS Update ES, HP, TH, & SSO Annual Assessment for Adults & HoH, 2021 CNY HMIS Update. <> Personal Identifying Information (Name, Social Security Number, Date of Birth, Gender, Veteran Status, photo) Personal identifying information about your dependents (if applicable) (Note: Anyone 18 years of age or older must sign a separate consent form.) WHAT IS HMIS of Central Florida? Explore collections of guided learning opportunities on a variety of topics. This means the agency representative signature must still be present. Data sharing is the ability to transfer data from one agency to another electronically through HMIS. LB HMIS Consent & LB ROI Page 1 of 4 Revision 20201110v5 . Households How-To GuideThis guide explains how to manage households in HMIS. People New. HMIS_Client_Consent_Form_10-26-2016 Connections for the Homeless (Connections) is a partner in the Northeast Illinois Homeless Management Information System . MEASURE Evaluation worked in Ethiopia to implement a HMIS in the Southern . The FY 2022 HMIS Data Standards have an effective date of 10/1/2021. HMIS Resource If you would like to get more technical support on the Homeless Management Information System (HMIS) please visit the OC HMIS Help Desk Knowledge Base . Below are some of the aspects of data sharing: If data are shared with the goals below, it is anticipated that agencies will be able to see how the network of services are working and performing, where improvements are needed, and whether households are becoming stable. The Can Food Pantry is here to serve and assist you. Effective March 1, 2014, the Institute for Community Alliances (ICA) became the HMIS lead organization for the State of Wisconsin. You have the right to receive a copy of this consent form. CES HUD Guidance For more information on CES, please visit the Coordinated Entry Community Sample Toolkit. Learn through self-paced online trainings, recorded webinars, and more. Section 4.2.4 of the2004 HUD Data and Technical Standards Noticeallows for retroactive application of amendments to the privacy notice, stating, A CHO must state in its privacy notice that the policy may be amended at any time and that amendments may affect information obtained by the CHO before the date of the change. SAP BusinessObjects User SettingsThis video demonstrates how all users should configure their BusinessObjects account settings. Request in-depth assistance with implementing a HUD-funded program. Homeless Management Information System (HMIS). Due to the nature of UHMIS, when client consentends, this agency will share no new information,but this agency will not remove anything already shared within the system. This Consent will expire 7 years from my last HMIS recorded activity. All Rights Reserved. The data systems are known as a Homeless Management Information Systems (HMIS). HMIS Other than Other Exits - Exit Destinations for HMIS projects are varied, but can generally be captured by one of the 30+ available destinations. KMNH has developed an extensive collection of reports and dashboards that may already meet your needs. anyone in need. We are the organized body of informal networking and formal linkages between homeless services providers and other public and private human service providers. 2021 HIC and Sheltered PIT submitted Orange County CoC Dashboard Published! Signing this consent form does not guarantee you services. Don't Miss: Corpus Christi Food Bank Donation. Housing Extension. Learn through self-paced online trainings, recorded webinars, and more. As many agencies are moving to phone-only interviews and meetings with clients, ICA has received several questions about obtaining verbal consent for a release of information (ROI). 2016 The Housing and Homeless Coalition of Central New York. An updated version of the HMIS Client Consent Form (both in English and Spanish) has been added to the list of Privacy Forms. Effective Wednesday, July 5, 2017, all Homeless Providers contributing data into HMIS are required to use this new form. . Either the Client Informed Consent form or the Client Release of Information form is required to be completed by clients who are allowing their information to be shared in Pinellas HMIS. Register for upcoming training, webinars, conferences, and more. All rights reserved. Confidentiality of client information is of utmost importance in data collection. To download the consent form, you can simply click on the preview pictures below. The HMIS team is a funded as a project through the collaborative COC grant funds received from HUD. For a privacy notice, an agency must post a sign at each intake desk (or comparable location) that explains generally the reasons for collecting HMIS information, and the uses and disclosures allowable. January 1, 1970. contact the HMIS System Administrator at 425-388-3270. By signing this form, I give this Agency permission to share (verbally, or through the HMIS, mail, fax, or by hand) information collected about me and any dependents listed on the back of this form with HMIS Partner Agencies, for the 800-594-9854 Ext. 112 or . }), Presidents Day - Mon, Feb 20, 2023Prince Kuhio Day - Fri, Mar 24, 2023 (Observed)Memorial Day - Mon, May 29, 2023, Copyright 2023 Bridging The Gap Hawaii |, Prince Kuhio Day - Fri, Mar 24, 2023 (Observed), BTG Client Informed Consent Form (Jun 2018), BTG Custom Data or Report Request Form (Apr 2019), HPO Memo Re: Consent to Share Privacy Forms - 11.1.17, BTG HMIS New User Agreement and Training Request Form (Feb 2020), BTG Duplicate Client ID Merge Form (Jul 2018), FY 2022 HMIS Data Standards Manual (Sep 2021), PATHHMISProgram Specifications (Jun 2019), Adult - TH, RRH, Non-CoC Program Funded PSH & HP, Adult - ES, TH, RRH, & Non-CoC Program Funded PSH, BTG Additional Family Member Form (Sep 2021), BTG SPDAT Individual Assessment (Nov 2020), BytePages Content Management System Powered by Byte Productions. Client Consent and Coordinated Assessment: What can I enter into HMIS? Please try again later. ICAs latest ShelterPoint videos can be found on our Moodle site or by clicking on this link. This consent form expires seven (7) years after the signature or at any time you choose to revoke your consent. LA-HOP. FileShare. Learn about what HUD grantees are doing across the nation. The HMIS code migration is scheduled for Tuesday January 3rd, 17th & 31st. The Projects for Assistance in Transition from Homelessness (PATH) Program participation in HMIS provides a platform for coordinating care and improving access to mainstream programs and housing resources and supports the generation of the PATH Annual Report. Please have the following readily available as you complete this form: The staff person at your agency who can provide accurate information and answer questions about the project; Knowledge of the funding source, including when the grant starts/started; For federally-funded projects, the grant identifier from your contract or grant; For shelters and housing projects, knowledge of the number of beds and units per this funding source. HMIS Client Consent Form: Informed Consent Agreement (Sample) Print ShareThis Date Published: June 2011 Description This is an example of an informed consent agreement. View MN HMIS' Provider List of over 200 agencies. Guidance included in the following documents aligns with HMIS requirements as stated by the Substance Abuse and Mental Health Services Administration (SAMHSA): The following entry/assessment and corresponding exit forms are intended to capture specific program requirements in each category: adults, youth and children. To comply with this requirement Kitsap County agencies that provide homeless housing and services participate in the Kitsap HMIS Collaborative, an agreement to share client data between agencies. The following forms are essential to compliance with client confidentiality and data security requirements, HUD Data Standards, PATH, and CES referral prerequisites. Data sharing is intended to meet identified needs with principles for implementation locally defined and need-based.