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Resources by Topic: Intake/Assessment/Case Managment

To ensure effective use of prevention resources, programs must assess client needs and circumstances in order to provide the appropriate level and type of support needed to stabilize the household. These tools and resources under this subtopic may help program managers think about how best to assess applicants, target resources, and provide case management services to those seeking prevention assistance.

  Resource Title Date Completed Abstract
HUD icon HPRP Area Median Income (AMI) Limits - Changes Between 2009 and 2010 Jun 2010 This table is intended for HPRP grantees seeking information on HPRP Area Median Income (AMI) limits. The table shows the change in the HPRP income limit (i.e., 50% AMI) for a....  More
Peer-to-Peer icon HPRP Income Eligibility Calculation Worksheet Apr 2010 To be eligible for HPRP, households must be at or below 50% of the Area Median Income (and meet other HPRP eligibility requirements, as outlined in the Notice). Grantees may u....  More
HUD icon Staff Certification of Eligibility for HPRP Assistance Mar 2010 This Staff Certification serves as documentation that the HPRP household named below meets all eligibility criteria for HPRP assistance, certifies that true and complete infor....  More
Peer-to-Peer icon HPRP Tools and TA Resources Nov 2009 This page is intended for grantees and subgrantees of the Homelessness Prevention and Rapid Re-housing Program (HPRP). It contains sample tools and templates, as well as techn....  More
Peer-to-Peer icon Case Management – Homelessness Prevention and Rapid Re-housing Oct 2009 This document explores the role of case management in preventing homelessness and in rapidly returning homeless individuals and families to housing stability. Tasks such as as....  More
Peer-to-Peer icon Consumer Exit Checksheet Oct 2009 The Consumer Exit Checksheet from Reinvestment in Communities of Gaston County, Inc. is used to gather information on consumer exiting from their program. The checklist includ....  More
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Peer-to-Peer icon HPRP Homeless Certification Template Oct 2009 This sample template can be used by HPRP grantees and subgrantees to obtain third-party verification of housing status for persons applying for assistance.  More
Peer-to-Peer icon HPRP Self-Declaration of Housing Status Template Oct 2009 This sample template can be used by HPRP grantees and subgrantees for self-certification of housing status for individuals applying for assistance when third-party verificatio....  More
Peer-to-Peer icon HPRP Self-Declaration of Income Template Oct 2009 This sample template can be used by HPRP grantees and subgrantees for self-declaration of income for individuals applying for assistance when third-party verification is not p....  More
Peer-to-Peer icon HPRP Verification of Income Template Oct 2009 This sample template can be used by HPRP grantees and subgrantees to obtain third-party verification of income for persons applying for assistance.  More
Peer-to-Peer icon Goal Plan May 2009 This Goal Plan from the Reinvestment in Communities of Gaston County, Inc. provides a format to assist the consumer in developing a short term, intermediate, and long term pla....  More
Peer-to-Peer icon Seasons of Sharing Eligibility Requirements Mar 2009 This document is used by the San Francisco Chronicle Seasons of Sharing Fund. The homeless assistance prevention program uses this document to determine client eligibility for....  More
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Peer-to-Peer icon Seasons of Sharing Intake Forms Mar 2009 This spreadsheet is a client intake/budget information form used by the San Francisco Chronicle Season of Sharing Fund, an emergency assistance program. The spreadsheet can be....  More
Peer-to-Peer icon Emergency Fund Client Service Form Feb 2009 This is an assessment form used for Chicago's Homeless Prevention Emergency Fund. Included in this assessment is a section for the caseworker to write a brief summary about th....  More
Peer-to-Peer icon Family Homelessness Prevention and Assistance Program All-Inclusive Client Assessment Form Jan 2009 This is an all-inclusive client assessment form developed by Wilder Research for the Family Homelessness Prevention and Assistance Program (FHPAP). It includes a universal ass....  More
Peer-to-Peer icon Family Homelessness Prevention and Assistance Program Program Exit Assessment Form Jan 2009 This is a program exit assessment form developed by Wilder Research for the Family Homelessness Prevention and Assistance Program in Minnesota. The form asks why the client is....  More
Peer-to-Peer icon Family Homelessness Prevention and Assistance Program Service Transactions Form Jan 2009 The Family Homelessness Prevention and Assistance Program (FHPAP) "Service Transactions Form", developed by Wilder Research, is a document which chronicals a clients service h....  More
Peer-to-Peer icon Adult HMIS Screening Form Dec 2008 This assessment/intake screening form, used by Hennepin County, is to be completed for all adults and unaccompanied youth, 18 years of age or younger. The assessment includes....  More
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Peer-to-Peer icon Barriers to Housing Stability Assessment Nov 2008 This Barriers to Housing Stability Assessment document, used by Hennepin County, is meant to be completed for the head of household, singles, and unaccompanied youth. Many pos....  More
Peer-to-Peer icon Emergency Assistance Voucher Intake Form Nov 2008 This intake form from the prevention program in Hennepin County is for emergency assistance voucher recipients. For those agencies creating prevention programs, this form mig....  More
Peer-to-Peer icon Family Rapid Exit Ledger Nov 2008 This is a service ledger for the Family Rapid Exit program in Hennepin County. This Excel spredsheet allows the program to track the service type, dollar amount expended, and....  More
Peer-to-Peer icon Sample Progress Note Topper Oct 2008 This document from the Amador Tuolome Community Action Agency provides case managers a sample progress note to be included in a case file. The example provides an outline for....  More
Peer-to-Peer icon Declaration of Income Statement Dec 2004 Most programs include an income verification form in case files. This document provides an example of the Texas Department of Housing and Community Affairs' form for document....  More
Peer-to-Peer icon Housing Resources Checklist Mar 2003 This is a checklist from the Amador Tuolome Community Action Association for the overview of documents needed for intake. There is a checklist for the completion of the applic....  More
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Peer-to-Peer icon ESGP Homelessness Prevention Assistance Application Aug 2002 This application from the Homeless Prevention Program at the Texas Department of Housing and Community Affairs provides an assessment of family/client needs, determines progra....  More
Peer-to-Peer icon Application for Prevention Funds This is an application/referral form used by the Community Housing Network, Inc. for a homeless initiative grant. This homeless initiative grant is limited to a one time use b....  More
Peer-to-Peer icon Description of Jobs 2 Housing Assessment Process This document offers a description of the assessment process for determining client eligibility for a program called Jobs2Housing, a program of the Community Shelter Board in....  More
Peer-to-Peer icon Home Safe Packet This client screening packet used by the Amador-Tuolome Community Action Association, includes a monthly budget plan, housing verification form, household composition, and con....  More
Peer-to-Peer icon Home Visit Checklist When case managers perform a home visit, this form from the Amador Tuolome Community Action Association provides a script of questions to ask and information to gather. This....  More
Peer-to-Peer icon Homeless Prevention Pilot Assessment Form Pickaway County, Ohio, uses this Excel spreadsheet as a client asessment/intake form for a homelessness prevention pilot program. The form collects information on the client'....  More
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Peer-to-Peer icon Housing Resource Office Information/Service Request This template from the Amador Tuolome Community Action Association provides an initial assessment for services when a call is received by the agency. It may be useful for age....  More
Peer-to-Peer icon Jobs 2 Housing Assessment Process This is a Jobs 2 Housing Assessment Process, developed by the Community Shelter Board. The document includes a flowchart to follow to determine eligibility for the program. It....  More
Peer-to-Peer icon Pasadena Homeless Prevention Program Intake Form This client intake/assessment form from the City of Pasadena Homeless Prevention Program includes a comprehensive needs assessment including income, housing status & cost, tra....  More
Peer-to-Peer icon Preventative Funds Referral and Application Acknowledgement The Preventative Funds Referral and Application Acknowledgement form letter from the Community Housing Network, Inc. provides an acknowledgement of receipt of an application s....  More
Peer-to-Peer icon Referral Form/Application This short document provides referring agencies with an overview of the program, including minimum eligibility requirements and qualities that make a candidate good for the pr....  More
Peer-to-Peer icon Rental Assistance Project (RAP) Brochure This is a brochure for the Rental Assistance Project from Connecting Point. The brochure includes the program's mission, hours of service, eligibility for the program, and wha....  More
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Peer-to-Peer icon Rental Assistance Project Policy This document from the Rental Assistance Project Program with Connecting Point provides a list of policies clients must adhere to in order to receive assistance from the agenc....  More
Peer-to-Peer icon ROSIE Intake Form At intake, it is important to make sure that all the information necessary for triage/assessment is gathered. This checklist from the Madison County CoC in Illinois provides....  More
Peer-to-Peer icon San Francisco Housing Opportunities Made Equal Client Contract This document from the San Francisco Housing Opportunities Made Equal (HOME) Program is a contract between the client and agency, which outlines the clients responsibilities a....  More
Peer-to-Peer icon San Francisco Housing Opportunities Made Equal Completion of Intake Notice The San Francisco Housing Opportunities Made Equal (HOME) Program developed this letter to advise clients/families that they have completed the initial intake process, request....  More
Peer-to-Peer icon San Francisco Housing Opportunities Made Equal Intake Form This intake/assessment form from the San Francisco Housing Opportunities Made Equal (HOME) Program provides a comprehensive overview of a families information, housing history....  More
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