| First Name (3.1) |
First Name |
Write-in |
Full, legal first name. Do not enter for clients who refuse consent |
Page 42 |
| Last Name (3.1) |
Last Name |
Write-in |
Full, legal last name. Do not enter for clients who refuse consent |
Page 42 |
| Social Security Number (3.2) |
SSN |
Write-in (Number) |
Nine-digit Social Security number of client. Do not enter for clients who refuse consent |
Page 42 |
|
SSN Code |
- Full = All 9 digits
- Partial = 4 digits
- Don't know
- Refused
|
Code used to assess the quality of the SSN |
Page 42 |
| Date of Birth (3.3) |
Date of Birth |
Write-in (Date) |
The month, day, and year of birth. If a client cannot remember the year of birth, ask the person's age and calculate the approximate year of birth. If the client is unwilling to provide this information or cannot remember the month or day of birth, record an approximate date of “01” for month and “01” for day and the actual or estimated year. If the client has experienced domestic violence, enter “01” for month and “01” for day and an approximate year of birth (1-3 years before or after the actual year of birth). |
Page 44 |
|
DOBCode |
- Full DOB = complete and accurate month, day, and year
- Approximate or Partial DOB = Estimated Date of Birth
- Refused
- Don't know
|
Code used to assess the quality of the Date of Birth |
Page 44 |
| Race (3.4) |
Race |
- American Indian or Alaska Native - a person having origins in any of the original peoples of North and South America, including Central America, and who maintains tribal affiliation or community attachment
- Asian - a person having origins in any of the original peoples of the Far East, Southeast Asia or the Indian subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand and Vietnam
- Black or African American - a person having origins in any of the black racial groups of Africa or Haiti
- Native Hawaiian or Other Pacific Islander - A person having origins in any of the original people of Hawaii, Guam, Samoa, or other Pacific Islands
- White - a person having origins in any of the original people of Europe, the Middle East, or North Africa
- Don't know
- Refused
|
Self identified race of client. Allow clients to identify multiple racial categories. Staff observations should not be used. |
Page 45 |
| Ethnicity (3.5) |
Ethnicity |
- Non-Hispanic
- Hispanic - a person of Cuban, Mexican, Puerto Rican, South or Central American or other Spanish culture or origin, regardless of race
- Don't know
- Refused
|
Self-identified Hispanic or Latino ethnicity of client. Staff observations should not be used. |
Page 46 |
| Gender (3.6) |
Gender |
- Female
- Male
- Transgendered Male to Female
- Transgendered Female to Male
- Other
- Don't know
- Refused
|
The reported gender of the client. Gender should be assigned based on the client's self-perceived gender identity. |
Page 47 |
| Veteran Status (3.7) |
Veteran |
- No
- Yes
- Don't know
- Refused
|
A veteran is someone who has served on active duty in the Armed Forces of the United States. This does not include inactive military reserves or the National Guard unless the person was call up to active duty. |
Page 48 |
| Disabling Condition (3.8) |
Disabled |
- No
- Yes
- Don't know
- Refused
|
A disabling condition means: (1) a disability as defined in Section 223 of the Social Security Act; (2) a physical, mental or emotional impairment which is (a) expected to be of long-continued and indefinite duration, (b) substantially impedes an individual's ability to live independently, and (c) of such a nature that such ability could be improved by more suitable housing conditions; (3) a developmental disability as defined in Section 102 of the Developmental Disabilities Assistance and Bill of Rights Act; (4) the disease of acquired immunodeficiency syndrome or any conditions arising from the etiological agency for acquired immunodeficiency syndrome; or (5) a diagnosable substance abuse disorder. |
Page 49 |
| Residence Prior to Program Entry (3.9) |
Residence Prior to Program Entry |
- Emergency shelter, including hotel or motel paid for with emergency shelter voucher
- Transitional housing for homeless persons (including homeless youth)
- Permanent housing for formerly homeless persons (such as SHP, S+C, or SRO Mod Rehab)
- Psychiatric hospital or other psychiatric facility
- Substance abuse treatment facility or detox center
- Hospital (non-psychiatric)
- Jail, prison, or juvenile detention facility
- Rental by client, no housing subsidy
- Owned by client, no housing subsidy
- Staying or living in a family member's room, apartment or house
- Staying or living in a friend's room, apartment or house
- Hotel or motel paid for without emergency shelter voucher
- Foster care home or foster care group home
- Place not meant for habitation (e.g., a vehicle, an abandoned building, bus/train/subway station/airport or anywhere outside); inclusive of “non-housing service site (outreach programs only)”
- Other
- Safe Haven
- Rental by client, with VASH housing subsidy
- Rental by client, with other (non-VASH) housing subsidy
- Owned by client, with housing subsidy
- Don't know
- Refused
|
The type of living arrangement of the client the night before their entry into the program. For rental by client and owned by client, select the response that includes the type of housing subsidy, if any, the client received. A housing subsidy may be tenant-, project- or sponsor-based and provides ongoing assistance to reduce rent burden. This includes either a housing subsidy provided through the Veterans Affairs Supportive Housing (VASH) program or other housing subsidy. Other housing subsidies may include a HUD-funded subsidy (e.g., public housing, Housing Choice Voucher or “Section 8”) or other housing subsidy (e.g., state rental assistance voucher) |
Page 51 |
|
Length of Stay in Previous Place |
- One week or less
- More than one week, but less than one month
- One to three months
- More than three months, but less than one year
- One year or longer
- Don't know
- Refused
|
The amount of time the client stayed at the location recorded in 'Residence Prior to Program Entry'. |
Page 51 |
| Zip Code of Last Permanent Address (3.10) |
Zip |
Write-in (Number) |
Five-digit zip code of the apartment, room, or house where the client last lived for 90 days or more. |
Page 53 |
|
Zip Data Quality |
|
Code used to assess the quality of the zip code |
Page 53 |
| Housing Status (3.11) |
Housing Status |
Literally homeless - Persons who are literally homeless include people who at program entry or exit are:
- Sleeping in a place not meant for human habitation, such as cars, parks, or the street
- Sleeping in an emergency shelter
- Staying in a hospital or other institution if the person was sleeping in an emergency shelter or other place not meant for human habitation immediately prior to entry into the hospital or institution
- Graduating from or timing out of a transitional housing program for homeless persons
- Victims of domestic violence
Housed and at imminent risk of losing housing - Persons who are housed and at imminent risk of losing housing include people who at program entry or program exit are experiencing one of the following:
- Being evicted from a private dwelling unit (including housing provided by family/friends)
- Being discharged from a hospital or other institution
- Living in housing that has been condemned by housing officials and is no longer considered meant for human habitation
Additionally, a person residing in one of these places must also meet the following two conditions:
- Have no appropriate subsequent housing options identified; AND
- Lack the financial resources and support networks needed to obtain immediate housing or remain in existing housing
Housed and at-risk of losing housing - Persons who are housed and at-risk of losing housing include people who at program entry or program exit:
- Are in their own housing or doubled up with friends or relatives and at-risk of losing their housing due to high housing costs, conflict, or other conditions negatively impacting their ability to remain housed; AND
- Lack the resources and support networks needed to maintain or obtain housing
Such persons are not in immediate danger of becoming homeless.
Stably housed - Persons who are stably housed are in a stable housing situation and not at risk of losing their housing (i.e. do not meet the criteria for being at-risk of losing their housing).
|
The housing status is determined by where the person is living at program entry or exit. A client cannot be in multiple reporting categories. |
Page 54 |
| Program Entry Date (3.12) |
Program Entry Date |
Write-in (Date) |
The month, day, and year of first day of service or program entry. For residential programs, this date would represent the first day of residence in the program. There should be a new program entry date for each continuous period of residence based on the program guidelines for your program type. |
Page 57 |
| Program Exit Date (3.13) |
Program Exit Date |
Write-in (Date) |
The month, day and year of last day of service. For residential programs, this date would represent the last day of residence in the program. For more detail, please see your program guidelines. |
Page 59 |
