HMIS Annual Survey 2011

Dear HMIS and CoC participants,

Each year, as HUD makes more changes and upgrades to the regulations, CARES, as your HMIS System Administrator has to make sure that the database properly reflects your programs.

Please take the time to fill out this below for EACH of your programs so that we can make sure we have all the information in our CARES Regional HMIS up to date and accurate.

Please fill out a survey for program in your agency that participates in the HMIS or is on the Housing Inventory Chart.

Thank you for your assistance. If you have any questions, please contact Andra Zubkovs or Allyson Thiessen at 518-489-4130 or hmis@caresny.org and we will be happy to assist an any way we can.

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1. Agency Information

Agency Information Formal Agency Name
Agency Address
Agency Phone Number

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2. Program Information (please fill out individual surveys for each program on the Housing Inventory Chart or in the HMIS)

Program Information (please fill out individual surveys for each program on the Housing Inventory Chart or in the HMIS) HUD Recognized/Formal Program Name
Other/informal Program Name
Program Address (for DV programs, put n/a)
Contact Person Name
Contact Person Phone Number
Contact Person e-mail
HUD Contract Number (if not a HUD program, put n/a)
Continuum of Care
County
Zip Code
Is this program currently in the HMIS?
If yes, what is the exact name in the HMIS?

IF YOU NEED TO EXPLAIN A PROGRAM/HMIS CONFIGURATION DUE TO PROGRAMMATIC CHANGES SINCE THE INITIAL SETUP, PLEASE E-MAIL THEM TO hmis@caresny.org

Thank you!

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3. Please choose your Program Group

Please choose your Program Group

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4. Please answer the following questions about the makeup of your program:

Please answer the following questions about the makeup of your program: # of Residence Units
# of Beds (count all permanent beds, but not cribs)
# of HIV/AIDS dedicated beds
# of beds dedicated to literally homeless persons
Does your program go by any other name?

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5. Does this program accept ONLY homeless persons?

Does this program accept ONLY homeless persons? Yes

No

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6. Please choose the approriate Program Site Configuration Type from the dropdown menu:

Please choose the approriate Program Site Configuration Type from the dropdown menu:

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7. Please choose the appropriate Housing Type from the drop-down menu:

Please choose the appropriate Housing Type from the drop-down menu:

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8. Please choose a program type from the dropdown menu:

Please choose a program type from the dropdown menu:

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9. Please choose the Primary Target Population for your program from the drop down menu:

Please choose the Primary Target Population for your program from the drop down menu:

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10. Please choose a secondary target population from the dropdown:

Please choose a secondary target population from the dropdown:

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11. Please choose your Operational Calendar from the dropdown menu:

Please choose your Operational Calendar from the dropdown menu:

HMIS Annual Survey 2011

1. Annual HMIS Survey

*1. Agency Information

*2. Program Information (please fill out individual surveys for each program on the Housing Inventory Chart or in the HMIS)

*3. Please choose your Program Group

*4. Please answer the following questions about the makeup of your program:

*5. Does this program accept ONLY homeless persons?

*6. Please choose the approriate Program Site Configuration Type from the dropdown menu:

*7. Please choose the appropriate Housing Type from the drop-down menu:

*8. Please choose a program type from the dropdown menu:

*9. Please choose the Primary Target Population for your program from the drop down menu:

*10. Please choose a secondary target population from the dropdown:

*11. Please choose your Operational Calendar from the dropdown menu: