OMB A pprovalN o. 2506-0145(ex p.

l 1130/2009)

U. S. Department of Housing and Urban Development Office of Communify Planning and Develooment

Annual ProgressReport (APR)
for Supportive HousingProgram ShelterPlus Care and Section 8 Moderlte Rehabilitation for SingleRoom Occupancy Dwellings (SRO) Program

HUD-401 18

ol l s ' publi c r e p o r t i n g b u r d e n ib r .th isco lle ctio n o fin fo r m a tio n ise sti matedtoaverage33hoursperresponse,rncl udi ngtheti nel orrevi ew i ngnl s truc dataneeded,and completingand reviewing lhe collectionoi infolnlation' searchingexisting data sources,gatheringand maintaining the unlessthat collectiondisplaysa valid OMB control number. is or not cond-uct rpol,ror, and a pelrson not required to respondto, a collectionofinformation

General Instructions purpose. The Annuai Progress Report (APR) is a reporlingtool that HUD usesto track programprogressand funding. and inform the Deparbrrent's competitive processfor homelessassistance accomplishments grants must submit 2 APR'S to HUD within 90 daYs after assistance Filing Requirements. Recipientsof HUD's homeless to be submitted the CommunityPlanningand Development the end of each operating vear. One copy of the reportmust the for responsible managing grant. The other copy must be subnritted idpnl Di'ision Directoi in the local HUD Field Office Attn: APR Data Editor, Room 7262, 45 1 7* S|reet, Urban Development, Deparlmentof Housing and to HUD Headquarlers, SW, Washington, DC. 20410, Failure to submit an APR will deiay receiving grant firnds and may result in a detenlination of lack of capacity for future funding. An APR must be submitted for eachoperatingyear in which HUD funding is provided. Granteesthat received SHp fundi1g for new conshuction, acquisition, or rehabilitation are required to operatetheir facilities for 20 years. They must submit an ApR 90 days after the end of the first operatingyear and every year tluoughout the 20 years. APR must be report nrustbe submittedfor each HUD grantreceived. For ShelterPlus Care (S+C), a separate A separate each S+C component. submrttedfor (seeExtension below). report coveringthat periodmust be submitted receiving an extension,a separate For thosegrantees Recordkeeping. Granteesmust collect and maintain information on eachparticipant in order to complete an APR. Optional rvorksheetsare attached. The worksheetsmay be used to record inforrnation manually or to design a computerizedsystem to store and tabulate the information. The worksheets should not be submittedto HIID with the APR. organization of the Report. The APR is organizedin the following manner: personsto self-sufficiency, in the part I: project progress. This portion of the report describes progress moving homeless for listing project goais,and accounting beds/units. documentingservicesreceived, receivingfunding under SHP, S+C, by part II: Financial Information. This portion of the reporl is completed all grantees and SRO. that do numbereverypage sequentially.Mark any questions Final Assembly of Report. After the entire reporl is assembled, for for not applicable. (SeeSpecialInstructions SSO Projectsbelow.) not apply to your program with'"N/A" fype is definedbelow. Note that a client's client/household Definitions of Client/I{ousehold Types. Each client/household householdcompositionat theprogram etxttydtte closestto the start of the t!,pe shouldbe basedon the client's age and/or operatingyear. at Families - A family is a householdcomposedof two or more relatedpersons, leastone of who is a child accompanied by an adult or ajuvenile Parent' by includingpregnantwomen not accompanied other by Singles not in Families - personsnot accompanied chrldren, youth, are singles not in families. When fwo adults or two unaccompaniedyouth present children and unaccompanied togetherfor services,eachpersonshould be countedin singlesnot in families.. Clients' househoidstatusshouldbe year. This basedon their householdcompositionat the programenfry dateciosestto the startof the operating determined that pregnant women expected to give birth during their program stay should stil1be counted as singlesnot in means famrlies. Adults in Families - Within a fam1|y,an adult is any person 18 yearsof age or older. For the purposesof APR reporting, composition the determinationof whethera person is an adult in family shouldbe madebasedon their ageand household year' at the program enhy date closestto the starl ofthe operating by Children in Families - Children in Famrliesare definedas childrenunderthe ageof 18 accompanied one or more also includeboth a juvemle parentand the parent'schild(ren). adults (parent,relative or guardian). Childlen in families of For rhe numosesof APR reporling,the determination whethera personis a child in family shouldbe madebasedon to their age and householdcompositionat the programentry dateclosest the stafi of the operatingyear. For exanrple,
H U D - 4 01 8 i

during clieutswho are lessthan 18 yearsof age onthe frrst day of the operatingyear or atprogram entry (if they entered even ifthey turn 18 during the courseofthe operatingyear. the operatingyear) shouldbe countedas children in Personsin Families - Persons fanriliesincludesadultsin farulies and childrenin families.

Other Key Definitions. The following terms are used in the APR. As indicated,in some cases, tems are applieddifferentiy dependingon u,hether funding is fi'om SHP, S+C, or SRO. the personas "an unaccompanied Chronically homelessperson - HUD definesa chlonically hon-reless homeless rndividual u,ith a disablingconditionwho has either been continuouslyhomeless a yearor rnore OR hashad at leastfour (4) for episodes homelessness the past tluee (3) years." To be considered of in chronicallyhomeless, personmust havebeen on a the sh'eets in an emergency sheiter(i.e., not in transitionalhousing)during thesestays, or HUD's definition of a cluonically homeless personis basedon the following components: . Unaccompanied homelessindividual: an unaccornpanied homeless individual hasthe samecharacteristics of a Singlenot in a Family (describedabove). . Disabling condition: seethe instructionsunder disablingcondition(below) to detemrine u,hether client is a disabled. Did not leave the program - This term refers to clientswho were in the programon the last day of the operating year. Disabling condition - HUD definesa disabling condition as: (1) A disability as defined in Section223 of the Social Qen"-in' a''t' ()\' physical,mental,or emotional inrpairmentwhich is (a) expectedto be of long-continued indefrnite a1d duration,(b) substantially inrpedes individual's ability to live independently, an and (c) of sucha naturethat suchability could be improvedby more suitablehousing conditions;(3) a developmentai disability as definedin section102 of the Deveiopmental DisabilitiesAssistance and Bill of Rights Act; (4) the disease acquiredimmunodeficiency of sl,ndrome or any conditionsarisingfrom the etiological agencyfor acquiredimmunodeficiency syrdrolne; or (5) a diagnosable substance abusedisorder. Entered the program - Enteredthe program refers to the first day a client receivesservices.For a residential program, this datewould represent hrst day of residencein the program's housing. For selices, this datemay represent day the the of program eruollnent, the day a servicewas provided, or the fust dateof a period of continuous participationin a sen'ice (e.g.,daily, weekly, or monthly). For S+C and SRO programs,the program enhy dateis the datethat the participantstartsto receiverental assistance. For S+C, ser-vices providedprior to this point are recognizedas necessary outreach/enrollment are eligible to count as for and match. Al Extension APR appliesto SHP and S+C grantees that requested and receivedan extensionof their grantterm from the HUD field office. The only differencebetweenan APR for the extension period and the regularAPR (besides the amountof time covered)is the signature page. Granteesshouldcircle "yes" to indicatethe APR is for an extension hpri^'l "'l ^i-^l^ rhe operatingyear for which the report is an extension. For example,if tiie grantee extending is year 3, the granteeshould submit an APR as usual for year 3 and submit anotherAPR for the extensionperiod, indicating the secondis an extension and also circling year 3 on the signature page. Grantee meansa directrecipient of the HUD alvard. Left the program - Left the progran refers to the last day a client receivessen'ices. For a residential prograrn, this date rvould represent last day of residence the program's housing. For serr,'ices, exit datemay represent last day the in the the a sen'icewas provided or the last date of a period of continuoussen/ice. If a client leavesthe programtenrporarily (e.g., for a hospitalization) is expectedto retum within 30 days,do not count that client as having left the program. but For S+C progran$, the program exit date refers to the date the parlicipantstopsreceiving rentalassistance is not and expectedto refum to S+C assisted housing. If tiie parlicipantrehrrnsto S+C assisted housingu'ithin 90 days,the person should not be considered exiting from the plogram. If the personreturrs to S+C assisted as housingafter 90 days,that person is considered new parricipant. The worksheetis designedto capfurethis information. a
HUD-401 l8

in receivedby particrpants the S+C project which, in the aggregate, Match for S+C is the value of supportiveservices provided over the life of the project. For SHP, match is cash must at leastequalthe value of the S+C rental assistance and supportiveservices porlion ofacquisition, rehabilitation,new conshuction.operations usedto provide the grantee's expenses. activitiesfor acquisition, the Operating year - For SHP progranrs, first operatingyear beginsafter development .-L.hil;+.ri^- .-.d new constnrction conrplete,after a copy of the Certificateof Occupancy sentto the local HUD are is into the project. For projectswithout acquisition, office, and when the first participantis accepted rehabilitation,or new cnncirrrnrinnrhAoperatingstartdatebeginswhen the granteeaccepts first participant. For dedicated the HMIS projects, the operatingyear beginswhen any eligible cost included in the approvedproject budget is incurred. For S+C (Sfu\, PRA and TRA components),the first operating year begins on the date HUD signs the grant agreement. For S+C/SRO and for Sec. 8 SRO, the first operatingyear begins with the effective date of the Housing AssistancePa).rnents (HAP) Contract. To deternine which operating year to circle on tire APR cover page, begin counting frorn the initial grant operating staft date and include renewal grants. For example, a project receiving an initial grant for three years and a renewal grant for two yearswould circle years 1, 2, and3 respectivelyon the APR cover sheetfor the initial grant and would circle 4 and 5 respectively for the renewal grant. For any future renewal grants, the granteewould begin by circling 6 on the APR cover sheet. Participants - The term parlicipantrefersto Singlesnot in Families and Adults in Famrliesas definedabove. Participalt who live with the adultsassisted. doesnot include children or caregivers responsiblefor carrying out the daily operationof the project, if the Project Sponsor meansthe organization organization is an entity other than the grantee.

Special Instructions for Supportive Service Onlv (SSO) Programs. SSO granteesshouldcompleteall questions, unlessa written agreementhas been reachedwith the field offrce concerning which questionscan be answeredusing estimates, or in rare instances. skipped. Below is an exampleof how informationcould be derived in a large, singie-service SSO project: A grantee/sponsor to staff membercould be assigned collect information from the organizations housingthe participants. The staff person would contact these individual organizationsto request information regarding the personsin that facility that use the service.For participants living on the street,the grantee/projectsponsormay provide estimates. Information could be coilected for eachparticipant or for parlicipants receiving servicesat a point-in-time. If estimatesor point-in-tirne counts are used, the method used must be described in the APR and the documentationkept on file. grants,grantees As with all projectsfundedunderHIID's homelessness assistance operatingSSOprojectsare expected to complete all APR questionsthat are applicable to them. Note that a1lprojects have been awarded funds as a result of personsobtafu/remain permanent responding the program goais of assisting to homeless in housingand increase their skills and income. The APR documentstheir progress in meeting these goals. In some circumstancesfield offices and granteesmay sigri a wr-ittenagreementconceming questionsthat can be ansrvered using estimates, in rare instances, skipped. Seethe specialinstructionsbelow for reportingon specialtypesof projects,such as or outreachonly projects,projectsproviding services children only, and transporlation, to medical,dental,and other single,shortdurationserviceprojects. SSOprogramsare a third priority for local HMIS implementation, following emergency shelters, transitional housingprogran1s, programs,and permanent outreach supportivehousingprograms. Once SSOprogramsare includedin the HMIS, SSO grantees will be able to answerail APR questions using their HMIS data. SSO grantees that arenot yet participatingin HMIS will need to collect datato answerthe APR questions using the specialinshuctionsprovided above. Outreach Only Projects. Projectswhich are soleiy devotedto streetouh'each and connectionto housingand sen'icesare not requiredto track participants beyondtheir contactwith personson the street. It is sufficient for theseprojects to enter
HUD-40118

infonlatiol on questions1- 10 (skipping questions1 1-13 and 17). Estimatesfor questions 5 -9 are allowed,given that participantsmay be reluctantto answerpersonalquestions. Answering the questionswill demonstratethat the granteeis serving the appropriatenumber of people, providing basic demographic infornation for Congress,dernonstratingthat homelesspersonsare being serled, demonstratingthe tlpes of housingparticipantsare connected and the flpe of sen'icesthey are leceiving. to, Hotline Projects. Hotline servicesare similar to outreach only projects, but contactbefweengrantee and. participantis often ofvery short duration - people enter and leave the programnearly simultaneously.It is sufficientfor theseprojectsto answer questions1-5 (skipping 4), 10, and i4-19 (skipping 17). Projects Providing Services To Children Only. Projectsthat provide child care,after schoolcare,courselingfor children, etc. make an important contribution toward moving a family out ofhomelessness. While the main focus of the project is providing servicesto the children,it is the adultswho arereporled on in questions 6-16 of the APR. Like all otherprojects, this type is also talgeted toward getting the families into housing and increasingthe famrlies' incomes. Granteesmay skrp question9; all other questions shouldbe answered(except 17). Transportation, Medical, Dental, and Other Single, Short-Duration Service Projects. Somegrantees proyide a single sewice of fairly short duration focused ONLY indirectly on assistinghomelesspersonsto obtain/rernainin permanent housingand increase their skills and incomes. It is sufficientfor theseprojectsto enterinformationon questiols 1-10 and 1419 (question 17 rnaybe skipped). However, with hansportation services, is unreasonable think that someone it to would have to give their age,race, and ethnicity to a bus driver to get a ride a few blocks. For these services,provide a narrative, which gives the number of rides given during the operating year, and provides estimates on the above statistics basedon the population that utilizes the service. Special Instructions For Safe Haven (SH) Proiects. Granteesshouldrepofi on all parricipants servedduring the operating year. Note: this is a changefrom prior inshuctions where granteeswere instructed to report on the first 25 participantsserved.

s for Homeless Nlanasemen nformation Svstem(HM
should fill out the cover sheetof the APR, Part II Financial Information, and the HMIS Activities secrron.

ts. HMiS grantees

I-iuD-401I I

THISPAGE - TO BE COMPLETEDBY ALL GRANTEES
Grantee:

HUD Grantor Project Number:

Department HumanServices of Cityand Countyof San Francisco,
ProjectSponsor:

cAO'1c501041
ProjectName:

lris Jelani, Center Center, LeeWoodward Counseling
Operating Year: (Circle the operatingyearbeing reportedon)

Reporting Period : (month/day/year)

Xr Jz n: L]+ Ds tro Dr trs trs f]to t rr i l r z [ r D r+E rs l ro D rz n rs n tq nzo
Indicate if extension: fl Yes X No Indicate if renewal: X Yes n No PreviousGrant Numbersfor this oroiect:

from:7/1/06

to:6/30/07

cAO1 c301 047
cA39C9601 01

Check the componentfor the program on which you are reporting

Supportive Housing Program (SHP) tr n tl n tr N Transitional Housing Permanent Housing for Homeless with Disabilities Persons Safe Haven Innovative Supportive Housing Supportive ServicesOniy HMIS

Shelter Plus Care (S+C)

Section 8 Moderate Rehabilitation I SingleRoom Occupancy (Sec.8 SRO)

X

n tr n

Tenant-basedRental Assistance(TRA) (SRA) RentalAssistance Sponsor-based (PRA) RentalAssistance Project-based Single Room Occupancy(SRO)

with a descriptionof population,number servedand accomplishnents Summary of the project: (One or two sentences this operatingyear)

provided to 26 unitsof permanent year,this project up housing homeless to this operating During families. of the All sheltersand had one or more specialneedsrelated mental families came from eitherthe streetsor emergency to health, substance ab(use), and/orHIV/AIDS.
Name & Title ofthe Personwho can answerquestionsabout this report: Phone: (include areacode)

Manager PlusCareProgram ShaneBalanon, Shelter
Addless:

(415) 558-1 980
Fax Number: (include areacode)

Department HumanServices of San Francisco P.O.Box 7988 San Francisco, 94120 CA Address shane. balanon@sfgov.org E-maii

(415)558-2834

I hereby certify that all the information stated herein is true and accurate.
and/orcivil penalties. Convictionmayresultincriminal (18U.S.C.1001, Warning; HUDwill prosecutefalseclaimsandstatements. 1010 .10 12 : 3 1 U.S.C . 3729. 3802\
Name & Title of AuthorizedGranteeOfficial: Signature& Date:

Shane Balanon, ShelterPlus Care ProgramManager
Name and Title of Authorized Proiect SponsorOfficial

=:--J;-u*,')p-"
X -. ___,i -4,./n?,-

"

-:F

'l: -!J', :'*t

Signature& Date

o

H U D - 4 01 8 1

(EXCEPT E{*{ES) pARr r. ro BE cc,MP.,ETED ALL G^tu,VrEES BY
ON PLEASESEE SPECIAL INSTRUCTIONS PAGE 3 OF TEIEAPR GRAI{TEES, SSO

Part I: Project Progress
1.
a lcatlon.

projectedlevel of persons to be served at a given point in tirne. (Thrsidormation comesfrom the most recentCoC
Number of SinglesNot 'in Families

2

ProiectedLevel Personsto be servedat a given point in time

Numberof Adultsin Families

Nr-rmberof Children in Families

of Number Families

zo

2.

PersonsServedduring the operatingyear.
Number of SinglesNot in Families Number of Adults in Families Number of Children in Families Number of Families

a.

Number on the first day of the operating year Number entering program during the operating year Number who left the program during the operating year Number in the program on the last day of the operating year (a +b -c)=d

27 2

48 6
6

23
z

b.
e

2
27

2

d.

49

23

Explanatory notes: which clients should be countedas SinglesNot in Types in the GeneralInslructionsaboveto determine SeeDefinitions of Client/Household tlpe that may Families,Adults in Families,and Children in Families. Note that this table doesnot accountfor changesin clienl4tousehold a type basedon the client's year. Instead,eachciient should be assigned single client4rousehold operating occur during the courseofthe age andlor household composition at tlxeprogratn entry date closest to the start ofthe operating year. In this way, each client is counted only once in the table. Use the following graphic and explanationsto determine who should be counted in rows a-d:

I -i--------_{ i

in on Clienl Progfam ll.stdayof year,lefr duringthe 'perating in 2a and2c. vear couni on in Client program firstday y of oper ati ngearandIas l year counl dayofoperaling i n2a and2d.
a+ Clienl enlered and len program dunng opefallng year: count tn2b and2c. Clienl enlered program during operatingyear and still in program on lasl day of year counl in 2b and 2d.

H Clienl entered and leR program before starl of operatingyear: do nol counl ln question2.

FiEt day oflhe operating year

Number on the first day ofthe operating year: This row includesall clientswho enteredthe program before the first day ofthe operating year and did not leave the program until after the first day ofthe operating year' b. Number entering the program during the operating year: This row includesall clients who enteredthe program on or after the first use the day ofthe operatingyear,up to and including the last day ofthe operatingyear. For clientswith multiple program entry dates, enfry date closestto the startofthe operatingyear. Do not count the client more than once even ifhe/she enteredthe programmore than once during the operating year. Number who left during the operating year: This row includesall clientswho left the program on or after the first day of the operatingyear,up to and including the last day ofthe operatingyear. For clientswith multiple program exit dates,use the exit date HUD-40118

once evenifhe/she exited the program more closcstto the end ofthe operatingyear.Do not count the client more than the operattngyear. d.

than once dudng

Number in the program on the last day of the operating year: This row includesall clientsrvho were in the programas of the first enteredduring the operatingyear and rvho did not leaveduring the operatingyear. The number of day ofthe operatingyear or 1,',ho to basedon the responses rows 2a through 2c. For in the programon the last day of the operatingyear is calculated clients or families of eachcoiun-n,add the nun-rber clientsor families in row 2a to the number of clientsor famtlies in row 2b and subtractthe number of 2d clients or families in row 2c. Thet-efore, : 2a + 2b - 2c.

3.

P r ojec t Capac i ty .
Number of Not Singles in Families Number of Adults in Families Nun-rber of Children in Families Number of Families

a.

Number on the last day (fi-om2d, colunrns 1 and 4) Nurlber proposedin application(from 1a, columns 1 and 4) Capacity Rate(divide aby b): %
%

,' ,:

ii

23 26
B B%

b.
c.

Explanatory Notes: is for Rowb refers themostrecent to CoCapplication u'hichtheprogram reporting

4.

Non-homelesspersons. This questionis to be completedfor Section8 SRO projects.

personswere housedby the SRO programduring the operatingyear? How many income-eligiblenon-homeless

5.

Age and Gender. Of thoseu'ho entered the project during the operatingyear,how many people are in the following age and gendercategories?
Sinele Persons(from 2b. column I Male Fernale

b.
d.

62 and over 5l -61 31-50 I 8-30 l'7 and under 62 andover 61 31 - 50 t8-30 t3-17 6-12
Under I

(from 2b. columns & 3) 2 Persons Families in

f, e. h.
J
1,

1
z

1 I I

m

Explanatory Notes: year.Onlyclients the duringtheoperating and in not Thisquestion refers only to Singles in Famjlies Persons Fanilieswho entered program T h etotal w h o m eet t hes ec nt e ri a c a n b e c o u n te d i n th i s ta bl e. numberofcl i entsreportedunderS i ngl eP ersonsshouldbeequalt ot he under Persons Families in reported should equal thesumof of be to 2b, number reported question columnl. Thetotalnumber clients in 2b. columns and3 in question 2 Answer questions6 - 10 only for participants who entered the project during the operating year (from 2b, columns| & 2). The tern participant meansSinglesnot in Families and Adults in Families. It doesnot include childrenor caregivers.NOTE: for Tlre total for questions 7 , 8 and 10 below should be the same;respondto each of thosequestions all participants.Someof , information for individualswho are chronically homeless. the questionsiisted throughoutthe APR will be asking

HUD-'+O118

6a. Veterans Status. A veteran is anyonewho has ever been on active military duty status. \\ere veterans? How manyparticipants | 0 |

homelessindividual with a disablingcondition who has eitherbeen continuously 6b. Chronically homelessperson. An unaccon.rpanied in ofhomelessness the pastthree (3) years. To be considered homelessfor a year or more OR has had at leastfour (4) episodes shelter(i.e. not transitionalhousing)during chronicallyhomelessa personmust have beenon the streets in an emergency or these stays. For further discussionof the definition of chronic homelessness, Other Key Definitions under the GeneralInstructrons see above. How many participantswere chronically homelessindividuals? | 0 |

7.
a

Ethnicit5'. How many palticipantsare in the following ethnic categories? Hisoanicor Latino Non-Hisoanicor Non-Latino

b.

0 2

Explanatory Notes: Each participantshould be listed in only one category. The total number ofparticipants in this table should equalthe numberofparticipants in question2b, columns 1 and2.

8.
a

Race. How n-rany participantsare in the following racial categories? American Indian/Alaskan Native Asran Black/African American Native Hawaiian/OtherPacific Islander White American Indian/Alaskan Native & White Asian & White Black/African American & White American IndianiAlaskan Native & Black/African American Other Multi-Racial

b. d. f.
o

h

Explanatory Notes: Eachparticipantshould be listed in only one category. A participantwhose race doesnot conespondto categories through i should be a countedin j, Other Multi Racial. The total number of participantsin this table should equalthe number of participants question2b, in columns 1 and2. If using HMIS data,you may combine HMIS race responsecategories generate APR response to the categories.

9a. Special Needs. How many participantshave the following? Participants may havemore than one. Ifso, count them in all applicablecategories.For eachcondition, also indicatethe number that u,erechronically homeless. AII Chronic a. Mental illness 2 0 n b Alcohol abuse 2

Drugabuse
d.
c-

2

0

f s. h.

HIV/AIDS and relateddiseases Develonmental disabilitv Phvsicaldisabilitv Domesticviolence Other (oleasesoecifV)

9b. How manyof theparticipants disabled? are 2 Explanatory Notes: To determine whichparticipants meetHUD's definition "disabled," "Disabling of see Condition" underOther Key Definitions theGeneral in Instructions.
HUD-401 I8

10. prior Living Situation. How many participantssleptin the following placesin the week prior to enteringthe project? (For each in participant,chooseone place. The total number of participantsin the "A11" columr should equalthe number of participants question 2b, columns i and 2). Also, indicatehow many chronically homelessparticipantssleptin the following places. (Chooseone) All I
l

Chronic

a

b.
d.

Non-housinq(street.park, car, bus station, etc.) Emersencvshelter persons Transrtional housinefor horrreless Psychiatricfacility* Substance abusetreatmentfacilitv* Hospital* Jail/nrison* Donrestic violence situation Livine with relatives/fri ends Rental housine Other (pleasespecify)

0 0

f,
g

;.:

h.

1..

*Ifa participant (psychiatric abuse came froman instr'tution facility,substance treatment facility,hospital, orjail), but wastherelessthan entering treatment the 30 daysandwasliving on the street in emergency or shelter before facility, he/she should counted eitherthe be in street shelter or catcgory. appropriate. as

Cornpletequestions11 - 15 for all participants who left during the operating year (from 2c, columns 1 and 2). The terrn parlicipantmeanssinglepersonsand adults in families. It doesnot include childrenor caregivers.The tenl chronically homelessperson meansan unaccompanied indivrdualwith a disablingconditionwho has eitherbeencontinuously homeless of homelessfor a year or more OR hashad at leastfour (4) episodes homelessness the pasttluee (3) years.To be considered in chronicallyhomelessa personmust havebeen on the streetS in an emergency or shelter(i.e. not transitionalhousing)during these stays.

1 1 . Am ount andS o u rc e o fMo n th l y l n c o me a tE n t ryandatE xi t. Ofthosepafi i ci pantsw hol eftduri ngtheoperati ngyear , howm any participants r.vere each ievelandwith each of at monthlyincome source income?Also,please place monthlyincome the levelandeach persons thesecond source income chronically of for homeless in column each of chart.Thenumber palcicipants Chart andB of in A should thesame. be
All A. Monthly Income at Entrv No incorne b.
1

Chrcnic C. Income Sources Entrv At

All i
a.

Chmnic
.:ir:.:

, irii

Supplemental SecurityIncome(SSf Social SecurityDisability Income (SSDI) Social Security GeneralPublic Assistance TemporaryAid to Needy Families(TANF)
L

$1- 150 $151 $25 0 1 $25 - $500 $501 $1, 0 0 0 z

b. c. d

d

0
f.
g

0

I
g

s i001-$15 0 0 $1501520 0 0 + $2001

StateChildren'sHealth Insurance Program(SCHIP) Veterans Benefits Emplol'rnent Income Unernployrnent Benefits VeteransHealthCare Medicaid Food Stamps
L

h.

h.
I

1

0

J

k
m.. n.

0
0

1

Other (pleasespecify) No Financial Resources

10

HUD-4011E

Atl B. Monthly Income at Exit
a.

Chonic D. IncomeSources Exit at
a

AII

Chrrnic

No income

Supplemental SecurityIncome (SSI) SocialSecurity DisabilityIncome(SSDI) SocialSecuritv GeneralPublic Assistance TernporaryAid to Necdy Families(TANF) program (SCHIP) StateChildren's Health Insurance VeteransBenefits Entployrnrent Income Unemploynrent Benefits VeteransHealth Care 1

b. c. d

$ 1-150

b.
c.

sl5l - s250

r s25- s500
$50r- $1,0 0 0 $100r - 5 0 0 $1 s 1501- 0 0 0 $2 + 52001

d.
e.

0

f.
g

f.

h.

h.

1

0 0 0

1.

Medicaid Food Stamps Other (pleasespecify) No FinancialResources 1

I
m. n.

Explanatory Notes: Table A: Monthly income at entry refersto the participant'smonthly income on the day he/sheenteredthe program (i.e., on the progra'r entry date or as closeas possibleto that day). You shouldnot report on income receivedbefore entcringthe program or incomereceived during the progrant stay. Table B: Monthly incomeat exit refe-rs the-participant's tomonthly income on rhe day he/sheleft the program(r.e.,on rheprogramexit date or as close as possibleto that day). You should not repofi on income receivedduring the progranrstay. Table C: Incone sources entry refet's the participant'ssourcesof income on the day he/sheentered program at to the (i.e., on the program entry date or as closeas possibleto that day). You shouldnot report on sourcesofincome receivedbeforeentering the programo. in"on-,,. receivedduring the programstay' Participantswith no incomeat the time of proglam entry should be reported in category No Financial i, Resources. Table D: Income sources exit refersto the participant's sources income on the day he/sheleft the progranr(i.e., at of on the programexjt date orasc losea sp ossib let ot hat day )Yous houldnot r epor to n s o u r c e s o f i n c o n - r e r e c e i v e d d u r i n g r h e p . o g . u , r 1 s ta ry i.c i p a n t s- r ,r ,i th n o . p at income at the time of programexit shouldbe reporled in categoryn, No FinancialResources.

12a. Of thoseparticipants u'ho left during the operatingyear (from 2c, colunrns 1 and2), how many r.ver-e the pro.lect in for the followrng lengthsoftime? Also, pleaseplace the length ofstay for chronically homelesspersonsrvho left during the operatingyear in the second column. AII
2

Chronic

b c. d. f h.
I

Less than I month I to 2 months 3 - 6 months 7 months- 12 months I3 montlis- 24 months

25m ont h s -3 y e a rs
4yea rs-5 y ear s 6yea rs-Ty ear s 8 years- l0 years

1
1

0

Over10years
Erplanatorl, Notes: Computeeachparticipant's lengthofstay usingthe participant's prograntenrrydateand programcxit date. Ifthe participant only one has progranl exit date during the operatingvear, calculatelength ofstay by subtractingthe progrim entry date fi.omthe pro_qram date. Ifthe exit participanthas multiple progranlexit datesduring the operatingycar, calculatethe length of stay foieach progam stay (by subtr.acting the programentry date fl'onrthe programexit date for eachprogramstay) and add thenrtogetherto produce a cumulativeiength ofstay. Each

11

HUD-40118

participantsl.rould associated with only one length of stay category. The total number of parlicipantsin the first column ("All") should be equal the number of participants question2c, colunms I and 2. in 12b. Length of Stay in Program. For thoseparticipantswho did not leave during the operatingyear (ffom 2d, coiumns 1 and 2), how long hc'o tlra', I'aan ir +r.o project? Also, pleaseplace the length of stay for chronically homelesspersons who did not leaveduring the yearin the second operating column. All
a.

Chronic

b.
C.

d. f.

s,
h.

Lessthan 1 month I to 2 months 3 - 6 months 7 months- 12 rnonths 13 months- 24 months 25 mon t hs - 3v ear s 4vea ls - 5v ear s 6yea rs - Tv ear s 8 years- l0 years Over 10 vears

L

1

4
o z

Explanatory Notes: Compute eachparticipant'slength ofstay using the participant'sprogram entry dateand the last day ofthe operatingyear. To calculate length ofstay, subtractthe programentry date from the last day ofthe operatingyear. Each participantshould be associated wlth only one length of stay category. The total numberof parlicipants in the first column ("All") should equalthe number of participants question2d, in columns I and 2.

13. Reasonsfor Leaving. Ofthose participantswho lgft the project during the operatingyear (from 2c, colunrns 1 and 2), how rnanyleft forthefollowingreasons? Ifaparticipantleftformultip'lereasons,includeonlvtheprimaryreason. Thetotalnumberofparticipants in the first column ("All") should equalthe number of participantsin question2c, columns 1 and 2. Also, pleaseplacethe primary reasonfor chronically homeless persons who left the project during the operatingyear in the secondcolumn. All
a.

Chronic

Left for a housingopportunitybefore completingprogram Completed program Non-pa1'mentof renVoccupancycharge

b.

d.

Non-compliance with proj ect Criminal activity / destructionof property / violence

1

0

f

Reached maximum time allowed in oroiect Needscould not be met by project Disagreement with rules/persons Death Other (pleasespecify) 1) transferred anotherS+C housing site to 1

c.
h.
I

J

1.

Unknownldisappeared

12

HUD-40118

who lg[t during the operatingyear (from 2c, columns1 and 2), horv many left for the following 14. Destination. Of thoseparticipants piace the destinationofchronically homelesspersonsu;ho left during the operatingyear in the second destination?Also, please column.

All PERMANENT(a-h)
b.
c

Chronic

Rental house or apartment (no subsidy) PublicHousing Section8 ShelterPlus Care house or apartnent HOME subsidized f.
g

d.

1

0

house or aparfinent Other subsidized Homeownership Moved in with farnily or friends persons Transitionalhousing for homeless Moved in with family or friends Psychiatrichospital facility lnpatient alcohol or other drug treatment Jail/prison Emergencyshelter

h. TRANSTTTONAL(i-j)
J'

INSTITUTION (k-m)

k

t.
m. EMERCENCY SHELTER (n) n.

OTIIER (o-q) p. q. LINKNOWN r

housing Othersupportive
Placesnot meant for human habitation(e.g. street)

specify) Other(please
Unknown 1

0

Explanatory Notes: provided.The response categories combine Identify eachparticipant'sdestinationupon leaving the program using the categories etc.) and "tenure" (e.g.,permanent, "destination" (e.g.,rental house or apaffment,public housing,homeownership, transitionai, etc.). and be sureto look at all ofthe response categories Considerboth destinationand tenureto determinethe most appropriateresponse, before category. making a selection.The table below provides a brief descriptionof eachresponse Enter the number of participantsunder eachdestinationcategoryin either the first column of the table or in both columnsif the participantis chronically homeless. Only one reasonfor leaving should be recordedper padicipant.The total number of participantsin the first column ("A11")should equal the number of participantsin question2c, columns I and2.

Tenure
Permanent
a

b. c, d.

Destination Rental house or apartment(no srrbsidv) Public housine Section 8 SheiterPlus Care HOME subsidizedhouse or apartment Other subsidizedhouse or apaltment

Description Participantis moving to an apartmentor housewithout any subsidy. P a n i c i p a nits m o v i n gt o a p u b l i ch o u s i n e n i t . u Participantwill use a housing choicevoucher(formerlyknown as a Section8 voucher)to rent a houseor aDartment. Participantis moving to a unit fundedby the ShelterPlus Care prosram (e.e.,TBA, SRA, PRA, Section8 SRO). Participantis moving to a unit with rentalassistance providedby the HOME program(tenanfbasedor project-based assistance). Participantis moving to a unit subsidized somepro$am other than by public housing,housing choice voucherprogram(formerly Section8), ShelterPlus Care,or HOME. Part crpant m o v i n qt o a u n i t r h a th e / s h e a sp u r c h a s e d . h Parlicipantis moving in with family or friends and expects live there to for 90 davs or more. Participantis moving into a unit fundedby a transitionalhousing program for homeiess people(e.g.,transitionalhousingfunded through the SupportiveHousing Program). Participantis moving in with family or friendsand expects live there to lessthan 90 days. is Participant mor ing to a psychiarric hospiral,

i.

h. Transitional
I

Homeownershio Moved in with family or friends Transitionalhousing for homeless people Moved in with family or fiiends

lnstitution

t.

Psvchiatrichosoital

11 IJ

HUD-401 l8

T en u r e

I m Emergency Shelter Other
n

alc I npat r ent oholor ot herd r u s heatmentfacility Jail,Frison Emergencyshelter housing Other suppofii\re

Descriution Purti.ipuntis moving to an inpatient alcohol or dlug treatmentfacility it P a r r i c i p a n s m o v i n qt o a i a i l o r p r i s o n . people. Participantis moving to an emergencyshelterfor homeless is Participant moving into supportivehousing that doesnot corespond (a-h) and is not transitional housing categories to any ofthe permanent people (i), such as Section81t housing.* housingfor horneless is Participant moving to a place not meant for humanhabitation,such as a car,park, sidewalk,or abandoned buildine. Participantis moving to a place that doesnot conespondto any ofthe catesories above(a-o). This response categoryshould be used ifyou areunsureaboutwhere the participantis moving or ifthe participanthas disappeared there and is no wav to find out where heisheis.

o.

p.
q.

Placesnot meant for human habitation specify) Other (please Unknorvn

Unkrown

r

*HLID encouragesprogran$ to linxit tlte use of tlte "Other Supportive Housing" APR responsecategory. Progt"antsshould report destinations to housing that are permanent or transitional in APR categories (a) through (h) or in categories (i) through O, respecti,tely. Exits to emergencysltelters should be reported in categoty (n).

year (from 2, colurnns 1 and 2), horv many receivedthe 15. Supportive Services. Ofthose participantswho teft during the operating placethe supportiveservrces receivedfor chronically duling their time in the project? Also, please following supportiveservices n-tay have receivedmultiple servicesand all who left during the operatingyear in the secondcolumn. Participants homelessparticipants servicesshould be reoortedin the table. All
a.

Chronic

Outreach Case management Life skills (outsideof casemanagement) Alcohol or drug abuseservices Mental health services
z

b.
c.

z

0 0

d.

f
q

HIV/AIDS-related services Other health care services Education Housing placement

h.

J
1,

Employrnent assistance Child care Transportation

m n.

Legal Other (pleasespecify)

I4

HUD-40118

16. overall ProsramGoals.Underobjectives, yourmeasulable list for objectives thisoperating (fromyour application, year Technical Submission, APR)for each thethree or of goals listedbelow. UnderProgress, describe youiptogr.ssin meeting objectives. the UnderNextOperating Year'sObjectives, specify nreasurable the objectives thenextop.ruilni y.ur. for
a. Residential Stability

Objectives: Please see attached. Progress: year'sObjectives: NextOperating

b.

Increased Skillsor Income Objectives: Please see attached.

Progress:

Next Operating Year'sObjectives:

c,

GreaterSelf-determination Objectives: Please see attached. Progress:

Next Operating Year'sObjectives:

17' Beds' sHPrecipients answer S+crecipients 17a. answer sRo recipients l7b. answer (SHp-SSOprojects do l7c. ,rot complete this question)
a' SHP' How manybedswereincludedin the application approved rhs projectunder'current Level,and under,New for -Effort,? How manyof these New Effort bedswereactuallyin placi at the endof theoperatin y"uri g CurrentLevel New Effort New Effort in place Numberof Beds: s+c' How manybeds dwellingGitswerebeingassisted project and w-with fundsat theendlithe operating year? (Include beds all participants, for otherfamily andcare giu"is.) -.n',b.rr, Number Beds: of 23 Number Dwelling of Units: 23 SRO. How manydwelling unitsrvere beingassisted theendof theoperating at year? (Include unitsoccupied "in place"non-homeless by persons quaiifyfor as-sistance.) who Number DwellineUnits: of

b'

c'

I)

HUD-40118

TRA SPCR cAO1cs01041
Reporting Period: 711106 6130107 Residential StabiliUt: 70%o pafticipants will remain in S+C housing for at least one year. of Objective: remainedin S+C housingfor at leastone year. Exceeded.83%ofthe participants Progress: will remain in S+C housingfor at leastone year. Objective: 7\oh of participants Next OperatingYear's Of tlne70Yoof participantswho remainedin S+C housing for at least one year, 55% will remain in their housing for at least two more years.. have remainedin housingfor at leasttwo years. Exceeded.90%of the participants Progress: Next OperatingYear's Objective: Of the 70Yo of parlicipants, 55% will remain in their housing, as families continue to stabilize, for at least two more years. Objective: Incrcased Skills or hrcome: 50% of participants will obtain and maintain employment during the operating year. during the operating Exceeded.55% of participants obtained and maintained enrploynnent year' Next Operatilg Year's Objective: 50'/" of participants wiil obtain and maintain employment durrrg the operatingyear. Objective: Progress: 60Yo ofparticipants will enroll in an education or emplolment haining program during the next operating year. Not achieved.46ok participants enrolled in an education or employment training program Progress: during the operating year. We will continue to strive towards this objective for the next operating year by assisting Sponsorswith resourcesfor clients of Next Operating Year's Objective: 60o/o partrcipantswill enroll in an education or employment training program during the next operatingyear. Objective: Gr eater Self- determ i n atio rt: 80% of parlicipantswho relapsewiii seekfi'eatment. Objective: Exceeded. 85Yoof the participants, who relapsed,sought treatment. Progress: Next OperatingYear's Objective: 80% of parlicipantswho reiapsewill seektreatment. of 75o/o pafticipants who are in recovery will remain drug-free while enrolled in the S+C program. Exceeded. 100o/oof participants who are in recovery have remained drug-free v,hile Progress: enlolled in the S+C program. NextOperating Year's Objective: 75o/oof participantswho are in recovery will remain dmg-free while enrolled in the S+C progran. Objective: gAokof participants will reunite with their children. Objective: None of the participantsrequiredreunificationwith their children. Progress: of Next Operating Year's Objective: 90o/o participants will reunite with their childlen. 100% of the chiidren andyouths will have up-to-dateimmunizationsand will attendal1 well-baby/childmedicalcheck-ups. Acltieved. 100% of the children and youths had up-to-date inrmunizationsand have Progress: attendedall well-baby/child medical check-ups. Next OperatingYear's Objective: I00Yo of the children and youths will have up-to-dateimmunizations and will attendail well-baby/childmedical check-ups. Objective: .

80% ofparticipantswill rate the quality ofservicesreceivedas at leastsatisfactory. Exceeded. 95% of parlicipants rated the quality of services received as at least satisfactorY. Next OperatingYear's Objective: 80% of parlicipantswill rate the quality of sewicesreceivedas at least satisfactory. Objective: Progress: 80o/oof participants who were in treatment will report being healthier than when they enteredtreatment. Progress: Exceeded. 100% of participants who were in treatment reporled being healthier than when they enteredh'eatment. Next Operating Year's Objective: 80% of pafiicipants who were in treatment will report being heaithier than when they enteredtreatment. Objective:

Part II: Financial Information
18. SupportiveServices. was spentduring setvices For SupporriveHousing (SHp), this exhibit providesinformationto HUD on how SHP funding for supportive "Other". of operating year. Enter the an-rount SHP funding spenton thesesupportiveservices. Include HMIS costsunder the Specifythe value of supportiveservicesfrom all match requirement. For Shelterplus Care(S+C'),this exhibit hacks the supportiveservices should keep personsreceivedduring the operating year. (S+C grantees sources that can be countedas match that all homeless ofsupportive services.) on documentation file, including soulce,amount,and type during the servicesreceivedbyhomelesspersons infonlation toHUD on the valueof suppofiive For Sectiong SRO,this exhibitprovides operatingyear.

SupportiveServices
a.

Dollars

Outreach Casemanagemenl Life skills (outsideof casemanagement)

b.

d.

Alcohol and drug abuseservices Mental health services

$ 26,374
q 1/- A?2

f.
g

AIDS-relatedservices Other healthcare services Education Housingplacemenl

h.

J

Employrnentassistance Child care Transportation

k.

m. n. o

Legal Other (pleasespecify) TOTAL (Sum of a through n)

$ 40,806 $ 40,806

Cumulativeamountof match provided to date for the Shelter Plus Care Program under this grant

I6

H U D .4 O1 I8

19. Supportive Housing Program: Leasing, Supportive Services, Operating Costs, HMIS Activities and Administration year.For expansion All grantees receivingfunding under the Supportive Housing Programmust completethesechartseachoperating projects: IfSHP grant funds are for the expansionofa pre-existinghonelessfacility, only the people and expenditures the additional for expansionmay be included,as in the original application or any grant atnendments. Documentationof resources usedis not required to be sublnittedu,ith this report but should be kept on file for possibleinspection HUD and Auditors. Do not include any expenditures by rnade beforethe SHP srant r.vas executed. Summary of Expenditures. Enterthe amountofSHP grant funds and cashmatch expended during the operatingyearfor each activity T his tab lesho ulda dd u p bot h hor iz ont ally and vertically. The SHP supportivesen rcestotal should be the sanre the SHP supportive as servicesin SHP Funds Total Expenditures

Supportive Services OpcratingCosts

HMISActivities
Administration

Note: Payments principal interest anyloanor mortgage notbe shorvn anoperating of on may as expense. and Sourcesof Cash Match. Enter the sourcesof cash identified in the CashMatch column, above,in the following categories.Use additional sheets, necessary. as Amount
a.

Grantee/project sponsorcash Local govemment(pleasespecify)

c.

Stategovernnrent(pleasespecify)

d.

Federalgovemment(pl easespecify)

Community Development Block Grant(CDBG)

Foundations(pleasespecify)

f

Private cashresources (pleasespecify)

a

Occupancycharge/ fees Total

n

t1

HUD-40118

Nerv Construction 20. Supportive Housing Program: Acquisition, Rehabilitation, and these charts theyearoneAPR in must or rehabilitation, new construction complete SHp fundsfor acquisition, that A1l grantees received of match amount SHPiunds the to enough cash at leastequally has to HUD thatthegrantee contributed will demonstrate oniy. Thisexhibit is to funds wereprovided not required be submitted that Documentation matching or rehabilitation, newconsfi'uction. spent acquisition, for inspection HUD andAuditors' by but be with thisreDofi should kepton file for possible
during the operatingyear for eachactivity Summary of Expenditures. Enter the amountof SHP grant funds and cashmatch expended SHP Funds
a.

Cash Match

TotalExpenditures

Acquisition Rehabilitation Neu, construction Total

b.
c.

d.

Cash Match. Enter the sourcesof cashidentified in the Cash Match column, above,in the follou,ing categories. Use additionalsheets, necessary. as

Amount
a

oject sponsorcash Grantee/pr Local govemment(pleasespecify)

b.

c.

Stategovernment(pleasespecify)

d.

Federal government (please specify) Community DevelopmentBlock Grant (CDBG)

(pleasespecify) Foundations

f

(pleasespecify) Private cashresources

o

Occupancy charge/ fees Total

h.

t8

HUD-40i 18

FOR HMIS ACTIWTIES OI,{LY
21. For Suprrortive Housine (SHP) - HMIS Activities was spentduring the operating year. Enter This exhibit providesinformation to HUD on how SHP-HMIS funding for supportiveservices the amountof SHP-HMIS fundine sDent theseactivities. on

HMIS Activities OnIv

Dollars

, Equipment
Central Server(s) Personal Comoutersand Printers Networking Security Subtotal Software/ User Licensing Software Installation Support and Maintenance SupportingSoftwareTools Subtotal

Senices
Training by Third Panies / Hostins, TechnicalServices Programming: Customization Programming: SystemInterface Programming: Data Conversron Security Assessmentand Setup On-line Connectivity (Intemet Access) Faciiitation Disasterand Recovery Subtotal Project Management Coordination / Data Analysis Programnring TechnicaiAssistance and Trainins Admrnistrative Suooort Staff Subtotal HMIS Space and Operations. SpaceCosts OperationalCosts
Total

19

HUD-401I 8

Describe any problems and/or changes implemented during the operating year.

Technical Assistance and Recommendations Based on your experienceduring the last year, are there any areasin which you need technical advice or assistance?Ifso, pleasedescribe.

20

HUD-401i 8

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