HMIS Administrative Documents
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This form is an agreement between an agency and NCCEH. It allows the Agency to use HMIS, assigning rights to user licenses. This copy is a sample. NCCEH uses DocuSign to electronically gather signatures.
Each User must sign this document that outlines user responsibilities. It is advised to complete user training, particularly privacy training, before signing the agreement. This copy is a sample. NCCEH uses DocuSign to electronically gather signatures.
HMIS License Request Form
If your agency has someone new to HMIS who needs training and onboarding, please use this form to request the license. You will be contacted by NCCEH Data Staff to begin the process of training and securing a license. Agency Administrators and Executive/Program Directors should submit on your agency's behalf. Please refer to your CoC's HMIS User License Policy as applicable:
HMIS License Inactivation Request Form
If your agency knows that one (or more) of your users will no longer need HMIS access, please use this form to let the Data Center know and we'll cut access to the license. Don't wait until you have another staff member trained - tell us as soon as possible to protect client privacy.
HMIS Agency Admin Roles and Responsibilities
In each agency, at least one HMIS User must be identified by the Executive Director (or equivalent leadership) as the Agency Administrator. The AA is a key role in HMIS participating agencies who supports maintenance, updates, and the ultimate success of HMIS!
These standards are for the operation of HMIS@NCCEH. They are governed by the HMIS Advisory Board and are updated annually.
Agencies should post copies of this sign-in locations where clients can clearly see the sign, especially in spaces where assessments and other data gathering are done. For example, post on the wall at the intake desk. HMIS Privacy Sign Spanish Translation
HMIS Release of Information
This form should be used with each client to explain why we gather information and what information may be shared with others. Signed documents should be collected for every adult client at the first in person meeting. For remote services, use the Verbal ROI Script, Verbal ROI How To's, and Verbal ROIs during COVID guides. HMIS Release of Information Spanish Translation
HMIS Privacy Notice
This document provides additional detail about a client's rights regarding data collection and sharing. It should be available upon request.
Agencies can use the Privacy Notice template as provided by NCCEH or customize it to include additional information. To use the template, agencies should fill in the agency name on page one and contact information at the very end. To customize, the agency must follow the Privacy Policy requirements in Section IIIA of the HMIS@NCCEH Operating Policies and Procedures. HMIS Privacy Notice Spanish Translation
HMIS Privacy Sample Script
Use this sample script to assist in walking clients through the HMIS Release of Information. There's also a six-minute video providing a model for a privacy conversation here.
HMIS Privacy Training
It is essential to understand privacy policies to fully protect clients and remain in compliance. We’ve streamlined documents and made updates to allow for coordination of services on the client’s behalf outside of HMIS.
Users need to watch the training video, sample privacy conversation, and complete a quiz. Staff and volunteers who work with clients should watch the videos, but don’t need to take the quiz.
Confirm your Coordinating Group!
Our ROI includes acknowledgment of sharing groups outside of HMIS. We'd like to be transparent and host members of your coordinating group for clients to reference. Please take a moment to complete this form for agencies that you coordinate with (byname lists, case conferencing, coordinating groups).
Privacy Options 1 pager for staff and clients
This one page guide helps staff and clients consider their options during a privacy conversation. This may supplemental the Release of Information if clients have questions.
Privacy Guidance during COVID-19 pandemic
Our HMIS Privacy Notice and HUD's HMIS Privacy and Security Standards allows for coodination of services and action to prevent or lessen threats to health and safety under these circumstances. Review page 1 of HUD's COVID-19 Data Sharing Practices guide. As you collaborate with the healthcare system, know that HHS has issued an HIPAA waiver for hospitals related to the crisis.
Find your project type below. Download and print the entry, interim, and exit assessment forms. A Client Profile Form is available for additional contact information.
Street Outreach (SO)
Project Start
Use this form when you enter clients into Street Outreach projects.
Project Interim
Use this form when you collect new information about Street Outreach clients.
Project Exit
Use this form when your client leaves Street Outreach projects. (Spanish Translation)
Supplemental Form for First Outreach Contact
Use this optional form to minimal information for the first contact with outreach clients.
Supplemental Form for Additional Outreach Contacts
Use this optional form to gather notes during efforts to engage outreach clients. Combine as many as needed to collect key information that changes often for clients.
PATH Street Outreach
Project Start
Use this form to collect intake data for clients in the Street Outreach side of Projects for Assistance in Transition from Homelessness (PATH) funded by the Substance Abuse and Mental Health Services Administration (SAMHSA).
Project Interim
Use this form to collect new information for clients in PATH SO projects.
Project Exit
Use this form to collect information when clients leave PATH SO projects.
Supportive Services Only (SSO)
Project Start
Use this form when you enter clients into projects that only provide services, such as emergency assistance, or diversion projects. (Spanish Translation)
Project Interim
Use this form when you collect new information on your clients. (Spanish Translation)
Project Exit
Use this form when your client leaves your project. (Spanish Translation)
PATH Supportive Services Only
Project Start
Use this form to collect intake data for clients in the Services Only side of Projects for Assistance in Transition from Homelessness (PATH) funded by the Substance Abuse and Mental Health Services Administration (SAMHSA).
Project Interim
Use this form to collect new information for clients in PATH SSO projects.
Project Exit
Use this form to collect information when clients leave PATH SSO projects.
Project Start
This general form should be used by Emergency Shelter Projects for every client. (Spanish Translation)
Project Interim
Use this form when you collect new information about your clients. (Spanish Translation)
Project Exit
Use this form when your client leaves Emergency Shelter Projects.
Health Care for Homeless Veterans (HCHV)
Project Start
Use this form when your client enters VA funded Emergency Shelter.
Project Interim
Use this form when you collect new information about your clients.
Project Exit
Use this form when your client leaves VA funded Emergency Shelter.
Project Start
Use this general form when your client enters your Transitional Housing project. (Spanish Translation)
Project Interim
Use this project to collect new information about your client. (Spanish Translation)
Project Exit
Use this form when your client leaves your Transitional Housing project.
Grant Per Diem (GPD)
Project Start
Use this form when your client enters your VA funded GPD Transitional Housing project.
Project Interim
Use this form to collect new information about your client.
Project Exit
Use this form when your client leaves your VA funded GPD project.
Project Start
Use this general form when you enter a client into a Homeless Prevention program.
Project Interim
Use this form when you gain new information about a client.
Project Exit
Use this form when a client exits a Homeless Prevention.
Housing Opportunities for People with AIDS/HIV (HOPWA)
Project Start
This form should be used for clients entering HOPWA funded Prevention projects like Short-Term Rent, Mortgage, and Utilities Assistance (STRMU).
Project Interim
This form should be to document new information about a client.
Project Exit
This form should be used for clients exiting HOPWA funded projects.
Supportive Services for Veterans and their Families (SSVF)
Project Start
Use this form when a client enters a VA funded SSVF Homeless Prevention project.
Project Interim
Use this form when you gain new information about your client.
Project Exit
Use this form when a client exits a VA funded Homeless Prevention project.
Project Start
Use this general form when a client enters a Rapid Re-Housing project. (Spanish Translation)
Project Interim
Use this form when you gain new information about your client. (Spanish Translation)
Project Exit
Use this form when a client exits a Rapid Re-Housing project. (Spanish Translation)
Supportive Services for Veterans and their Families (SSVF)
Project Start
Use this form when a client enters a VA funded SSVF Rapid Re-Housing project.
Project Interim
Use this form when you gain new information about your client.
Project Exit
Use this form when a client exits a VA funded Rapid Re-Housing project.
Project Start
Use this general form when a client enters a Permanent Supportive Housing project. (Spanish Translation)
Project Interim
Use this form when you gain new information about your client. (Spanish Translation)
Project Exit
Use this form when a client exits a Permanent Supportive Housing project. (Spanish Translation)
Housing Opportunities for People with AIDS/HIV
Project Start
This form should be used for clients entering HOPWA funded PSH projects like Tenant Based Rental Assistance.
Project Interim
This form should be used when you gain new information about a client.
Project Exit
This form should be used for clients exiting HOPWA funded PSH projects.
HUD-VASH
Project Start
This form should be used for clients entering PSH projects funded by both HUD and the VA called HUD-VASH.
Project Interim
This form should be used when you gain new information about a client.
Project Exit
This form should be used for clients leaving PSH projects funded by both HUD and the VA.
Project Start
This form should be used for clients entering Permanent Housing projects that do not require a disabling condition for eligibility.
Project Interim
This form should be used when you gain new information about a client.
Project Exit
This form should be used for clients leaving OPH projects.
This document defines Data Quality, outlines the roles and responsibilities of CoCs, the HMIS Lead Agency, and HMIS@NCCEH Participating Agencies to Data Quality, and the monitoring mechanism to support. This plan is reviewed annually.
Use this page as a reference for the DQ Standards included in the current Data Quality Plan.
HMIS@NCCEH Secure SSN Updates
Social Security Numbers (SSN) are locked down in HMIS to to meet HUD collection requires while maintaining client privacy. Use your CoC's copy of the encrypted Excel form and follow the instructions on the first tab.
Submission Link