PSH Program Guides

 

PSH Program Intake Forms

Below are the most up to date versions of all forms to be completed at Intake.

FormDescription
Tasks and Forms GuideTasks and Forms Guide for PSH Teams: Guide for Case Managers to plan tasks and forms needed for visits with participant. From intake to housing search, to Lease up and ongoing supports. Also provides guidance on expectations for Housing Stability Plan
HMIS ROIHMIS ROI
Program Entry-Intake Form AdultsProgram Entry-Intake Form Adults: Intake or entry form that gathers the basic data that HMIS asks when creating an Entry/Enrollment in Service Point.
Program Entry-Intake form MinorsProgram Entry-Intake Form Minors: Intake or entry form that gathers the basic data that HMIS asks when creating an Entry/Enrollment in Service Point.
Welcome PacketPSH Welcome Packet for new participants
PSH Roles & ResponsibilitiesPSH Roles & Responsibilities
HUD VAWA DocumentViolence Against Women Act (VAWA)
Self Verification of COVID related HardshipSelf Verification of COVID related Hardship
Participant Acknowledgement FormParticipant Acknowledgement Form: Form where participant acknowledges that they have been oriented to the program, including a review of the Welcome Packet, Roles and Responsibility, and any other important forms and releases the Case Manager reviewed during intake.
Housing Needs FormHousing Needs Form printable version. After CM has completed the form with participant, Info must be entered here:
hlthousingneeds.com
Self Sufficiency MatrixSelf Sufficiency Matrix - required form to be completed initially with participant on 2nd intake meeting. This form can help guide Housing Stability Planning goals, as well as track progress over different areas. This form can be completed on paper but must be uploaded into HMIS. Complete every 3 months.
Housing Stability Plan TemplateHousing Stability Plan Template

 

PSH Forms - Ongoing Housing Supports

Forms and tools for Housing Case Managers working with participants ongoing
Form Description
Bridge Housing WorkflowBridge Housing Workflow - Guide for Case Managers requesting Bridge Housing from HSN
Bridge Housing AgreementBridge Housing Agreement - Agreement to be signed by participant entering Bridge Housing. Case Manager should upload this signed agreement into HMIS profile prior to requesting Bridge Housing.
COVID Risk Factor Screening ToolCOVID Risk Factor Screening Tool - Before requesting Bridge Housing: Check HMIS profile to see if a COVID Risk factor has already been uploaded by the Navigator. If not, Case Manager completes this screening tool, uploads into HMIS, and enters responses in HMIS profile under Assessments tab>Coordinated Entry System>COVID Risk Factor Screening tool
Personal Guest PolicyPersonal Guest Policy - tool for tenants to create their own house rules for guests. Should be introduced as a concept before housing, completed with tenant within 2 weeks of moving in, updated as tenant feels the need to make changes.
Monthly Budget ExcelHonest Monthly Budget Excel Version. Needs to be downloaded into excel to function.
Crisis Planning WorksheetCrisis Planning Worksheet - Optional
Rent Calculation FormRent Calculation Form - required monthly to request rent amounts from HSN. DOwnload the google sheet into excel first, complete the form, and email to HLTfinance@hsncfl.org
Monthly Exit & Change ReportMonthly Exit and Change Report - required monthly to update HSN on upcoming exits, household changes, and move outs. Download the google sheet into excel first, complete the form, and email to HLTfinance@hsncfl.org
Florida Health Care Finder siteFlorida Health Care finder: this is a site that lets you select what kind of health care service you need and then gives you all the available options in our community. Search for things like Homemaker services, ALFs, Health Clinics, etc.

 PSH Exit Forms and Guides

Forms and guides to be used to transition someone off PSH

ResourceDesciption
No Contact Notice LetterNo Contact Notice Letter - to be used when tenant has not been seen or available for visits. Case Manager should place notice in the door frame in an envelope (with unit address only - no personal identifiers). To be used after attempts to locate at hospitals, hot spots, jails.
Exit Planning WorksheetExit Planning Worksheet - optional tool to help with Exit Planning with participants
Housing Program Exit Notice - Agency SpecificAgency Specific Program Exit Notification Template - this letter should be used when it has been determined that the participant is being exited from from your program.
CoC PSH Program Exit NoticeCoC PSH Program Exit Notification Letter - this letter should be used when it has been determined that the participant is being exited from PSH without the option to transfer or re-apply with another PSH program at this time. Generally this is only to be used after a PSH Staffing committee has determined there are major safety issues or the participant has decided they do not want to participate with any PSH program at this time. Also to be used if a participant is over income for all programs.
Housing Program Exit Template - Final NoticeHousing Program Exit Template - Final Notice: This is a template for notifying tenants of a final decision to exit them from PSH. Must be downloaded from google doc into Word doc in order to fully function.