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Ask a basic policy or reporting system question. View HUD's HMIS Standard Reporting Terminology Glossary. Housing Extension. The HMIS client consent form should explicitly state how the data will be collected, shared, and used, and explain a client's right to protect and limit its use. Provider Request Form (PRF) This form allows the Institute for Community Alliances (ICA) to configure data collection appropriately for agencies in the database. - Click HERE to download the videos PowerPoint slides. PA HMIS Collaborative Client Consent Release of Information via PA HMIS If I decline to release my information, it will be hidden from all other PA HMIS participating agencies, except in the case of a referral. You have the right to receive a copy of this consent form. On a paper copy of the HMIS ROI, the form must be completed except for the client signature. o A copy of your consent form o A copy of your HMIS record (agency staff must review this information with you if you request such a review The Baltimore City Mayor's Office of Homeless Services serves as the HMIS Lead Agency for the Baltimore City Continuum of Care. HMIS Client Informed Consent Client Release of Information and Informed Consent IMPORTANT: Do not enter personally identifying information into HMIS for clients who are: 1) in DV agencies or; 2) currently fleeing or in danger . The HMIS and CES are shared homeless and 2023 US Department of Housing and Urban Development, Client Consent Form: Informed Consent (Sample), HMIS Client Consent Form: Informed Consent Agreement (Sample). Forms & Documents for Agency Administrators, Santa Clara County CoC Continuous Data Quality Improvement Process, VI-SPDAT (Replaces H1K Vulnerability Index), Justice Discharges VI-SPDAT (JD-VI-SPDAT), SPDAT Forms (Replaces Self-Sufficiency Matrix), Homeless Prevention Assessment Tool (HPAT), Homeless Prevention Services Program (HPS), HHS Runaway and Homeless Youth Program (RHY), SAMHSA Projects for Assistance in Transition from Homelessness (PATH), Clarity HMIS: HUD-CoC Congregate NCV Program Intake (Back Data Entry), Santa Clara County Community Queue Referrals - Standard Location Practices, Domestic Violence, Sexual Assault, and Human Trafficking Pre-Screening Tool and Referral Guide, How to Create an Anonymous Client Profile, How To Fix Common Annual Assessment Errors, Victim Services Screening Tool and Training, How to ask well-being questions in PSH Enrollment, Bed and Unit Inventory (BUI) Update Form (2021), 2022 HMIS Data Standards- Data Dictionary, HMIS Standard Operating Procedures (SOPs), SCC HMIS Partner Agency Privacy and Data Sharing Agreement, Technical Administrator and Security Officer Agreement, SCC HMIS Quarterly Compliance Certification Checklist, SCC HMIS Quarterly Compliance Self Certification, Santa Clara County Agency Admin. The following HUD documents are available for download to help navigate and better understand HMIS data collection. WHAT IS HMIS? <> Mailing address change. Learn through self-paced online trainings, recorded webinars, and more. Beginning at 8:00 p.m. the system will be unavailable to allow the HMIS Team to install updates. FileShare. With your consent, your personal information, including historical information in HMIS, will be made available to other agencies providing services to you through HMIS. TheHMIS Privacy and Security Standardsthat were established in 2004 by HUD still provide the basic framework for data privacy. In general, client consents requiring amendments would necessitate obtaining client consent (again) for the amended sections. Resources. Data sharing is the ability to transfer data from one agency to another electronically through HMIS. End User Best Practices Cheat SheetTips and reminders for HMIS users. WHAT IS HMIS of Central Florida? The client always has the right to request corrections to HMIS record. 112 or . To comply with this requirement Kitsap County agencies that provide homeless housing and services participate in the Kitsap HMIS Collaborative, an agreement to share client data between agencies. Signing this consent form does not guarantee you services. A Homeless Management Information System (HMIS) is an online database that enables organizations to collect data on the services they provide to people experiencing homelessness and people who are at risk for homelessness. Decisions regarding permitted types of consent (inferred, written, verbal, etc.) Kitsap's data-sharing system provides benefits such as improved client . The client is not guaranteed to receive assistance by consenting to share data. Explore collections of guided learning opportunities on a variety of topics. Client Informed Consent is a blanket document that indicates the client wishes to share all identifying information . FileShare. The Vulnerability Index Service Prioritization Decision Assistance Tool (VI-SPDAT) was developed by OrgCode Consulting and is a triage survey administered to homeless individuals and families that helps to determine acuity of need and prioritization of BTG's housing resources and supportive services. System Administration provided by Bitfocus, Inc. The following consent forms and policy documents support specific confidentiality and security standards to protect and inform both the client and provider. The HMIS code migration is scheduled for Tuesday January 3rd, 17th & 31st. We want to see that homelessness is rare in King County, racial disparities are eliminated, and if one becomes homeless, it is brief and only a one-time occurrence. EIN # 84-1705573 policies and corresponding procedures that are appropriate locally and that are compliant with federal, state, and local law. While the general HMIS ROI does not require a written signature, there may be other data privacy and sharing requirements in effect that are specific to your agency. Please send all requests for changes to support@bitfocus.com. If you have any further questions, please contact ourHelpdesk! Request in-depth assistance with implementing a HUD-funded program. Since its inception in 2004, BTG has utilized the HMIS to collect client-level data, as well as data on the provision of housing and services to at-risk and homeless individuals and families. You may contact the food pantry manager, Carla Schroyer at 410-285-4674 ext. x]&qWZF>/ifi5oS @f) The document informs clients about services, fees, records, and limitations that may affect the client. There are strict legal guidelines for who has access to your information, and it is protected by electronic encryption. Please contact mnhmis@icalliances.org if you need assistance filling out this form. Meet SAP BusinessObjectsThis video introduces SAP BusinessObjects, a software program used to build and store the reports that help make HMIS data actionable. Ask a basic policy or reporting system question. There was a problem submitting your feedback. An amendment to the privacy notice regarding use or disclosure will be effective with respect to information processed before the amendment, unless otherwise stated. In instances where past privacy notices did not include a statement about amendments and retroactive impact, client data obtained under those privacy notices would not be permitted to be used for any purposes other than the original uses and disclosures outlined in the privacy notice. Household DHS HS Entry - Housing and Supportive Services, Household DHS HS Interim - Housing and Supportive Services, Household DHS HS Exit - Housing and Supportive Services, Single DHS HS Entry - Housing and Supportive Services, Single DHS HS Interim- Housing and Supportive Services, Single DHS HS Exit - Housing and Supportive Services, Household DHS HS Entry - Emergency Shelter, Household DHS HS Exit - Emergency Shelter, Instructions: Last Updated August 15, 2022, DHS-HS HMIS User Guide for Housing and Supportive Services, DHS-HS HMIS User Guide for Emergency Shelter, Maia Uhrich: Housing and Support Services, Household LTHSSF Entry: Doc | Fillable PDF, Household LTHSSF Interim: Doc | Fillable PDF, Household LTHSSF Exit: Doc | Fillable PDF, Single LTHSSF Interim: Doc | Fillable PDF, Household SOR Entry - Street Outreach Projects: Doc | Fillable PDF, Household SOR Entry - Services Only Projects: Doc | Fillable PDF, Household SOR Interim: Doc | Fillable PDF, Single SOR Entry - Street Outreach Projects: Doc | Fillable PDF, Single SOR Entry - Services Only Projects: Doc | Fillable PDF, Instructions: Last Updated August 17, 2022, Household ESP Entry - Emergency Shelter & Street Outreach Projects: Doc | Fillable PDF, Household ESP Entry - All Other Project Types: Doc | Fillable PDF, Household ESP Interim: Doc | Fillable PDF, Single ESP Entry - Emergency Shelter & Street Outreach Projects: Doc | Fillable PDF, Single ESP Entry - All Other Project Types: Doc | Fillable PDF, DHS-OEO ESP HMIS User Guide for Rapid Rehousing and Homelessness Prevention, DHS-OEO ESP HMIS User Guide for Emergency Shelter and Street Outreach, Katelyn Warburton, State Program Administrator: katelyn.warburton@state.mn.us, Rabya Hassen,Homeless Grant Program Manager: Rabya.N.Hassen@state.mn.us, Household THP Interim: Doc | Fillable PDF, Instructions: Last Updated August 12, 2022, Annie McCabe, Homeless Grant Program Manager: Ann.E.McCabe@state.mn.us, PATH Street Outreach (SO) Entry-Exit Form: Doc | Fillable PDF, PATH Street Outreach (SSO) Entry-Exit Form: Doc | Fillable PDF, RHY Single Entry/Exit Combined - BCP-Prevention/TLP/MGH Programs: Doc | Fillable PDF, RHY Single Entry/Exit Combined - BCP-Emergency Shelter Programs: Doc | Fillable PDF, RHY Single Entry/Exit Combined - Street Outreach Programs: Doc | Fillable PDF, Family and Youth Services Bureau (FYSB)Website, Household HUD CoC Entry: Doc | Fillable PDF, Household HUD CoC Interim: Doc | Fillable PDF, Household HUD CoC Exit: Doc | Fillable PDF, Single HUD CoC Interim: Doc | Fillable PDF, Household ESG Entry - Emergency Shelter & Street Outreach Projects: Doc | Fillable PDF, Household ESG Entry - All Other Project Types: Doc | Fillable PDF, Household ESG Interim: Doc | Fillable PDF, Single ESG Entry - Emergency Shelter & Street Outreach Projects: Doc | Fillable PDF, Single ESG Entry - All Other Project Types: Doc | Fillable PDF, Instructions: Last Updated November 2, 2022, HUD-ESG HMIS User Guide for Homelessness Prevention and Rapid Rehousing, HUD-ESG HMIS User Guide for Emergency Shelter and Street Outreach, HUD- ESG HMIS User Guide for Night-by-Night Emergency Shelter , Household HOPWA Entry - Emergency Shelter & Street Outreach Projects: Doc | Fillable PDF, Household HOPWA Entry - All Other Project Types: Doc | Fillable PDF, Household HOPWA Interim: Doc | Fillable PDF, Singles HOPWA Entry - Emergency Shelter & Street Outreach Projects: Doc | Fillable PDF, Singles HOPWA Entry - All Other Project Types: Doc | Fillable PDF, Singles HOPWA Interim: Doc | Fillable PDF, Hennepin County Single YHDP Entry/Exit Combined, Household VASH Entry/Exit Combined: Doc | Fillable PDF, Household VASH Interim: Doc | Fillable PDF, Single VASH Entry/Exit Combined: Doc | Fillable PDF, Household FHPAP Entry: Doc | Fillable PDF, Household FHPAP Interim: Doc | Fillable PDF, Household FHPAP Entry/Exit Combined: Doc | Fillable PDF, Single FHPAP Entry/Exit Combined: Doc | Fillable PDF, Street Outreach Single FHPAP Entry/Exit Combined: Doc | Fillable PDF, Instructions: Last Updated September 27th, 2022, Minnesota Homeless Prevention Assessment Tool (M-PAT) Guide, Household HSWH Interim: Doc | Fillable PDF, Instructions: Last Updated November 7, 2022, Homework Starts with Home HMIS User Guide, Videos: Homework Starts with Home Data Entry Demo, Household LTH Interim: Doc | Fillable PDF, High-Priority Homeless Form Instructions (video), Instructions:Last Updated August 15, 2022, Household MN Universal Entry - Emergency Shelter and Street Outreach Projects: Doc | Fillable PDF, Household MN Universal Entry - All Other Project Types: Doc | Fillable PDF, Household MN Universal Interim: Doc | Fillable PDF, Household MN Universal Exit: Doc | Fillable PDF, Single MN Universal Entry - Emergency Shelter and Street Outreach Projects: Doc | Fillable PDF, Single MN Universal Entry - All Other Project Types: Doc | Fillable PDF, Single MN Universal Interim: Doc | Fillable PDF, Single MN Universal Exit: Doc | Fillable PDF, Hennepin Single Adult Shelter Instructions: Last Updated November 1st 2022, HCC Shelter Training: Checking-in a Client with an ASC Reservation, HCC Shelter Training: Managing Clients in ShelterPoint, Hennepin Single Adult Shelters (for both night-by-night and extended stay programs), General ShelterPoint Instructions: Last Updated January 7th, 2022. Download the Client Consent and Supplemental Form. Partners In Care, 200 N Vineyard Blvd Suite A-210, Honolulu. All requests are subject to review by KMNH and the BTG BOD to assess complexity, feasibility, and to ensure that BTGs privacy standards are upheld. HMIS. HMIS Client Consent Form with Supplemental.pdf. Your feedback will help shape future HMIS training events. A head of household's consent will apply for every other household member. Client/server system: Architecture in which the client and server computers are connected via a LAN or This form can be used to request ad hoc analysis or to develop new custom reports or dashboards. In general, HMIS standards do not stipulate what form of consent must be obtained to share data within HMIS. Learn about what HUD grantees are doing across the nation. See Washington State HMIS forms here. Increased visibility of HMIS information is designed to ensure a safe and confidential method for sharing data. Minnesotas HMIS is a collaborative project of the 10 Minnesota Continuums of Care, the Minnesota Tribal Collaborative to Prevent and End Homelessness, the State of Minnesota, the Institute for Community Alliances, and participating partner agencies. Before a request is made, please review the reports page of this website and the set of existing reports that are currently available in the system. BTGs HMIS application enables homeless service organizations to improve case management by collecting information about client needs, goals, and service outcomes and allows for timely access to resources and prioritized referral information to better manage coordinated entry operations. The document informs clients about services, fees, records, and limitations that may affect the client. HMIS. WI HMIS includes your demographic information and other essential personal information needed to best determine your service needs. CES HUD Guidance For more information on CES, please visit the Coordinated Entry Community Sample Toolkit. We serve as the community coalition to address homelessness and housing vulnerability. A consent form gives written permission to another party to perform an activity or host an event, indicating that the signatory understands the associated terms and cannot hold the other party liable for any injury or harm. Policy. KMNH has developed an extensive collection of reports and dashboards that may already meet your needs. CLIENT CONSENT TO DATA COLLECTION AND ROI Page 4 of 6 Version 2020-03-11 This form may not be amended or modified except on approval of the County of Santa Clara's Office of Supportive Housing. 2021 CNY HMIS Entry DV Bonus Assessment, 2021 CNY HMIS Entry TH, HP & SSO Programs for Adults & HoH, 2021 CNY HMIS Entry Assessment for Adults & HoH Cayuga County Emergency Shelters, 2021 CNY HMIS Entry Assessment for Adults & HoH Tompkins County Emergency Shelters, 2021 CNY HMIS Entry Assessment for Children under 18, 2021 CNY HMIS Entry SO ONLY Assessment for Adults & HoH, 2021 CNY HMIS ES Entry Assessment for Adults & HoH, 2021 CNY HMIS HHS RHY Entry Assessment Child of Parenting Youth, 2021 CNY HMIS HHS RHY ES & SO Entry Assessment HoH or Single Youth, 2021 CNY HMIS HHS RHY TH & HP Entry Assessment HoH or Single Youth, 2021 CNY HMIS PSH Entry Assessment for Adults & HoH, 2021 CNY HMIS PSH Entry Assessment for Children under 18, 2021 CNY HMIS RRH Entry Assessment for Adults & HoH, 2021 CNY HMIS HHS RHY Annual.Update Assessment HoH or Single Youth, 2021 CNY HMIS HHS RHY Follow-up Assessment HoH or Single Youth, 2021 CNY HMIS PSH Update Annual Assessment for Adults & HoH, 2021 CNY HMIS SO ONLY Update Annual Assessment for Adults & HoH, 2021 CNY HMIS Update Annual Assessment for Adults & HoH, 2021 CNY HMIS Update ES, HP, TH, & SSO Annual Assessment for Adults & HoH, 2021 CNY HMIS Update. 2023. Resource Management System. I can receive a copy of this Consent and the Client Information Sheet I may refuse to sign this Consent. Don't Miss: Corpus Christi Food Bank Donation. Your identity and information collected in the WI will HMIS be shared, with your written consent, in the network and with network partners who have written agreements with ICA. One of these forms must be completed for EACH funding source/grant within the agency project that will be using HMIS. BTG Client Informed Consent Form (Jun 2018) BTG Authorized Agency List (Apr 2021) Client Consent and Data Privacy Notice documents are on the Administrative Documents page. Please note that the training request form will need to be submitted along with the new user agreement form. Baltimore City HMIS Information Sharing Consent form (Spanish) Baltimore City HMIS Information Sharing Revocation of Consent form (Spanish) HMIS Participating Agencies include housing programs and service providers throughout the City of Baltimore who contribute data to the HMIS. Intergovernmental Review-EO 12372. The HMIS (Homeless Management Information System) is a local web-based information technology system that San Diego's Continuum of Care (CoC) uses to capture and report on client, project, and system level information regarding homeless services utilization, performance and outcomes. If I refuse, I will not lose any benefits or services. Please note, the Orange County CoC is required to retain all data stored in HMIS for seven . PART II - YOUR CONSENT Basic Information: This information will be shared through HMIS and with members of the Collaborative. For technical support contact nevada@bitfocus.com. The following forms must be completed and submitted to the HMIS admin team if new users require access to the system or if duplicate clients require merging. The Homeless Management Information System, or HMIS, is an electronic data management system that provides vital insights on homelessness to our agency partners, while helping Calgary Homeless Foundation allocate resources for highest impact and outcomes. page of this form.Report developers and HMIS staff may also see your d ata. Client consent will end seven years after the signaturedate by default; however, clients may also changetheir consent to share at any time. This consent form expires in three (3) years, meaning that any data collected after that time will require an updated consent form before that data will be shared. Please try again later. Homeless Management Information System (HMIS). and they may reflect local laws and policies. Additionally, make sure theData Privacy Noticeis available to clients at intake, even if an intake is being conducted over the phone. 2023 US Department of Housing and Urban Development, 2004 HUD Data and Technical Standards Notice. HMIS New User Authorization - A new process for HMIS new user authorization. Agencies should refer first with their own data privacy agreements, then any data sharing arrangements theymay have. With this form, you can give permission to have information about you collected and shared with Partner Agencies that help King County provide housing and services. Client Consent To Data Collection And ROI, How to add an Electronic Signature ROI (PDF), How to add an Electronic Signature ROI (Video). Continuum of Care. Homeless Management Information System (HMIS) Client Consent Form Template (to be printed on Agency letterhead) Client Name: ___________________________________ Date of Birth:____________ Household members: Name__________________________________________ Date of Birth:_________________ Name__________________________________________ Date of A Client Consent to Data Collection and Release of Information (ROI) must be completed for each client who consents to have their personally identifying information (PII) entered into the King County HMIS System. People New. Capacity Building. This is an example of an informed consent agreement. $(this).parent('.panel').find('.fa-minus').show(); We work with and for the homeless and formerly homeless or other interested consumers and stakeholders. Policy. Housing Extension. While the general HMIS ROI does not require a written signature, there may be other data privacy and sharing requirements in effect that are specific to your agency. This Consent will expire 7 years from my last HMIS recorded activity. Report a rental evader. ICAs latest ShelterPoint videos can be found on our Moodle site or by clicking on this link. A list of agencies participating in HMIS that may have access to your information if you sign this authorization is at . For a privacy notice, an agency must post a sign at each intake desk (or comparable location) that explains generally the reasons for collecting HMIS information, and the uses and disclosures allowable. Find point of contact information for HUD's grantees. HMIS Sample Forms Clarity Human Services Help Center 2022 Data Standards 2022 Data Standards HMIS Sample Forms The HMIS sample forms below are specific to each program listed. HMIS Privacy & Data Sharing Overview - Client Consent Form attached at the bottom What does it mean to share data? Search for a specific grantee and view itsawards, contact information, and reports, and more. San Diego uses the software Clarity (distributed by . This consent form expires seven (7) years after the signature or at any time you choose to revoke your consent. NH HMIS and CE Release of Information - Printable, NH HMIS and CE Release of Information - Virtual Signature, Link clients to mainstream benefits and services, Enable comprehensive system-level performance measurement. View brief descriptions of HMIS Project Types. HMIS is a data collection system specifically designed to support planning, management, and decision making in health facilities and organizations. View Definitions, helpful to use with data collection. HMIS. Register for upcoming training, webinars, conferences, and more. Tourist Development Forms. 446 Account status change request. Participants were informed of their freedom to participate in the study . Client Informed Consent FY 2021-2022. January 1, 1970. Voluntary verbal informed consent was obtained from all respondents prior to interviews. Institute for Community Alliances Capacity Building. Homeless Management Information System (HMIS) - Intake Form. }) Learn about what HUD grantees are doing across the nation. * 1. What's new HMIS documentary Digital Learning - New HMIS Portal Latest Technical note released on: Wed, Dec 04, 2019 for Version 8.6.7 Request to waive penalty. Appalachian Regional Commission Program (ARC) Community Development Block Grant (CDBG) Community Development Block Grant-Mitigation (CDBG-MIT) Emergency Solutions Grant (ESG) Housing Opportunities for Persons with HIV/AIDS (HOPWA) HUD Consolidated Plan and Executive Summary. Section 4.2.4 of the2004 HUD Data and Technical Standards Noticeallows for retroactive application of amendments to the privacy notice, stating, A CHO must state in its privacy notice that the policy may be amended at any time and that amendments may affect information obtained by the CHO before the date of the change. NEW Elements of Focus Training Days Elements of Focus Training will now be on Tuesdays only. A In general, HMIS standards do not stipulate what form of consent must be obtained to share data within HMIS. Click here to see examples of completed ROIs. HMIS Data Collection Template (PDF) - recent standards revision, a form any agency may use for collecting all of the required HMIS elements at enrollment and exit. Welcome to HMIS! Agency Agreements Agency Participation Agreement (Sample)This form is an agreement between an agency and NCCEH. HMIS Forms & Manuals | CARES of NY, Inc. CCHMIS Manuals, Request Forms, and Resources COVID-19 Administration HMIS Manuals eForms entries Showing 1 to 5 of 5 entries Previous Next CCHMIS Paper Forms Intake Discharge Update Assessment Contact Showing 1 to 10 of 50 entries Previous Next General HMIS InstructionsA guide with information about basic HMIS features and step-by-step instructions for common data entry activities. }), Presidents Day - Mon, Feb 20, 2023Prince Kuhio Day - Fri, Mar 24, 2023 (Observed)Memorial Day - Mon, May 29, 2023, Copyright 2023 Bridging The Gap Hawaii |, Prince Kuhio Day - Fri, Mar 24, 2023 (Observed), BTG Client Informed Consent Form (Jun 2018), BTG Custom Data or Report Request Form (Apr 2019), HPO Memo Re: Consent to Share Privacy Forms - 11.1.17, BTG HMIS New User Agreement and Training Request Form (Feb 2020), BTG Duplicate Client ID Merge Form (Jul 2018), FY 2022 HMIS Data Standards Manual (Sep 2021), PATHHMISProgram Specifications (Jun 2019), Adult - TH, RRH, Non-CoC Program Funded PSH & HP, Adult - ES, TH, RRH, & Non-CoC Program Funded PSH, BTG Additional Family Member Form (Sep 2021), BTG SPDAT Individual Assessment (Nov 2020), BytePages Content Management System Powered by Byte Productions. By signing this form, I give this Agency permission to share (verbally, or through the HMIS, mail, fax, or by hand) information collected about me and any dependents listed on the back of this form with HMIS Partner Agencies, for the Got Questions? Resources and assistance to support HUD's community partners. HMIS -Homeless Management Information System. *, If a project will operate in more than one Continuum of Care (CoC), you will need to complete one form for EACH CoC of service.*. HMIS Privacy Policy- The goal of HMIS Privacy Policies and Procedures is to ensure confidentiality and security of all client data captured in HMIS in conformity with all current regulations related to privacy and data confidentiality rights. Powered by Help Scout. Client-level data: Data about an individual HMIS client. A signature is not required on the generalHMIS ROIand agencies can document that verbal consent has been obtained from the client by indicating this on the signature line. If I need to be referred to another agency for services, my information will be forwarded to only Click HERE to download the videos PowerPoint slides, HMIS Standard Reporting Terminology Glossary, Household DHS HS Exit - Housing and Supportive Services, Family and Youth Services Bureau (FYSB)Website, HUD- ESG HMIS User Guide for Night-by-Night Emergency Shelter, Homework Starts with Home Data Entry Demo. HMIS Privacy & Data Sharing Overview - Client Consent Form attached at the bottom, Password: Reach out to your System Administrator. anyone in need. Find answers to frequently asked questions. It allows the Agency to use HMIS, assigning rights to user licenses. Please have the following readily available as you complete this form: We want to see that homelessness is rare in King County, racial disparities are eliminated, and if one becomes homeless, it is brief and only a one-time occurrence. 'Client Revocation of Consent' form with this agency. Categories: Homeless Management Information System (HMIS) File Type: Download: 290: Size: 0.00 KB: Create Date: January 1, 1970: Last Updated: November 15, 2016: File Action; Form 1119 - Consent To Share Protected Personal Information (English) Share: . Vice President, Data Analytics. sg+QN y]ZU(_,iOw0*'% |xw/"402wu1*y@R,) ?cmJ*J@ d@4FET~2ZREKdW^8>+V$lL)'+F7e;xtbYiyRn^a$Vh|oF Find point of contact information for HUD's grantees. Disclaimer: All peer approved resources shared on the HUD Exchange have been provided by the organization that developed them. 2003-2021 Bitfocus, Inc. All rights reserved. Information collected in the HMIS database is protected in compliance with the standards set forth in the Health Insurance Portability and Accountability Act (HIPAA) and the U.S. Department of Housing and Urban Development HMIS Data Standards. Form 1119 - Consent To Share Protected Personal Information (English) Share: . Search for a specific grantee and view itsawards, contact information, and reports, and more. A signature is not required on the general HMIS ROI and agencies can document that verbal consent has been obtained from the client by indicating this on the signature line. Giving That Gives Back Serving. I understand that I may obtain a copy of my signed consent . This copy is a sample. HMIS Resource If you would like to get more technical support on the Homeless Management Information System (HMIS) please visit the OC HMIS Help Desk Knowledge Base .