With AIDS (HOPWA) Program

Housing Opportunities for Persons

With AIDS (HOPWA) Program

Quarterly Report

Reporting Coversheet

Electronically submit this report in Word (.doc) format to with a copy to . A confirmation email will be sent when the report is received. If a confirmation email is not received by the business day following your submission, please re-submit the report.

Reporting due dates:

* Each report should have year-to-date information. The 4th Quarterly Report is a cumulative year-end report.

Project Sponsor Narrative Summary

Instructions: The following information should be specific to housing related activities.

1.  Discuss any concerns and/or significant changes related to staffing at the Project Sponsor level (e.g. staff positions vacant longer than 90 days).

2.  Describe any needs assessments or other activities to solicit community input that occurred during the quarter. Include public meetings/forums, advisory group meetings, ad hoc group meetings, web-based activities, and any major material distribution activities. (If appropriate, please attach copies of minutes and agendas to this report.)

3.  Describe coordination activity that occurred during the quarter between the Project Sponsor and other service providers, including but not limited to: other housing programs, TB elimination programs, immunization programs, STD clinics, Federally Qualified Health Centers (FQHCs), health care delivery systems, and Ryan White Parts A, C, and D.

4.  List and describe housing-related training provided to the Project Sponsor during the quarter.

5.  Describe training/technical assistance (TA) needs expressed by the Project Sponsor staff. Describe the steps taken to secure training/TA. If further assistance is required in securing training/TA, please provide details.

Project Sponsor Information

Instructions: Report year-to-date information for each quarter; the 4th quarter report serves as the annual report. Please review responses to assure accuracy and completeness before submission. The colored cells indicate numbers that should match. The report period for the annual report is FEBRUARY 1 – JANUARY 31. Please note this report period is for the HOPWA Project year (12 months).

Part 1: Narrative and Performance Measures Assessment

A.  STATUS OF HOPWA WAITING LIST

Provide the current number of HOPWA-eligible individuals on the waiting list for STRMU and TBRA.

B.  PERFORMANCE MEASURES EVALUATION

·  Provide an overview of your program’s performance measure accomplishments for the project year as established in the program plan.

·  Provide the number of NEW clients entering into each program activity during each quarter. Each client should only be listed once per program activity per project year, regardless of the number of times they received assistance. (For example, if an STRMU client received assistance in the 1st quarter, and then reapplied / received STRMU assistance in the 3rd quarter, they would only be counted once in the 1st quarter).

·  All clients served within the 1st quarter should be counted regardless if they are continuing from the previous project year.

·  Year to Date (YTD) clients should be the sum of quarters 1 through 4 and should be unduplicated per program activity.

C. OUTCOMES ASSESSED

Briefly assess how HOPWA-assisted households were enabled to establish and/or better maintain a stable living environment in housing that is safe, decent, and sanitary, and reduce their risks of homelessness and improve their access to health-care and other supportive services. Provide success stories or examples illustrating how the HOPWA program prevented the clients’ risk of homelessness and/or helped them access medical care and supportive services. “None”, “N/A”, “No Progress” and/or cut and paste responses from previous reports are not acceptable.

D. BARRIERS AND RECOMMENDATIONS

Select one or more barriers encountered during this quarter from the following list:

Please describe the issues involved, actions taken in response to the barriers, and plans toward program improvement. For the 4th quarterly report, please summarize Barriers and Recommendations for the entire project year. Do not cut and paste from previous reports. This must be reviewed and updated each quarter. Emphasize issues that have workable solutions, rather than systemic issues such as lack of housing, etc.

E. TECHNICAL ASSISTANCE

Based on the program’s experience during this quarter, are there any areas in which technical advice or assistance is needed? If so, please describe. This must be reviewed and updated each quarter. Do not cut and paste from previous reports.

Part 2: Information on HOPWA Clients, Beneficiaries, and Households

F. HOPWA CLIENTS

Please indicate below the year-to-date unduplicated number of HOPWA clients who received HOPWA assistance during this project year. Rule of thumb: If the charts are not asking for TBRA and STRMU separately (as in this chart), then the count is an unduplicated count.

G. SPECIAL NEEDS CLIENTS

Please indicate the total year-to-date number of HOPWA Clients who have the following special needs, if known. Clients may count in more than one category.

Revisions: Removed categories of Domestic Violence Survivors and Homeless

H. PRIOR LIVING SITUATION

·  Row (a) Column 1: Enter the number of HOPWA clients that are continuing if they received HOPWA assistance in the prior project year and are also receiving HOPWA assistance in the current project year. Do not include beneficiaries.

·  Under New HOPWA Clients - Please indicate the prior living situation year-to-date only for new HOPWA Clients who began receiving HOPWA housing assistance during this project year. DO NOT report the prior living situation of the HOPWA clients continuing from the prior project year in row (a). Only indicate the (one) category that best describes the clients’ most recent living situation.

Please check: Row (q) [1] should equal the total number of HOPWA clients under Part 2, Section F

Removed requirement to report separately for TBRA and STRMU categories.

I. HOPWA BENEFICIARIES

Please report the total number year-to-date of HOPWA beneficiaries receiving HOPWA assistance. Beneficiaries are all HOPWA Clients and ALL associated members residing with the HOPWA client whose income was counted as part of the HOPWA client’s assistance eligibility criteria (roommates, paid caregivers, live-in aides are not beneficiaries).[2]

Removed requirement to report Row (b) for categories Supportive Services and PHP, 02/2011 deleted row (d) that asked for totals for all services. Now only totals in Section J and K need to match each other.

J. AGE AND GENDER OF BENEFICIARIES

Report the age and gender of the HOPWA clients and their beneficiaries.

Please check: Row (f) should equal the total in Row (d) [1] (Green) in Section I above

Removed requirement for listing TBRA and STRMU separately by age and gender.

K. RACE AND ETHNICITY OF BENEFICIARIES

Report the race and ethnicity of the HOPWA clients and their beneficiaries. For Column 2, of the beneficiaries reported in column 1, report those that are ALSO Hispanic and Latino. Column 2 is a subset of Column 1.

Please check: Row (k) [1] should equal the total in Row (f) (Green) in Section J above

Removed requirement to report [1] and [2] by TBRA and STRMU separately.

L. HOUSEHOLD AREA MEDIAN INCOME

Please indicate the area median income for all unduplicated households served with HOPWA assistance. For information on the median income in your area, please refer to www.hud.gov.

Please check: Row (e) should equal the total number of HOPWA clients under Part 2, Section F

DSHS is required to report these four levels on the Beneficiary. There were previously three levels in this chart on this report.

Removed (1) M. Household Monthly Income and (2) N. Mortgage Assistance

Part 3: Leveraged Information (To be completed in the 4th Quarter Report only)

M. LEVERAGED HOUSEHOLDS

Enter the total HOPWA-eligible households assisted with non-HOPWA funds. DO NOT include the HOPWA households receiving DSHS HOPWA funds, which have already been reported or other households receiving non-DSHS HOPWA funds. Leveraged households are clients of your agency and are eligible for HOPWA but are assisted by other funds or another housing assistance program.

·  Leveraged Households are those served by your agency that would be eligible to receive HOPWA TBRA and/or STRMU but are receiving direct housing assistance (similar to HOPWA TBRA and STRMU) from a non-HOPWA source.

·  These households must be receiving HOPWA Supportive Services and/or Permanent Housing Placement but are receiving direct housing assistance from a program other than HOPWA.

·  Example: A client receiving HOME rental assistance but is receiving HOPWA Supportive Services.

·  Must be connected to HOPWA to be leveraged. These are households served by your agency that also receive HOPWA Supportive Services and/or Permanent Housing Placement with their non-HOPWA housing assistance. This means leveraged households are receiving direct housing assistance (i.e. rental assistance or emergency assistance similar to HOPWA TBRA and STRMU) from a non-HOPWA source (i.e. State Services/Delivery, Ryan White, Housing Choice Voucher (Section 8), HOME, Shelter Plus Care, or any other direct housing funding source). For example, a client receives HOPWA Permanent Housing Placement but is receiving rental assistance from State Services funding in your agency.

N. LEVERAGED SOURCES BY PROGRAM ACTIVITY

Identify the amount and source(s) of cash or in-kind resources leveraged from other sources year-to-date, and used in delivery or operation of HOPWA activities. These funds include other funds used for on-site or other specific activities directly connected to serving HOPWA client households, at the activity or program level.

Make a good faith estimate of the sources of leveraged funds that you are aware of used to provide housing assistance, supportive services, and administration in the delivery of the HOPWA program. This is any money used to support HOPWA households that are non-HOPWA dollars. Supportive Services may include:

·  adult day care and personal assistance

·  alcohol and drug abuse services

·  client management/advocacy/access to benefits and services

·  childcare and other child services

·  education

·  employment assistance and training

·  health/medical/intensive care services (if approved, client records must conform with 24CFR 574.310)

·  legal services

·  life skills management (outside of case management)