1. Housing-Type Targeting Tool<br /> Client Name: _______________________ HMIS #:________________<br /> Staff Completing:_________________________________ Date: ________________ <br />General Scoring – Read the indicator and score the Head of the Household (HH), unless directed otherwise by the questions, (5, 3, 1, 0) according to the description that most closely fits. Indicator5310SCOREHOUSINGDoes the HH or other adult(s) have a history of evictions or foreclosures in the last 7 years?More than 1 eviction and/or 1 foreclosure1 evictionNo housinghistoryNo evictionsHas the HH or other adult(s) lost a Housing Choice Voucher or been evicted from a government assisted housing program?Lost assistance, owes debtLost assistance, debt paidNever had / never lost assistanceHas the HH been homeless for the prior 12 months consecutively or 4 times in the previous 3 years?YesHistory of homeless in the last 3 yearsNoEDUCATIONDoes HH or other adult(s) have a GED or equivalent?No GED or equivalentGED/HS DiplomaWhat is the literacy level of the HH?Cannot read, write, and speak in EnglishCannot read and write in English, can speak EnglishNo literacy issuesSUBSTANCE ABUSE/MENTAL HEALTH/PHYSICAL HEALTHSubstance Abuse (SA) History?Refusing TreatmentCurrently in or willing to engage in treatmentHistory of Substance Abuse - In recoveryNo history of Substance AbuseMental Health History? (SMI = Serious Mental Illness) Refusing, currently in, or willing to engage in treatment for SMIHistory of SMINo history of SMIPhysical Health History?Long-term disability that substantially impedes ability to live independentlyShort / medium duration disability, 6 months or less until full recoveryNo serious physical health problemsDEBT / INCOMEDoes the HH or other adult have bad debt / bankruptcy in the last 7 years?Bad debt owed to utility, house or car in excess of $2,000 or bankruptcyBad debt in excess of $2,000Bad debt less than $2,000 or No credit historyNo bad creditTotal household income (Use Income Chart below to determine.) Extremely Low Income30% or less w/o ability to increase w/in 6 mo.Extremely Low Income30% or less with ability to increase w/in 6 mo.Very Low Income31 - 50% More than 50% TOTAL SCORE<br />FY 2010 Income Limit Category1 Person2 Person3 Person4 Person5 Person6 Person7 Person8 PersonVery Low (50%) Income Limits$36,250$41,400$46,600$51,750$55,900$60,050$64,200$68,350Extremely Low (30%) Income Limits$21,750$24,850$27,950$31,050$33,550$36,050$38,550$41,000Low (80%) Income Limits$45,100$51,550$58,000$64,400$69,600$74,750$79,900$85,050B. Permanent Supportive Housing Indicators (PSH) – In order for a client to qualify for PSH, all of the following questions 1-3 must be answered “yes.” For families, indicators apply to the head of household (HH) only. Circle ‘yes’ or ‘no.’#IndicatorResult1Does the client (or head of household) have a documented disabling condition that is expected to be of long-continued and indefinite duration and that substantially impedes his or her ability to live independently (includes mental, physical or substance use disorders?) Yes / No2Does this disability impact their ability to work full-time or earn at least 50% of the Income Limit?Yes / No3Has the client used or been in need of at least two of the following services in the past 12 months: homeless or housing services, Child Protective Services, Adult Protective Services, mental health treatment, substance abuse treatment, care for a chronic medical condition, intellectual or developmental disability services, brain injury services or the correctional system?Yes / NoC. Special Populations (For families, indicators apply to head of household or other adult only unless otherwise noted.) Circle ‘yes’ or ‘no.’#IndicatorResult1Are there children currently in foster care that are in the process of reunifying with the head of household?Yes / No2Is the client homeless due to domestic violence, stalking or human trafficking?Yes / No3Is the client a veteran?Yes / No4Is the head of household between the ages of 18 – 24?Yes / No5Is the client a recent immigrant, refugee or asylee?Yes / No6Is the client elderly (62 or older)?Yes / No7Does the client (or other adult in the household) have a felony?Yes / No8Is the client (or any member of the family) a registered sex offender?Yes / NoIf yes to number 1, client may be eligible for the Family Unification Program.If yes to number 2, 3, 4, 5 or 6, client may be eligible for programs designed specifically for those populations. If yes to number 7, client may be ineligible for housing that has restrictions on a person with a felony.If yes to number 8, very specific location and other housing requirements will need to be met for client. Review current probation / parole requirements as well as state and local law.D. Indicated Housing Type – Based on the score from section A and the indicators from section B and C, determine which type of housing is appropriate. Please select only one option. If the score indicates that PSH or Market Rate Housing is appropriate, please choose a sub-category based on your experience, expertise, and knowledge of the client’s situation. #Housing TypeDescription√1Permanent Support Housing (PSH)Score of 18 or above and all answers ‘yes’ in Section BSubcategory - 24 Hour Care24 hour care with staffingSubcategory - Intensive Supports4-7 staff visits / contacts per weekSubcategory - Moderate Supports1-3 staff visits / contacts per week2Transitional HousingScore of 15 or above3Market Rate HousingScore of 14 or belowSubcategory – Time Limited Supportsfollow-up for 3-15 monthsSubcategory – No additional Supportsno follow-up necessaryE. Worker’s Notes – Include any information about the CL that would make the Housing Type indicated by this tool inaccurate. Please indicate what type of housing is more suited for the CL. <br />