Forms and Instructions

General Use: for all funding sources


Provider Request Form (PRF)

This form allows the Institute for Community Alliances (ICA) to configure data collection appropriately for agencies in the database. Please have the following readily available as you complete this form: 

  1. The staff person at your agency who can provide accurate information and answer questions about the project; 
  2. Knowledge of the funding source, including when the grant starts/started; 
  3. For federally-funded projects, the grant identifier from your contract or grant; 
  4. For shelters and housing projects, knowledge of the number of beds and units per this funding source. 

Click here to fill out the form.

Important Notes! 

  • One of these forms must be completed for EACH funding source/grant within the agency project that will be using HMIS.*
  • 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.*
  • Please contact mnhmis@icalliances.org if you need assistance filling out this form. Thank you!

*If this project has 3 or more funding sources funding the units/beds, OR operates in 3 or more CoCs, please contact the Helpdesk at the email above so that we can assist you in streamlining this process. 

By Funding Type:

DHS_logo DHS- Department of Human Services

HS-Housing Support

HTA-Healthy Transitions to Adulthood

Forms: Last Updated June 27th, 2019

Instructions:

Main Contact:

Nic Vogel: MN Department of Human Services

LTHSSF-Long Term Homeless Supportive Services Fund

OEO ESP-Emergency Services Program

OEO HYA-Homeless Youth Act

Forms: Last Updated June 27th, 2019

Emergency Shelter

Youth Supportive Housing

Emergency Shelter and Youth Supportive Housing

Instructions:

Main Contact:

Andrea Simonett: Youth Program Specialist, Minnesota Department of Human Services

OEO THP-Transitional Housing Program

Forms: Last Updated June 27th, 2019

Instructions:

Main Contact:

Isaac Wengerd, Homeless Programs Supervisor: isaac.wengerd@state.mn.us

hudlogo    HUD- Housing and Urban Development

CoC-Continuum of Care

ESG-Emergency Solutions Grant

HOPWA-Housing Opportunities for Persons with AIDS

MN.ico.png    Veterans Affairs – Supportive Services for Veteran Families

 Instructions: Last Updated April 3rd, 2018

MN.ico.png    Other – Universal Assessment

 Forms: Last Updated June 27th, 2019


MN.ico.png    Other – ShelterPoint Workflows

 Forms: Last Updated May 29th, 2019


MN.ico.png    Other – Homework Starts with Home

Forms: Last Updated August 28, 2019

Written Instructions: Last Updated July 12th, 2019

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