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1. Acknowledgment of Data Collection and Consent to Share

1.1. Data Privacy Notice, Acknowledgment, and Consent

This document contains the following components:

Staff Instructions

Client Rights Information

In-Person Acknowledgment of Data Collection and Consent to Share

Verbal Acknowledgment of Data Collection and Consent to Share

Posted Data Privacy Notice

Clients should complete the Acknowledgment of Data Collection and Consent to Share before their information is entered in HMIS. Clients should complete this form yearly. A verbal (over the phone) version is available on Page 4 of this document.

The Posted Data Privacy Notice must be displayed in your agency's client intake area.

Please email feedback, suggestions, or new form requests to hmis@cohhio.org

1.2. Data Privacy Notice, Acknowledgment, and Consent - Spanish

This document contains the following components:  

Staff Instructions

Derechos de Clientes (Client Rights)

Reconocimiento de Recolección de Datos y Consentimiento para Compartir Datos (Acknowledgment of Data Collection and Consent to Share)

Aviso de Privacidad de Datos (Data Privacy Notice)

Clients should complete the Acknowledgment of Data Collection and Consent to Share (Reconocimiento de Recolección de Datos y Consentimiento para Compartir Datos) before their information is entered in HMIS. Clients should complete this form yearly. A verbal (over the phone) version is nto avilable in Spanish.

The Posted Data Privacy Notice must be displayed in your agency's client intake area. A Spanish version of this notice is available on Page 4 of this document.

Please email feedback, suggestions, or new form requests to hmis@cohhio.org.

1.3. List of Active Agencies

Upon request, any client may be provided with a list of agencies who share data in HMIS (ServicePoint). This list is updated annually. Please direct questions about this list to hmis@cohhio.org.

2. HMIS Forms

2.1. HMIS Forms for Balance of State and Mahoning CoCs

The forms available on this page have been created by COHHIO for use by the Balance of State CoC and the Mahoning CoC. They are based on the most recent HUD standards (September 2020).

Please remember to enter the client data collected you record on these forms within five days of the client's intake, update, referral, or exit.

The forms here are in Microsoft Word format (.docx) so that they may be modified if necessary.

Please email feedback, suggestions, or new form requests to hmis@cohhio.org.

3. New Project Form

3.1. New Project Form

The New Project Form is to be used to notify COHHIO that a new homeless dedicated project is beginning or has begun to serve clients in the Ohio Balance of State Continuum of Care (BoSCoC). For HMIS-participating new projects, the Agency Administrator should submit this form whenever a new project begins to serve clients. Non-HMIS participating projects should also submit this form when the project begins to serve clients.

Please print this form plus the HIC Verification Report, if necessary, and send to ohioboscoc@cohhio.org or the address listed below. Upon approval by Ohio BoSCoC staff, the HMIS team will update HMIS.

Erica Mulryan

COHHIO

175 S. Third Street, Suite 580

Columbus, OH 43215

For information about the HIC Verification Report and its uses, please visit http://hmis.cohhio.org/index.php?pg=kb.page&id=119.


Mahoning Projects should communicate with the Mahoning CoC about project changes and additions.


4. HMIS Diversion Form and Screening Script

4.1. HMIS Diversion Form and Screening Script

The HMIS Diversion Form should be downloaded and printed in the case that you cannot enter the information directly into HMIS. This data collection should occur after the client provides verbal (by phone) or written consent to data collection and before you have the diversion conversation with the client using the Diversion Screening Script.

Please email feedback, suggestions, or new form requests to hmis@cohhio.org.

5. Resources

5.1. List of HMIS Resources

HMIS Resources 

Matt Dicks
mattdicks@cohhio.org
(614) 280-1984 ext. 120
Genelle Denzin
genelledenzin@cohhio.org
(614) 280-1984 ext. 123
Amanda Wilson
amandawilson@cohhio.org
(614) 280-1984 ext. 115
Carolyn Hoffmancarolynhoffman@cohhio.org(614) 280-1984 ext. 119



Ohio Balance of State HMIS login page: https://sp5.servicept.com/odod
Youngstown HMIS login page: https://sp5.servicept.com/youngstown
Help Desk Portal (Website): http://hmis.cohhio.org/
Help Desk Email: hmis at cohhio dot org

Ohio Balance of State HMIS Policy and Procedures Manual: http://hmis.cohhio.org/index.php?pg=kb.page&id=38
Ohio Balance of State HMIS Data Quality Standards: http://hmis.cohhio.org/index.php?pg=kb.page&id=39

COHHIO: http://www.cohhio.org/
Ohio Balance of State's HMIS Lead = COHHIO
Youngstown's HMIS Lead = Catholic Charities Regional Agency

HUD: https://www.hudexchange.info/
HUD’s websites about HMIS: https://www.hudexchange.info/hmis/ or http://www.hudhdx.info/ or
http://portal.hud.gov/hudportal/HUD?src=/program_offices/comm_planning/homeless/hmis

VA’s website about HMIS (for SSVF programs): http://www.va.gov/HOMELESS/HMIS.asp

Learn about VAWA: http://en.wikipedia.org/wiki/Violence_Against_Women_Act

National Alliance to End Homelessness: http://www.endhomelessness.org/