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It captures project start date and determines whether translation assistance is needed, including preferred language options. The form gathers sensitive identifiers such as Social Security number with quality indicators, current name components with quality, date of birth with reporting quality, gender, and race and ethnicity selections. It also records veteran status details, including theaters of operations, military branch, discharge status, and reporting quality selections.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/clarity-hmis-hud-coc-project-intake-form/515620/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/clarity-hmis-hud-coc-project-intake-form/515620.png","ImageObject",300,407,{"name":92,"@type":93},"asba","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-09","2026-10-06",true,{"@type":102,"interactionType":103,"userInteractionCount":29},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Does the form need to be completed for all household members?","Question",{"text":112,"@type":113},"Yes. The form states that a separate form must be completed for each household member.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What options are provided for translation assistance?",{"text":117,"@type":113},"The form asks whether translation assistance is needed and, if yes, provides choices for preferred language such as English, Spanish, Vietnamese, Tagalog, Mandarin, and other/different preferred language.",{"name":119,"@type":110,"acceptedAnswer":120},"How is veteran status captured on the form?",{"text":121,"@type":113},"Veteran status includes a yes/no selection for adults, fields for years entered and separated from service, multiple theater-of-operations checkboxes, plus military branch and discharge status selections.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},515620,1791462970,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":29,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":52,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144,"preview_page_count":4},3985747872567,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","Agency Name:  \n___________________________________________  \nCLARITY HMIS: HUD-CoC PROJECT INTAKE FORM Use block letters for text and bubble in the appropriate circles.  \nPlease complete a separate form for each household member.  \nPROJECT START DATE [All Clients]  \n\n|  |  | - |  |  | - |  |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |\n\nMonth Day Year  \nTRANSLATION ASSISTANCE NEEDED? Would the client like services to be provided in a language other than English?  \n\n| ○ | No | ○ | Client doesn’t know |\n| --- | --- | --- | --- |\n|  |  | ○ | Client prefers not to answer |\n| ○ | Yes |  |  |\n|  |  | ○ | Data not collected |\n\nIF “YES” TO TRANSLATION ASSISTANCE NEEDED – INDICATE PREFERRED LANGUAGE  \n\n| ○ | English | ○ | Tagalog |\n| --- | --- | --- | --- |\n| ○ | Spanish | ○ | Client doesn’t know |\n| ○ | Vietnamese | ○ | Client prefers not to answer |\n| ○ | Mandarin | ○ | Data not collected |\n| ○ | Different Preferred Language (specify): |  |  |\n\nSOCIAL SECURITY NUMBER [All Clients]  \n\n|  |  |  | - |  |  | - |  |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |\n\n\n| QUALITY OF SOCIAL SECURITY |  |  |  |\n| --- | --- | --- | --- |\n| ○ | Full SSN reported | ○ | Client doesn’t know |\n|  |  | ○ | Client prefers not to answer |\n| ○ | Approximate or partial SSN reported | ○ | Data not collected |\n\n\n| CURRENT NAME [All Clients] |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | N/A |\n| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |\n| Last |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | ○ |\n| First |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| Middle |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | ○ |\n\n| Suffix |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | ○ |\n| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |\n| QUALITY OF CURRENT NAME |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| ○ | Full name reported |  |  |  |  |  |  |  |  |  |  |  |  |  |  | ○ |  | Client doesn’t know |  |  |  |  |\n| ○ | Partial, street name, or code name reported |  |  |  |  |  |  |  |  |  |  |  |  |  |  | ○ |  | Client prefers not to answer |  |  |  |  |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | ○ |  | Data not collected |  |  |  |  |\n\nDATE OF BIRTH [All Clients]  \n\n|  |  | - / |  |  | - / |  |  |  |  | Age: |\n| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |\n\nMonth Day Year  \n\n| QUALITY OF DATE OF BIRTH |  |  |  |\n| --- | --- | --- | --- |\n| ○ | Full DOB reported | ○ | Client doesn’t know |\n| ○ | Approximate or partial DOB reported | ○ | Client prefers not to answer |\n|  |  | ○ | Data not collected |\n\nGENDER [All Clients]  \n\n| ○ | Woman (Girl, if child) | ○ | Questioning |\n| --- | --- | --- | --- |\n| ○ | Man (Boy, if child) | ○ | Different Identity (specify): |\n| ○ | Culturally Specific Identity (e.g. , Two-Spirit) | ○ | Client doesn’t know |\n| ○ | Transgender | ○ | Client prefers not to answer |\n| ○ | Non-Binary | ○ | Data not collected |\n\nRACE AND ETHNICITY all applicable)  \n(Select [All Clients]  \n\n| ○ | American Indian, Alaska Native, or Indigenous | ○ | Native Hawaiian or Pacific Islander |\n| --- | --- | --- | --- |\n| ○ | Asian or Asian American | ○ | White |\n| ○ | Black, African American, or African | ○ | Client doesn’t know |\n| ○ | Hispanic/Latina/e/o | ○ | Client prefers not to answer |\n| ○ | Middle Eastern or North African | ○ | Data Not Collected |\n\nVETERAN STATUS [All Adults]  \n\n| ○ | No |  | ○ | Client doesn’t know |\n| --- | --- | --- | --- | --- |\n| ○ | Yes |  | ○ | Client prefers not to\u003Cbr>answer |\n|  |  |  | ○ | Data not collected |\n| IF “YES” TO VETERAN STATUS |  |  |  |  |\n| Year entered military service (year) |  |  |  |  |\n| Year separated from military service (year) |  |  |  |  |\n\n| Theater of Operations: World War II |  |  |  |\n| --- ","cbCaimlobgpoNk5a","https://ap.wps.com/l/cbCaimlobgpoNk5a","pdf",258242,"English","# Project intake information\n## Translation assistance and preferred language\n## Personal identifiers and reporting quality\n## Demographics and veteran status","[{\"question\":\"Does the form need to be completed for all household members?\",\"answer\":\"Yes. The form states that a separate form must be completed for each household member.\"},{\"question\":\"What options are provided for translation assistance?\",\"answer\":\"The form asks whether translation assistance is needed and, if yes, provides choices for preferred language such as English, Spanish, Vietnamese, Tagalog, Mandarin, and other/different preferred language.\"},{\"question\":\"How is veteran status captured on the form?\",\"answer\":\"Veteran status includes a yes/no selection for adults, fields for years entered and separated from service, multiple theater-of-operations checkboxes, plus military branch and discharge status selections.\"}]","CLARITY HMIS - HUD-CoC Project Intake Form | PDF",1791320246,25]