[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-248416-105":3,"detail-sidebar-cat-1-en-105":81,"doc-detail-248416-en":127},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","coc-hmis-data-collection-template-project-entry","CoC HMIS Data Collection Template - Project Entry","","A data collection form for CoC-funded project types, designed to capture standardized client and household information while minimizing duplication across household members. It defines instructions for text entry in block letters and selection of responses using X marks. The form collects a project start date that anchors data accuracy for all elements. It then gathers detailed demographics and household relationships for each adult and child, including name components, data quality indicators, relationship to head of household, ethnicity, race, gender, and health-related disabilities and conditions.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/template/","Template",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/template/forms/","Forms",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/template/coc-hmis-data-collection-template-project-entry/248416/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/coc-hmis-data-collection-template-project-entry/248416.png","ImageObject",442,249,{"name":42,"@type":43},"Cart","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-23","2026-09-12",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",8,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"Who should complete this form and for which CoC-funded project types is it intended?","Question",{"text":63,"@type":64},"The form can be used by all CoC-funded project types including Prevention, Street Outreach, Safe Haven, Transitional Housing, Rapid Re-housing, Permanent Supportive Housing, and Services Only. Instructions also note that some project types may require additional tracking using supplemental forms.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"How is the project start date used in the data collection process?",{"text":68,"@type":64},"The Project Start Date serves as the information date for all data elements collected on the form. All data must be accurate as of this date, regardless of when each piece of information was collected.",{"name":70,"@type":61,"acceptedAnswer":71},"What does the form do to avoid duplicating data within households?",{"text":72,"@type":64},"The form is divided into two sections—All Clients and Head of Household and Other Adults in the Household—to eliminate duplication when household characteristics apply to certain members.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},248416,1790311265,{"code":4,"msg":82,"data":83},"success",[84,89,94,99,104,109,113,118,123],{"id":85,"doc_module":22,"doc_module_name":25,"category_name":86,"show_sort_weight":87,"slug":88},11,"Presentations",90,"presentations",{"id":90,"doc_module":22,"doc_module_name":25,"category_name":91,"show_sort_weight":92,"slug":93},12,"Resumes",80,"resumes",{"id":95,"doc_module":22,"doc_module_name":25,"category_name":96,"show_sort_weight":97,"slug":98},14,"Invoices",70,"invoices",{"id":100,"doc_module":22,"doc_module_name":25,"category_name":101,"show_sort_weight":102,"slug":103},15,"Posters",60,"posters",{"id":105,"doc_module":22,"doc_module_name":25,"category_name":106,"show_sort_weight":107,"slug":108},16,"Social Media",50,"social-media",{"id":110,"doc_module":22,"doc_module_name":25,"category_name":29,"show_sort_weight":111,"slug":112},17,40,"forms",{"id":114,"doc_module":22,"doc_module_name":25,"category_name":115,"show_sort_weight":116,"slug":117},18,"Letters",30,"letters",{"id":119,"doc_module":22,"doc_module_name":25,"category_name":120,"show_sort_weight":121,"slug":122},21,"Paper Templates",5,"papers-templates",{"id":124,"doc_module":22,"doc_module_name":25,"category_name":125,"show_sort_weight":4,"slug":126},158,"General","general-158",{"code":4,"msg":82,"data":128},{"doc_id":79,"user_id":129,"nickname":42,"user_avatar":130,"doc_module":22,"category_id":110,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":55,"language":136,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":12,"update_tm":140,"read_time":30},18829141979164,"https://eur-avatar.wpscdn.com/davatar_6f874abed73319feea01a86fa6f0fab8","This form can be used by all CoC-funded project types: Prevention, Street Outreach, Safe Haven, Transitional Housing, Rapid Re-housing, Permanent Supportive Housing , and Services Only. Some project types are also required to track other information such as contacts, engagement, or move-in date. See supplemental forms for Prevention, Rapid Rehousing , Permanent Supportive Housing, and Street Outreach projects.  \nFOR TEXT FIELDS, USE BLOCK LETTERS. OTHERWISE, MARK APPROPRIATE BOXES WITH AN “X”  \nThe form is broken into two sections for All Clients , and Head of Household and Other Adults in the Household in order to eliminate duplication of data gathering when characteristics apply to certain members of households.  \nDATA FOR ALL CLIENTS  \nRespond to the following questions for all household members—each adult and child. A separate form should be included for each household member.  \nPROJECT START DATE (e.g., 08/24/2017)  \nThe Project Start Date will serve as the information date for all data elements collected on this form; all data must be accurate as of this date, regardless of the date collected.  \n\n|  |  | / |  |  | / |  |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |\n\nMonth Day Year  \nNAME (first, middle, last name, suffix, e.g., Jr, Sr, III)  \nUse a client’s full, legal name whenever possible. Generally, projects do not need to verify that the information provided matches legal documents, unless specifically required by a funder.  \n\n| First name |  |\n| --- | --- |\n| Middle name |  |\n| Last name |  |\n| Suffix |  |\n\nNAME DATA QUALITY  \nStreet outreach projects may record a project start with limited information about the client and improve on the accuracy and completeness of client data over time. If using a “made up name” for such an initial identification, indicate that here.  \n􀂅 Full name reported  \n􀂅 Client doesn’t know  \n1  \n\n| 􀂅 | Client doesn’t know |\n| --- | --- |\n| 􀂅 | Client refused |\n\n\n| 􀂅 | Client doesn’t know |\n| --- | --- |\n| 􀂅 | Client refused |\n\nDATA FOR ALL CLIENTS (CONTINUED)  \nRELATIONSHIP TO HEAD OF HOUSEHOLD  \nIn a household of a single individual, that person must be identified as the head of household. In multi-person households, one of person must be designated as the head of household and the rest must have their relationship to the head of household recorded. If the group of persons is composed of adults and children, an adult must be indicated as the head of household.  \n\n| 􀂅 | Self (head of household) |\n| --- | --- |\n| 􀂅 | Head of household’s child |\n| 􀂅 | Head of household’s spouse or partner |\n\nETHNICITY  \n􀂅 Non-Hispanic / Non-Latino  \n| 􀂅 | Head of household’s other relation member (other relation to head of household) |\n| --- | --- |\n| 􀂅 | Other: non-relation member |\n\n\n| 􀂅 | Client doesn’t know |\n| --- | --- |\n| 􀂅 | Client refused |\n\nRACE  \nMore than one race is permitted. Client doesn’t know and Client refused should only be selected if no other response is selected. If the client wishes to indicate “Hispanic or Latino,” please indicate that in Ethnicity and then select the  \nappropriate race category here.  \n􀂅 American Indian or Alaska Native  \n􀂅 Black or African American  \n| 􀂅 | White |\n| --- | --- |\n| 􀂅 | Client doesn’t know |\n| 􀂅 | Client refused |\n\nGENDER  \nWhich of these genders best describes how the client identifies?  \n\n| 􀂅 | Female |\n| --- | --- |\n| 􀂅 | Male |\n| 􀂅 | Trans Female (MTF, or male to female) |\n| 􀂅 | Trans Male (FTM, or female to male) |\n\n\n| 􀂅 | Gender Non-Conforming (i.e. not exclusively male or female) |\n| --- | --- |\n| 􀂅 | Client doesn’t know |\n| 􀂅 | Client refused |\n\n2  \nDATA FOR ALL CLIENTS (CONTINUED)  \nPHYSICAL DISABILITY  \nDoes the client currently have a physical disability?  \n􀂅  \nNo  \n􀃐  \n\n| 􀂅 | Client doesn’t know |\n| --- | --- |\n| 􀂅 | Client refused |\n\n[IF YES] Is the physical disability expected to be of long-continued and indefinite duration and substantially impair the client’s ability to live independently?  \n􀂅 No  \nDEVELOPMENTA","cbCaiqzxseIerWFW","https://ap.wps.com/l/cbCaiqzxseIerWFW","pdf",344845,"English","# Project instructions\n## Scope of covered CoC-funded project types\n## Data accuracy date and entry formatting\n# Data for all clients\n## Household member coverage and separate forms\n## Project start date\n## Client name and data quality\n## Relationship to head of household\n## Ethnicity and race\n## Gender\n## Disability and health conditions\n## Physical disability\n## Developmental disability\n## Chronic health condition\n## HIV/AIDS\n## Mental health problem\n## Substance abuse problem","[{\"question\":\"Who should complete this form and for which CoC-funded project types is it intended?\",\"answer\":\"The form can be used by all CoC-funded project types including Prevention, Street Outreach, Safe Haven, Transitional Housing, Rapid Re-housing, Permanent Supportive Housing, and Services Only. Instructions also note that some project types may require additional tracking using supplemental forms.\"},{\"question\":\"How is the project start date used in the data collection process?\",\"answer\":\"The Project Start Date serves as the information date for all data elements collected on the form. All data must be accurate as of this date, regardless of when each piece of information was collected.\"},{\"question\":\"What does the form do to avoid duplicating data within households?\",\"answer\":\"The form is divided into two sections—All Clients and Head of Household and Other Adults in the Household—to eliminate duplication when household characteristics apply to certain members.\"}]","CoC HMIS Data Collection Template - Project Entry | PDF",1789245904]