HPRP Client Checklist Rapid Rehousing by VdJ5J0E7

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									                                HPRP Rapid Re-Housing Program

                                       Eligibility Requirements

Client Name: ______________________________ Date: ______________________________

Agency: _______________________________ Project: _______________________________

Agency Staff Completing Form: ____________________________________


   I.   Eligibility Criteria, Homeless by HUD definition by meeting one of the following
        definition criteria:
        (Per Title IV Section D.4, pg. 25 of 2009 HPRP Notice)

         Sleeping in an emergency shelter

         Sleeping in a place not meant for human habitation

         Staying in a hospital or other institution (up to 180 days) but was in emergency
          shelter or other place not meant for human habitation immediately prior to hospital or
          institution.

         Graduating from or timing out of transitional housing program

         Victim of domestic violence


   II. All program participants must meet ALL of the following criteria:
       (Per Title IV Section D.2, pg. 22 of 2009 HPRP Notice)

         50% or less of AMI for family size (see chart below).

                               2009 Area Median Income Guideline Chart
                1           2        3        4       5         6               7        8
                Person      Person Person Person Person Person                  Person   Person
        50%
        AMI     $23,850 $27,250 $30,650 $34,050 $36,750 $39,500 $42,200 $44,950
        Level



                                                                Form Continued on Reverse

Pierce County 2009 HPRP / Client Checklist Rapid Re-Housing / August 18, 2009
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        Household must be homeless and meet BOTH of the following circumstances:

                 No appropriate subsequent housing option have been identified;

                AND
                 The household lacks the financial resources and support networks needed to
                  obtain immediate housing or remain in its existing housing.

III.    The following documentation is attached:

         Homeless Verification
         Income verification


Answer Defining Question: “Would this individual or family be homeless but for this
assistance?”

         Yes
         No

IV.     If met above criteria - will have Initial consultation with case manager to determine
        appropriate type of assistance.

        Provide date of initial consultation:
        ____________________________________________




Pierce County 2009 HPRP / Client Checklist Rapid Re-Housing / August 18, 2009
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