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Housing First
Desk Guide
FY2015
Form: HFP-100
Desk GuideHousing First ProgramFY2015
Table of Contents
INTRODUCTION................................................................................................................................................................ 3
GENERAL INFORMATION .............................................................................................................................................. 4
COMPLIANCE ..................................................................................................................................................................... 6
REGIONAL HOUSING TEAM MEETINGS / CONTINUUM OF CARE MEETINGS ............................................... 9
HOMELESS MANAGEMENT INFORMATION SYSTEM (HMIS)............................................................................. 9
INCOME ELIGIBILITY .................................................................................................................................................... 10
GRANT ADMINISTRATION .......................................................................................................................................... 14
Initial Grant Documents ...................................................................................................................................................................... 14
Request for Payment / Back-Up Forms ............................................................................................................................................... 16
On-Site Administration ........................................................................................................................................................................ 22
Records to Maintain ............................................................................................................................................................................ 23
Client File Forms .................................................................................................................................................................................. 24
Close Out ............................................................................................................................................................................................. 25
Effective: April 1, 2015
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Form: HFP-100
Desk GuideHousing First ProgramFY2015
Introduction
Purpose
The purpose of the Housing First Program (HFP) is to provide funding for any housing/service provider proposing
permanent housing solutions with access to supportive services that will address the homeless and at-risk of
homelessness population.
History
In FY 2012, Missouri Housing Development Commission (MHDC) was able to secure $420,000.00 in Fund Balance monies
to implement the HFP. Housing First is a national model that relieves program participants of stipulations and barriers
to housing. The funding level remained at $420,000.00 in FY 2015. It is the goal of MHDC to continue the HFP through
the Fund Balance budget.
Eligibility Requirements
Who can apply?
Applicants must be a non-profit or for-profit corporation or partnership entity formed pursuant to
applicable Missouri law, must be in good standing with the state of Missouri, and provide housing or
housing services. Applicants must demonstrate access to a substantial supply of permanent housing and
client-centered services, as well as a diverse funding stream for housing and services.
Who can be served?
Any person, or persons (families) who are homeless (by the HUD definition), or at risk of homelessness, and who are
considered low-income (50 percent of the area median income or below) and in need of permanent, affordable housing.
The HFP provides a link between housing and services; however, the recipient is not obligated to receive case
management or treatment in order to receive Housing First assistance.
Eligible Uses
The grant may be used to support new or existing HFP’s in Missouri. The HFP’s do not have to be standalone entities; it
may be integrated into existing systems and programs. Transitional housing may be provided until permanent housing is
available. Eligible uses include rental assistance, rental deposits, rental arrears (up to six months), utility assistance,
utility deposits, utility arrears (up to six months), and administrative expenses.
It is the purpose of the HFP to serve those with the greatest housing and housing service needs in the state of Missouri
with attention given to the lowest-income residents in the areas where those needs exist.
Effective: April 1, 2015
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Form: HFP-100
Desk GuideHousing First ProgramFY2015
Funding Regions for the 2015 Grant Cycle
Allocation Areas
Balance of State
Adair, Atchison, Audrain , Barry, Barton, Bates, Benton, Bollinger, Boone, Butler, Caldwell, Callaway, Camden, Cape Girardeau,
Carroll, Carter, Cass, Cedar, Chariton, Clark, Clay, Clinton, Cole, Cooper, Crawford, Dade, Dallas, Daviess, Dent, Douglas, Dunklin,
Gasconade, Gentry, Grundy, Franklin, Harrison, Henry, Hickory, Holt, Howard, Howell, Iron, Johnson, Knox, Laclede, Lafayette,
Lawrence, Lewis, Linn, Livingston, Macon, Madison, Maries, Marion, McDonald, Mercer, Miller, Mississippi, Moniteau, Monroe,
Montgomery, Morgan, New Madrid, Oregon, Osage, Ozark, Pemiscot, Perry, Pettis, Phelps, Pike, Platte, Polk, Pulaski, Putnam,
Ralls, Randolph, Ray, Reynolds, Ripley, Saline, Schuyler, Scotland, Scott, Shannon, Shelby, St. Clair, St. Francois, Ste. Genevieve,
Stoddard, Stone, Sullivan, Taney, Texas, Vernon, Wayne, Worth, and Wright Counties
Jasper/Newton Counties
Kansas City/Independence/Lee’s Summit/Jackson County
Springfield/Greene, Christian, Webster Counties
St. Charles, Lincoln, and Warren Counties
St. Joseph/Andrew, Buchanan, DeKalb Counties
St. Louis City
St. Louis County
General Information
Website
All information and forms pertaining to the FY2015 Housing First grant can be found under “FY 2015 Items” on the
MHDC website at: http://www.mhdc.com/ci/hfp/index.htm
Contacts
Below are the contacts for the FY2015 grant year. Joselyn Pfliegier is the primary contact for the HFP grant. Please
direct all questions, concerns, updates and submission of documents to her, with the exception of Payment Requests
and Back-up forms. All Payment Requests and Back-Up forms shall be submitted electronically to Community
Initiatives Accountant OR mailed hard-copy to Community Initiatives Department, at the below addresses. Agencies
should not send both a hard copy and an electronic copy to avoid processing duplicates.
Effective: April 1, 2015
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Form: HFP-100
Desk GuideHousing First ProgramFY2015
Please direct questions, concerns, updates, and miscellaneous submissions to:
Joselyn Pfliegier
Community Initiatives Coordinator
920 Main, Suite 1400
Kansas City, MO 64105
(816) 759-7228
jpfliegier@mhdc.com
Please submit electronic Payment Requests and Back-up forms to:
Andrea Jenkins
Community Initiatives Accountant
ajenkins@mhdc.com
Please submit hard-copy Payment Requests and Back-up forms to:
Missouri Housing Development Commission
Community Initiatives Department
920 Main, Suite 1400
Kansas City, MO 64105
Timeline – FY2015
NOFA Posted on MHDC Website:
Proposal Deadline:
Staff Recommendations:
Awards Notification:
Funded Training:
Grant Year Begins:
Quarter 1 (Q1):
Q1 Payment Request Deadline (MHDC-KC office):
Quarter 2 (Q2):
Q2 Payment Request Deadline (MHDC-KC office):
Quarter 3 (Q3):
Q3 Payment Request Deadline (MHDC-KC office):
Quarter 4 (Q4):
Q4 Payment Request Deadline (MHDC-KC office):
Last Day to Expend Funds:
Final Payment Request Deadline (MHDC-KC office):
Final Back-up forms Deadline (MHDC-KC office):
Grant Close Out Deadline:
Effective: April 1, 2015
June 23, 2014
September 5, 2014
December 5, 2014
January 2015
February 10, 2015
April 1, 2015
April 1, 2015-June 30, 2015
June 30, 2015
July 1, 2015-September 30, 2015
September 30, 2015
October 1, 2015-December 31, 2015
December 31, 2015
January 1, 2016-March 31, 2016
March 31, 2016
March 31, 2016
March 31, 2016, 4:30 p.m.
April 30, 2016, 4:30 p.m.
April 30, 2016
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Form: HFP-100
Desk GuideHousing First ProgramFY2015
Compliance
During the grant year, MHDC staff will evaluate the grantee’s capacity to administer their HFP grant. The grantee’s
capacity will be evaluated using two compliance levels: minor and major violations. Grantee’s capacity will be assessed
during on-site compliance visits conducted at the designated grantee location as well as through grantee’s ability to
meet administrative requirements such as meeting required deadlines and submitting fully complete documents.
On-Site Compliance Visits
An MHDC staff member will perform announced and/or unannounced site visits to review grantee files at the site
designated by the grantee. During site visits, the MHDC staff member will review 50 percent of the instances of
assistance with a minimum of ten (10) and a maximum of twenty-five (25) randomly chosen instances per visit to check
for the required maintained records. This information is gathered from the HMIS Client Detail Report submitted with
grantee’s back-up. The MHDC staff member will not provide the grantee the names of the files to be checked prior to
the visit; this is to ensure that all files will be reviewed in the state in which they are normally kept. The requested files
are expected to be produced within fifteen (15) minutes of the MHDC staff member’s arrival. Failure to produce
requested files within fifteen (15) minutes will result in a major compliance violation*. Therefore, it is vital that a
grantee staff member is always available to assist the MHDC staff member as needed at the location and during the
times provided by grantee. At the conclusion of the site visit the MHDC staff member will discuss the findings of the visit
with the appropriate grantee staff member. The MHDC staff member will send a site visit report after the visit detailing
findings.
* The only exception is if a staff member is assisting a client.
Announced Visit
The announced site visit is scheduled by MHDC staff with the grantee. If MHDC staff is unsuccessful in scheduling a site
visit after three (3) attempts have been made via telephone and/or e-mail, MHDC staff will send an e-mail to the grantee
informing them that they have fifteen (15) days to schedule a site visit, otherwise their funding will be suspended and
this will be a major compliance violation, where funds are subject to recapture.
Unannounced Visit
MHDC staff members have the right to conduct unannounced visits at the location and times furnished by the grantee in
the original application, updated on the Site Contact Form or updated via email to Joselyn Pfliegier (whichever is most
recent). If a MHDC staff member attempts to conduct an unannounced site visit and the designated grantee location is
closed or staff is unavailable, this will result in a major compliance violation. It is the grantee’s responsibility to notify
MHDC if business hours change or if the grantee will be closed for an extended amount of time.
Other
If any allegations are made regarding employees putting clients in danger; an immediate site visit will take place and the
Community Initiatives Manager will determine compliance violation.
Out of Compliance
If the MHDC staff member finds that the grantee is out of compliance for reasons such as the files have not been kept to
the specified standard, individuals have been assisted who do not meet the income limits or the facility is unsanitary or
unsafe, the MHDC staff member will record that the grantee is “out of compliance.” Until the MHDC staff member has
Effective: April 1, 2015
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Form: HFP-100
Desk GuideHousing First ProgramFY2015
verified that the issue(s) has/have been resolved, funding will be suspended. During this time, the MHDC staff should be
used as a resource to determine what needs to be corrected.
If the grantee is found “out of compliance” they will need to submit a Corrective Action Plan (CAP) detailing the
reason(s) for “out of compliance” status and how the findings will be corrected. Depending on the reason(s) for “out of
compliance” status, grantee may also be subject to a follow-up site visit conducted by MHDC staff in order to ensure
that the issues have been resolved. If the compliance issues require a follow-up visit, it will not be until the next
completed Back-Up Form is submitted that a MHDC staff member may conduct the follow-up site visit. The follow-up
site visit will be based on the most recent back-up documentation.
If the issue(s) that caused the grantee to be out of compliance are resolved after the CAP and/or follow-up site visit
review, the MHDC staff member will inform the grantee in writing that their funding is no longer suspended. If the
issue(s) that caused the grantee to be out of compliance are still not resolved after the CAP and/or follow-up site visit
review, the MHDC staff member will send the grantee inform the grantee in writing of their findings, and funding will be
suspended for all grants that the agency has been awarded through the Community Initiatives department.
If the grantee is determined to be an unclean or an unsafe environment: The grantee will be notified that their funding
will be suspended until they have made the necessary accommodations to make the grantee environment clean and
safe. A MHDC staff member will return for another site visit to verify changes; upon the MHDC staff members’ approval,
funding will be reinstated.
If the grantee is lacking files: The grantee will be notified that their funding will be suspended until they have an
appropriate system for maintaining client information. Please utilize MHDC staff as a resource to assist in
creating/maintaining a filing system.
If no personnel are present at an unannounced visit: The grantee will be notified in writing of the attempted
unannounced site visit and that the grantee is out of compliance. Additionally, if the grantee personnel refuse the site
visit, the grantee will be out of compliance.
If no grantee staff is available for the second attempt, funding will be suspended until a compliance officer is able to
complete the site visit. On the third attempt, if no grantee staff is available again the grant is subject to recapture.
Electronic Files
If the grantee elects to maintain electronic files in lieu of paper files, the grantee will be required to print off all required
documentation for compliance visits. As with all files, the time limit to produce these files is fifteen (15) minutes during a
site visit.
Effective: April 1, 2015
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Form: HFP-100
Desk GuideHousing First ProgramFY2015
Compliance Violations
Below is a detail of the minor and major compliance violations as well as the consequences of each violation.
Minor
Minor violations will be noted in grantee file and points may be assessed during future application cycles.
1.
2.
3.
4.
5.
6.
7.
8.
9.
Client file does not contain all required documentation
Funded grant training not attended
Funded grant documents not received by deadline
Funds not drawn quarterly
Grant not fully closed by due date (all funds backed up, all required documentation received and correct)
Did not attend required number of CoC/RHT meetings for grant year
Not within 10 percent of MWOB projections on Close Out
Not within 10 percent of 25/50 AMI projections on Close Out
Outcome goals were not met
Major
Major violations may be assessed as indicated below:
Description
Action Taken
1.
Grantee currently out of compliance with HFP
“Out of Compliance” status; suspension of HFP funds; points
assessed during future application cycles; requires Corrective
Action Plan and/or follow-up visit to reinstate “in compliance
status” and reinstate funding
2.
Grantee out of compliance for more than one site visit
“Out of Compliance” status; suspension of all Community
Initiatives Department funds; points assessed during future
application cycles; requires Corrective Action Plan and/or follow-up
visit to reinstate “in compliance status” and reinstate funding
3.
Site Visit Compliance: More than one-half of files
reviewed during on-site compliance visit contained a
minor finding; Files unable to be reviewed during visit;
files not produced within 15 minute time frame
“Out of Compliance” status; points assessed during future
application cycles; Requires Corrective Action Plan (CAP) and/or
follow-up visit to reinstate “in compliance status” and reinstate
funding
4.
Grant partially / fully recaptured – resulting from funds
not fully expended by end of grant term or other noncompliance.
Noted – points assessed during future application cycles
5.
Grantee deemed to be unsafe or unsanitary;
allegations of clients being put in danger by grantee
“Out of Compliance” status; suspension of all Community
Initiatives Department funds; points assessed during future
application cycles; Requires CAP and/or follow-up visit to reinstate
“in compliance status” and reinstate funding
6.
Grantee will not schedule visit; after multiple attempts
and no response from letter sent within fifteen (15)
days of date of letter
“Out of Compliance” status; points assessed during future
application cycles
7.
Files unable to be reviewed during visit
“Out of Compliance” status; suspension of HFP funds; points
assessed during future application cycles; Requires CAP and/or
follow-up visit to reinstate “in compliance status” and reinstate
funding
Effective: April 1, 2015
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Form: HFP-100
Desk GuideHousing First ProgramFY2015
Regional Housing Team Meetings / Continuum of Care Meetings
In an effort to encourage collaboration and knowledge of services within areas of the state, all Housing First agencies
will be required to sign in and attend at least 75 percent of all Continuum of Care (CoC)/Regional Housing Team
Meetings in the Continuum in which the majority of its Housing First funding is allocated. These meetings bring together
many different agencies working toward the improvement of housing and ending homelessness in the state of Missouri.
Grantee will be required to submit attendance tracking sheet for meetings attended at the close out of the grant. It is
grantee’s responsibility to provide CoC representative with attendance tracking sheet within the requested timeframe to
complete after each meeting that is attended.
In the rural communities, these meetings are typically held quarterly. In urban areas they often occur monthly. If you
have any questions about which meeting your agency should attend please refer to the contact information for each
area.
Here is a link to the map of the Continua of Care regions: http://mo-ich.org/MoCoC.pdf
Area:
Balance of State
Kansas City Metro
St. Joseph
St. Louis City
St. Louis County
St. Charles
Springfield
Joplin
Contact Person:
Dustin Allen - dallen@mhdc.com
Vickie Riddle - vriddle@hscgkc.org
Randy Sharp - rsharp@inter-serv.org
Justin Jackson - jacksonju@stlouis-mo.gov
Andrea Holak - aholak@stlouisco.com
Dottie Kastigar - dkastigar@communitycouncilstc.org
Michelle Garand - mgarand@commpartnership.org
Tammy Walker - twalker@escswa.org
Homeless Management Information System (HMIS)
HMIS is a system that records and stores data regarding the clients that the grantee assists. All funded agencies
providing direct client assistance are required to enter data into the HMIS system of their continuum. Grantees are
exempt from entering data into HMIS systems if they serve specifically excluded populations i.e., domestic violence
victims, foster children and clients that do not consent to being entered into an HMIS system. The data must be entered
into the HMIS system that represents the county of service. If grantee serves persons with HFP monies in multiple
continua, please ensure that the HMIS data is entered into the appropriate HMIS systems. The following is the contact
information for each area:
CoC
Balance of State, Springfield and Joplin
St. Charles
St. Louis City and St. Louis County
Kansas City and St. Joseph
Effective: April 1, 2015
Contact Person:
Sandy Wilson- sandy.wilson@icalliances.org
Sherry Saunders- ssaunders@communitycouncilstc.org
Deb Little –dlittle@misi.org
John Rich-jrich@maaclink.org
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Form: HFP-100
Desk GuideHousing First ProgramFY2015
Income Eligibility
All households assisted through the HFP are required to be at or below 50 percent of the Area Median Income (AMI). If
the AMI for the county of service is lower than the Missouri State AMI, grantee shall use the AMI for the State to
determine eligibility. Please refer to Maximum Income Limits (Form: HFP-109) to determine recipient eligibility.
Grantees are required to use Direct Assistance Summary / Income Worksheet (HFP-105) to determine income
eligibility. The income limits are to be used throughout the entire FY2015 grant year unless otherwise notified by MHDC.
Currently the HFP program bases its calculation method from HUD’s Part 5 definition; however, there are minor
differences.
Standard Forms of Income Grantees are expected to utilize the list below when calculating a household’s income.
Inclusions:
•
•
•
•
•
•
•
•
Income from all members of the household age 18 and over
Gross wages
Full amount of periodic payments
Unemployment, Worker’s Compensation, Severance
Entitlements (TANF, SSI)
Periodic and determinable allowances (alimony and child support)
Net income from business operations
Interest, dividends or other net income from personal property
Exclusions:
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Income from children under 18 years of age
Foster care payments
Lump sum payments
Reimbursement or payment of medical expenses
Income of live-in aide
Financial Aid
Resident service stipend (part-time work that enhances the quality of life – not to exceed $200/month)
Temporary, non-recurring income (gifts)
Earnings over $480/year for full time students 18 years and older (excluding Head of Household)
Adoption assistance payments
Amounts paid by state to household with a developmentally disabled child to keep them in the home
Food Stamps
LIHEAP Earned Income Tax Credit
WIC Payments
Additional Forms of Income when a household’s assets have a value of $5,000 or over, that should be included as
income.
Inclusions:
•
•
Cash held in savings and checking accounts, safe deposit boxes, home, etc.
Cash value of revocable trusts
Effective: April 1, 2015
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Form: HFP-100
Desk GuideHousing First ProgramFY2015
•
•
•
•
•
•
•
Equity in rental property
Cash value of stocks, bonds, treasury bills, CDs and money market accounts
Individuals Retirement and Keogh Accounts
Retirement and pension funds
Cash value of life insurance policies
Personal property held as an investment
Lump sums not intended as periodic payments
Exclusions
•
•
•
•
•
•
•
•
Necessary personal property (clothing, furniture, cars, primary residence, etc.)
Interest in Indian Trust Lands
Assets not effectively owned by applicant
When assets are held in an individual’s name, but the benefit is to someone that is not in the household
Equity in co-operations in which the family lives
Assets not accessible to and that provide no income
Term life insurance policies
Assets that are part of an active business
Direct Assistance Summary / Income Worksheet (HFP-105)
Due Date:
Income eligibility must be certified at first instance of assistance with HFP. If household
is receiving ongoing HFP financial assistance, income needs to be re-certified every six
months thereafter. At each income eligibility certification, proof of income must be
current within 30 days.
Required:
Yes
Submission / Retention:
Retained in client file
Description:
This form is intended to be used to verify income eligibility as well as to summarize all
assistance details for instances of assistance. This form will also serve as a checklist for
grantees as well as MHDC staff when an on-site compliance visit is conducted. This
form contains all the elements reviewed during a compliance visit.
Completion Instructions:
The electronic form can be obtained on the MHDC website at MHDC.com at
http://www.mhdc.com/ci/hfp/index.htm under “FY2015 Items”
1. Household Members: Complete Household information for all members of the
household. The “Total Number of Members in Household” will automatically
calculate depending on the number of persons listed in the Household Members
section. The number of members in the household is used to automatically calculate
the AMI for the household size; therefore it is very important that all members of
the household are included in that section.
2. Income Calculation: This step must be completed before the calculation of Area
Median Income. Once all the members of the household are listed, income will
need to be calculated for all members 18 and older. There are eight “Income” tabs
at the bottom of the workbook which contain an income calculation worksheet. A
separate tab should be used for each individual in the household that is over 18
years of age. If an individual has zero income please indicate “Zero Income” under
“Income Type” and record the date the Zero Income Certification was signed under
“Date of Income / Letter”. If individuals share assets (i.e., couple that has a shared
savings account) which will be used in calculating income, please only list the assets
on ONE income calculation worksheet, otherwise the assets will be calculated twice.
Effective: April 1, 2015
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Form: HFP-100
Desk GuideHousing First ProgramFY2015
Submission Instructions:
3. Area Median Income (AMI): Once all of the income calculation and deductions
worksheets have been completed for all members of the household 18 and older,
the AMI can be calculated. Choose the county of service from the drop down. If the
county of service is not listed then that county’s AMI is lower than the State AMI
and the “MISSOURI - State” should be selected. If “MISSOURI – State” is selected,
please also select the county of service from the drop down. Once the appropriate
county is selected the AMI breakdown for that selection should populate. The total
household income is automatically calculated and is populated from the individual
income calculation worksheets. The service provider can then compare the
household income to the AMI breakdown for the county of service to determine if
household meets income eligibility requirements.
4. Assistance Information: This section summarizes the assistance information that is
required to be kept for HFP files. This is information that MHDC staff will look at in
the client file during the audit. The completion of this section should act as a
checklist for required information/items for compliance site visits.
Retained in client file for every income certification
Effective: April 1, 2015
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Form: HFP-100
Desk GuideHousing First ProgramFY2015
Direct Assistance Summary / Income Verification Form (HFP-105) - Example
1
3
3
4
2
Effective: April 1, 2015
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Form: HFP-100
Desk GuideHousing First ProgramFY2015
Grant Administration
The administration of your FY2015 HFP grant will consist of forms/documents/information that will be submitted to
MHDC and forms/documents/information that is required to be kept on site. This section will discuss, in detail, the
requirements for document submission as well as the information that is required to be kept on site for this grant type.
Throughout this section, forms that require submission will indicate if a hard-copy or electronic version is required.
Below is the information for each submission; please ensure that the document is submitted to the correct contact.
Hard-Copy Submissions:
Missouri Housing Development Commission
Community Initiatives Department
920 Main, Suite 1400
Kansas City, MO 64105
Electronic Submissions:
jpfliegier@mhdc.com
Electronic Payment Request
and Back-Up Submissions:
ajenkins@mhdc.com
Initial Grant Documents
Before any funds can be released, all required initial grant documents must be complete and received by MHDC by April
1, 2015.
2015 Grant Agreement
Due Date:
Required:
Submission / Retention:
Description:
Completion Instructions:
Submission Instruction:
(Agency Grantee)
April 1, 2015
Yes
Submitted to MHDC
The grant agreement specifically details the requirements and expectations for the
administration of the grant. It is the grantee’s responsibility to know and adhere to all
provisions set forth in the grant agreement.
There are three places where the Grant Agreement must be signed by grantee:
1. Signature page – signature and notary.
2. Workforce Eligibility Affidavit – signature and notary; and
3. Rider B – signature.
All signatures must be ORIGINAL and by an authorized signatory as designated in HFP101. The entire original signed, notarized agreement must be returned to MHDC to be
considered complete. If any pages of the grant agreement are missing, the Grant
Agreement will not be considered complete. Failure to submit a fully complete, properly
executed grant agreement before April 30, 2015 will result in grant recapture. Please
note that the Rider “A” is a part of your grant agreement and specifically details the
eligible uses for the grant year.
Hard-copy, original signatures to Joselyn Pfliegier
Direct Deposit Form (HFP-118)/ Blank Check
Due Date:
April 1 2015
Required:
Yes
Submission / Retention:
Submitted to MHDC
Effective: April 1, 2015
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Form: HFP-100
Desk GuideHousing First ProgramFY2015
Description:
Completion Instructions:
Submission Instructions:
All disbursements from MHDC to grantee will occur using an Electronic Funds Transfer
(EFT). This form is required to be submitted with initial grant documents. It provides
MHDC with the grantee’s banking information for the electronic transfer. A blank voided
check from the indicated banking institution is also required to be submitted with the
Direct Deposit form. Please note that by default your grantee’s banking information
will be updated for ALL MHDC accounts. If the banking information provided is for the
Housing First program or one grant ONLY – it must be indicated on the direct deposit
form.
PDF fillable form can be obtained at MHDC.com. Form must be signed with original
signatures by authorized signatory.
Hard-copy, voided hard-copy check, original signatures to Joselyn Pfliegier.
Authorized Signature Card (HFP-101)
Due Date:
April 1, 2015, updated as needed
Required:
Yes
Submission / Retention:
Submitted to MHDC
Description:
This form designates all authorized signatories for each grant. All documents/forms that
are required to be signed by grantee MUST be signed by a designated authorized
signatory from this form. If an unauthorized person signs a document/form, the
document/form will be rejected.
Completion Instructions:
Electronic form can be obtained from MHDC.com. Form must designate AT LEAST two
authorized signatories. The form must have ORIGINAL signatures from all designated
signatories. Please note the Authorizing Official must sign in the Authorizing Official box
as well as at the bottom of the form.
Submission Instructions:
Hard-copy, original signatures to Joselyn Pfliegier
Sources and Uses (Grant Agreement)
Due Date:
April 1, 2015
Required:
Yes
Description:
The Sources and Uses details the program budget for the FY2015 grant year.
Completion Instructions:
Grantee shall update the Sources and Uses from what was initially provided at time of
application. The updated Sources and Uses should reflect the actual amount of HFP
funds awarded for this grant.
Submission Instructions:
Hard-copy, original signatures to Joselyn Pfliegier
E-Verify Memorandum of Understanding (MOU)
Due Date:
April 1, 2015
Required:
Yes
Description:
The E-Verify MOU is an agreement between the Department of Homeland Security
(DHS) and Grantee stating that grantee agrees to participate in the Employment
Eligibility Verification Program (E-Verify).
Completion Instructions:
Grantee shall submit a copy of the full and complete MOU generated from DHS’ E-Verify
online system.
Submission Instructions:
Hard-copy, to Joselyn Pfliegier
Certificate of Liability Insurance
Due Date:
April 1, 2015
Required:
Yes
Effective: April 1, 2015
P a g e | 15
Form: HFP-100
Desk GuideHousing First ProgramFY2015
Submission / Retention:
Description:
Completion Instructions:
Submission Instructions:
Site Contact Form (HFP-110)
Due Date:
Required:
Submission / Retention:
Description:
Completion Instructions:
Submission Instructions:
Submitted to MHDC
The Certificate of Insurance is a one page summary of Liability Insurance held by
grantee. The insurance held by grantee may include: General Liability, Automobile
Liability Umbrella Liability, Excess Liability, Worker’s Compensation and Employers’
Liability. The Certificate of Liability Insurance must be current. If coverage lapses during
to the grant year, it is grantee’s responsibility to provide MHDC with an updated
Certificate.
Grantee shall provide a copy of the Certificate of Liability Insurance.
Hard-copy, to Joselyn Pfliegier
April 1, 2015
Yes
Submitted to MHDC
This form will be submitted with initial grant documents. This form is to ensure that
MHDC has updated information for the upcoming grant year. The site visit location and
hours of operation will be used to conduct scheduled and unscheduled site visits.
Complete information pertaining to the grant. If grant contact or hours of operation
change, grantee is responsible for submitting an updated Site Contact Form.
Hard-copy, to Joselyn Pfliegier
Request for Payment / Back-Up Forms
Before any funds can be released for FY2015, the following criteria must be met:
1. All previous HFP grants must be completely closed out:
a. All funds expended;
b. Close Out form received;
c. Updated Sources and Uses; and
d. Previous grant(s) are fully backed up.
2. All current year grant documents are complete and received.
3. All previous compliance issues are resolved (i.e., grantee is “in compliance”).
Once all the above criteria are met, grantee may then begin requesting funds from their FY2015 grant. Receiving funds
for an HFP grant is split into two processes: Request for Payment and Back-Up form. This is split into two processes to
allow grantees to advance up to 25 percent of their grant award throughout the year. Once any amount of funds is
advanced, that amount must be fully backed up before any further funds will be released.
Funded agencies may submit payment requests and/or any back-up documentation electronically by emailing the
documents to the Community Initiatives Accountant (Andrea Jenkins at ajenkins@mhdc.com). Funded agencies may
choose to send in original paper copies if they prefer this method instead. Agencies should not send in both electronic
and hard copies to avoid processing duplicates.
Request for Payment
The grantee may submit a Request for Payment as of April 1, 2015. The grantee may choose to draw up to 25 percent
of their total grant award without back-up documentation. This amount must be backed up before additional funds can
Effective: April 1, 2015
P a g e | 16
Form: HFP-100
Desk GuideHousing First ProgramFY2015
be released. If the Request for Payment is under 25 percent that amount must still be backed up before the next
Request for Payment will be processed. After the first Request, no Requests over 25 percent of the grant can be
processed without back-up at the time of the request. The following form must be used for all requests for payment:
Request for Payment (HFP-102)
Due Date:
At least quarterly until funds expended
Required:
Yes
Submission / Retention:
Submitted to MHDC
Description:
The Request for Payment form is required to be submitted for any and all
disbursements of grantee funds.
Completion Instructions:
All fields are required to be completed for Request for Payment form to be accepted
and processed.
1. Complete general fields: Date, Grantee, Grant Number, Site Address, and Grant
Award Amount.
2. Requested Amount. No more than 25 percent of the grant award amount can be
requested without back-up.
3. Check the box for which disbursement is being submitted. If “Final Disbursement”
please indicate.
4. Two authorized signatories listed on the Authorized Signature Card (HFP-101)
must sign the Request for Payment.
Submission Instructions:
Electronically to Community Initiatives Accountant (Andrea Jenkins at
ajenkins@mhdc.com) OR Hard-copy to the Community Initiatives Department. Agencies
should not send both a hard copy and an electronic copy to avoid processing duplicates.
Quarterly Draws
The grantees must have a minimum of one disbursement per quarter. Discarded or zero amount Requests for Payment
will not fulfill the Quarterly Draw requirements. HFP quarters and submission deadlines are detailed above under
“Timeline – FY2015”
Incomplete/Ineligible Requests for Payment
If the grantee submits a Request for Payment that is incomplete/ineligible MHDC will notify grant contact via email that
the Request for Payment is incomplete or ineligible and that the Request is being discarded. Grantee will need to submit
a new and complete Request for Payment.
EXAMPLES: Unsigned or dated forms, previous request not fully backed-up, compliance issues, etc.
Back-Up
Grantee is required to submit the following form to account for all HFP spending during the FY2015 grant year.
Back-Up Form – (HFP-103)
Due Date:
After initial disbursement, before disbursement of additional funds
Required:
Yes
Submission / Retention:
Submitted to MHDC
Completion Instructions:
1. General Information / Back-Up Check List / Summary: All fields in these sections are REQUIRED. If
information is missing from these sections, the Back-Up form will be considered incomplete and will be
discarded. The dates listed in the Reporting Period section should reflect the dates the expenses were
Effective: April 1, 2015
P a g e | 17
Form: HFP-100
Desk GuideHousing First ProgramFY2015
2.
3.
4.
5.
6.
incurred AND paid. Grantee must check whether the Back-Up form is a current submission or whether it is a
replacement for a previous back-up submission.
Summary of Direct Assistance by Region: This section summarizes the information from the attached HMIS
report / Non-HMIS Client Detail Report. Please pay attention to the regions in which HFP monies are spent.
Monies cannot be spent outside of the region(s) specified in the grant agreement.
Total HMIS Summary: This section is a summary of all HMIS Reports/ Non-HMIS Client Detail Reports
submitted with the back-up. Please note that each line should represent the sum of the entire HMIS report /
Client Detail Report not each of the page totals. Please limit each Back-Up form to five (5) HMIS / Client
Detail Reports per submission. Additional Reports will need to be submitted in a separate back-up form.
Administrative Detail Report (if taking 10 percent administrative fee): If a grantee chooses to take the 10
percent administrative fee (as indicated in grantee’s Rider “A”), the Administrative Detail Report form is
required to be completed detailing all expenses that will be charged to HFP. This form is a part of the BackUp form and has separate tabs on the Excel Back-Up form. For staff salaries please include the last four
digits of the employee’s Social Security number in the detail section of the Administrative Detail Report
Form.
Administrative Back-Up (if taking 10 percent administrative fee): Administrative back-up support of cost
incurred AND proof of payment is required to be submitted with Back-Up form for every line item in the
Administrative Detail Report. See Administrative Records chart below for acceptable forms of
documentation to be submitted with back-up.
Back-Up Total Summaries: This section sums up all back-up being submitted in the report.
a. Total Direct Assistance – Summary of all HMIS / Client Detail Reports submitted for back-up,
summed from the line item detail entered above. This number should equal the Total Spent for all
regions from the Summary of Direct Assistance by Region section.
b. Total Administrative Expenses –Summary from all Administrative Detail Reports completed within
this Excel workbook. This total automatically sums as the Administrative Detail Report is completed.
c. Total HFP Grant Funds Expended – Summary of Total Direct Assistance and Total Administrative
Expenses.
Submission Instructions:
Electronically to Community Initiatives Accountant (Andrea Jenkins at
ajenkins@mhdc.com) OR Hard-copy to the Community Initiatives Department. Agencies
should not send both a hard copy and an electronic copy to avoid processing duplicates.
Effective: April 1, 2015
P a g e | 18
Form: HFP-100
Desk GuideHousing First ProgramFY2015
Administrative Expenses
Below is a detail of the eligible and ineligible uses of the ten percent administrative fee and required documentation.
Eligible Administrative Costs:
•
•
•
Ineligible Administrative Costs:
Each sub-grantee can use up to 10 percent
of what was awarded for administration
costs as long as it is specified in the
grantee’s Rider “A”
Examples: Program staff salary,
administration building; utility bills, program
audits, office supplies, maintenance and
travel when clients are present
Maintenance activities include routine or
minor measures to upkeep office space
equipment and fixtures, and/or preventative
measures to keep the building and its
property working appropriately.
•
Funds cannot be used for conferences and training costs, travel when clients are
not present or any food purchases
Administrative Records
Record
Bills Paid
Services Performed
Office Supplies
Salary
Acceptable Forms of Documentation
(both Cost Incurred and Proof of Cleared Payment are required)
Cost Incurred
Proof of Payment
•
•
Invoice
Receipt
•
•
Payroll report with pay period dates, and HFP portion detailed
Check register or credit card statement with payments made by HFP highlighted and/or
returned checks log
Last four digits of SSN and position at agency
Proof of position
•
•
Effective: April 1, 2015
•
Check register or credit card statement with payments
made by HFP highlighted and/or returned checks log
P a g e | 19
Form: HFP-100
Desk GuideHousing First ProgramFY2015
Back-Up Form-(HFP-103) - Example
1
5
2
4
Auto
Fill
Effective: April 1, 2015
P a g e | 20
Form: HFP-100
Desk GuideHousing First ProgramFY2015
Back-Up Form-(HFP-103) – Example (continued)
3
6
a
b
c
Incomplete/Ineligible Back-Up
If the grantee submits a Back-Up form that is incomplete or ineligible MHDC will notify grantee that the Back-Up is
incomplete or ineligible and MHDC will discard it. Grantee will need to submit a new and complete Back-Up form,
including all attachments and signatures.
Other Back-Up Forms
HMIS Report
Due Date:
Required:
Submission / Retention:
Description:
Completion Instructions:
Submission Instructions:
Submitted with Back-Up form
Yes
Submitted to MHDC with Back-Up form
The HMIS report is generated from the respective HMIS systems. The report generated
details information about each instance of assistance as well as a sum of the direct
assistance.
The entering of information and the generating of the report should be executed as
instructed by HMIS system. All HFP recipients should be entered into the appropriate
HMIS system unless the recipient is a part of a protected population (i.e., domestic
violence, youth) or refuses to be entered into the HMIS system.
The HMIS report should be submitted with the HFP Back-Up form. The HMIS report does
require signatures by authorized signatories as designated in HFP-101.
Non-HMIS Client Detail Report Form – (HFP-107)
Due Date:
Submitted with Back-Up form
Required:
Yes – ONLY for recipients that are not entered into HMIS (i.e., domestic violence, youth,
refused to be entered into HMIS)
Submission / Retention:
Submitted to MHDC with HFP Back-Up form
Effective: April 1, 2015
P a g e | 21
Form: HFP-100
Desk GuideHousing First ProgramFY2015
Description:
Completion Instructions:
Submission Instructions:
The Non-HMIS Client Detail Report Form is specifically for recipients that have not been
entered into an HMIS system. These recipients would include protected populations
(i.e. domestic violence, youth) or recipients which refuse to be entered into the HMIS
system. Grantee must receive prior approval before using the Non-HMIS Client Detail
Report Form. If grantee submits both an HMIS report AND the Non-HMIS Client Detail
Report Form, all instances of assistance listed should be distinct from each other. There
should be NO DUPLICATION of instances of assistance between the two reports.
Grantee should complete all fields for every instance of assistance. Therefore if
recipient is receiving repeated service (i.e., rent paid for multiple months) every
instance of assistance should have its own line on the form.
The HMIS report should be submitted with the HFP Back-Up form. The HMIS report does
require signatures by authorized signatories as designated in HFP-101.
On-Site Administration
Client Files
Below is a list of eligible uses for Housing First. An agency is restricted to the uses specified in their Rider “A “of the grant
agreement.
Eligible Uses:
•
•
•
•
•
•
Rental Payments (current month’s rent only)
Utility Payments
Rent Deposits
Utility Deposits
Rental Arrears ( up to six months)
Utility Arrears (up to six months)
Effective: April 1, 2015
Ineligible Uses:
• Individuals or families needing assistance with bills that are not
necessities.
o Examples: telephone, cable television, internet, etc.
• Individuals or families needing assistance to pay any sort of taxes
• Rental/Utility Arrears in excess of six months
P a g e | 22
Form: HFP-100
Desk GuideHousing First ProgramFY2015
Records to Maintain
All of the following should be kept on file and should be easily accessible for compliance purposes: These items are
specified in the Rider “A” of the grant agreement.
Client Records
Record
*Direct Assistance Summary/
Income Verification Form (HFP105)
Income Verification
Criteria
•
Use to calculate income eligibility
•
•
•
•
Income eligibility must be certified
every six months for households
receiving ongoing HFP financial
assistance
At each certification, proof of income
must be current within 30 days of
instance of assistance
Proof of gross monthly income needed
for all members of the household age
18 and over
NO INCOME (18 and older in
household): Certification of Zero
Income” (HFP-104) found at
www.mhdc.com
Documentation of housing status
Proof of Residence
•
Payment Contact
•
Proof of Payment
•
Proof of Requested Need
•
Documentation of client/household’s
need for HFP assistance.
Photo Identification
•
Needed for all members of the
household age 18 and over
Social Security Identification
•
Consent Form
•
Card/number needed for all members
of the household to document number
of individuals in the household
This signed form gives MHDC the right
to review files and verifies “safe and
decent housing”. This form needs to be
filled out every six months.
Form provided by MHDC and can be
found on MHDC’s website at
www.mhdc.com
•
Documentation of whom assistance
was paid to, address, and phone
number
Payment date must be within 30 days
of each instance of assistance
Effective: April 1, 2015
Acceptable forms of Documentation
• Direct Assistance Summary / Income Verification Form (HFP105)
• Pay stub, SSI/SSDI award letter/printout, child support
statement
• Signed/dated statement from employer verifying frequency
and amount of hourly wages (including cash payments)
• Certification of Zero Income (HFP -104)
•
•
•
•
•
•
Letter from landlord or emergency shelter
Copy of lease
Piece of mail
Copy of current lease
Letter from Landlord
Copy of bill
• Copy of check register or credit card statement with payment
highlighted and/or returned check log
Copy of bill
Eviction notice
Letter from the landlord or emergency shelter
Signed, current program contract or copy of lease
Driver’s license, state ID, temporary ID/license, school ID with
photo, passport-U.S. or foreign, U.S. passport card, permanent
resident card, employment authorization document, U.S.
citizen ID card, military ID, Native American tribal card
• Copy of Social Security Card
• Print out from social security office
•
•
•
•
•
• HFP Consent Form (HFP- 106)
P a g e | 23
Form: HFP-100
Desk GuideHousing First ProgramFY2015
Client File Forms
Direct Assistance Summary / Income Verification Form (HFP-105) Please see “Income Verification” section
Certification of Zero Income (HFP-104)
Due Date:
Completed at first instance of assistance, and re-certified every six months thereafter
for households receiving ongoing HFP financial assistance
Required:
Yes – All members of household without income, 18 and over
Submission / Retention:
Retained in client file
Description:
The Certification of Zero Income form must be completed and signed by all recipients of
the household age 18 and over who do not have income. The current year HFP-104 form
is the only acceptable form of certification of zero income and other versions or
alterations of this form will not be accepted.
Completion Instructions:
All members of household without income, 18 and over must sign a Certification of Zero
Income. The date of the form must be within 30 days of the instance of assistance.
Submission Instructions:
The original signed forms retained in client file.
Consent Form (HFP-106)
Due Date:
Required:
Submission / Retention:
Description:
Completion Instructions:
Submission Instructions:
Completed at first instance of assistance, and re-certified every six months thereafter
for households receiving ongoing HFP financial assistance
Yes
Retained in client file
The consent form must be completed and signed by head of household at each
certification. The current year HFP-106 form is the only acceptable consent form and
other versions or alterations of this form will not be accepted.
The head of household must sign the Grant Recipient’s Consent to Release Information
every six months. The date of the form must be within 30 days of the instance of
assistance. The head of household must also check one of the boxes at the bottom of
the consent form. If a box is not checked then the form is not considered complete. If
recipient checks the “IS NOT” box, please address in client file.
The original signed form retained in client file.
Maximum Income Limits (HFP-109)
Due Date:
N/A
Required:
Yes – Must use to determine income eligibility of all HFP recipients
Submission / Retention:
Retained for grantee reference
Description:
The Maximum Income Limits designate the maximum income limits, by household size,
allowable by HFP for the FY2015 grant year. This break out of AMI by household is
calculated by HFP statute. These income calculations should be used to determine
household eligibility for the entire FY2015 grant year.
Completion Instructions:
N/A – for grantee reference
Submission Instructions:
N/A – for grantee reference
Effective: April 1, 2015
P a g e | 24
Form: HFP-100
Desk GuideHousing First ProgramFY2015
Fair Market Rents (HFP-108)
Due Date:
Required:
Submission / Retention:
Description:
Completion Instructions:
Submission Instructions:
N/A
Yes – If grantee owns property where rents are paid. It is strongly recommended that
Fair Market Rent guidelines are followed when paying rent outside of grantee’s
property.
Retained for grantee reference
Fair Market Rents as determined by HUD for 2015. These will be in effect for the entire
FY2015 HFP grant year. Adhering to Fair Market Rents is REQUIRED for grantees paying
rent on property owned by grantee.
N/A – for grantee reference
N/A – for grantee reference
Close Out
Once all funds have been expended, grantee is required to “Close Out” their grant. The Close Out process consists of
several components:
1. Close Out Form
2. Sources and Uses (Updated)
3. Housing Meeting Attendance Form
4. All funds backed up
All complete and final Close Out information is due to MHDC by April 30, 2016. Any funds that are not backed up by April
30, 2016 are subject to recapture.
Close Out Forms
Close Out Form – (HFP-112)
Due Date:
Required:
Submission / Retention:
Description:
Completion Instructions:
April 30, 2016
Yes
Submitted to MHDC
The close out form is a collection of summary questions about the administration of the
grant throughout the FY2015 grant year.
All information is required to be completed.
1. General Information: Please complete general information including date, agency,
grant number, and grant award amount.
2. Percentage of households assisted: Grantee will report on the percentage of
households assisted for the entire FY2015 grant year. Please note that these
reported numbers will be assessed against your original projections in your FY2015
application. Grantees more than 10 percent off from their original projections are
subject to point deductions in future application rounds.
3. Minority / Women Owned Business: Grantee will report on the certified Minority /
Women Owned businesses utilized throughout the ENTIRE AGENCY for the FY2015
grant year. Proof of costs incurred and proof of payment for services are NOT
required to be submitted with back-up, but MHDC does reserve the right to request
that information and those records should be maintained.
4. Program Information Breakdown: Grantee will provide a breakdown of funds spent
during FY2015 grant year.
Effective: April 1, 2015
P a g e | 25
Form: HFP-100
Desk GuideHousing First ProgramFY2015
Submission Instructions:
Sources and Uses (Close Out)
Due Date:
Required:
Description:
Completion Instructions:
Submission Instructions:
5. Service Demographics. Grantee will report on the categories of clients served in
program for FY2015 grant year.
6. Outcomes: Grantee will report on outcomes that were indicated in FY2015 HFP
Application submitted. Grantee will provide results of outcomes as well as
discussion of the outcome results.
7. General Housing First information: Grantee will discuss any comments on HFP
requirements and processes, how HFP has benefited grantee and will attach any
additional information about program.
8. Point-In-Time Count information: Grantee will indicate whether or not they are
involved in their community’s annual Point-In-Time Count. If involved, grantee
should detail their involvement.
9. Project Homeless Connect information: Grantee will indicate whether or not their
community has conducted a Project Homeless Connect. If not, grantee should
indicate whether or not they are interested in conducting an event in their
community.
10. Clients Served. Grantee will designate the percentage of total HFP grant spent by
county. If grantee did not spend funds in a county, please leave blank.
Electronic submission to Joselyn Pfliegier
April 30, 2016
Yes
The Sources and Uses detail the program budget for the FY2015 grant year.
Grantee shall update the Sources and Uses from what was provided at the beginning of
grant year. The updated Sources and Uses should reflect the actual amount expended in
this program. If grantee received more than one grant from MHD for the FY2015 grant
year, the funds should be designated in separate columns.
Electronic submission to Joselyn Pfliegier
CoC/RHTM Housing Meeting Attendance
Due Date:
April 30, 2016
Required:
Yes
Submission / Retention:
Submitted to MHDC with grant’s Close Out form
Description:
The CoC / Regional Housing Team Meeting (RHTM) Attendance form will be used by
grantees to keep a record of attendance to their designated CoC / RHTM meeting.
Completion Instructions:
Grantee will complete the initial information: Agency, HFP Grant Number, and
Designated CoC Meeting. The form with the initial completed information will be taken
to every CoC / RHTM meeting attended. The Meeting Date, Agency Representative, CoC
Representative and CoC Representative (signature) will be obtained for every meeting
attended.
Submission Instructions:
The completed form will be submitted electronically to Joselyn Pfliegier along with
grantee’s close out form. This form will not be accepted before the close of the grant.
Effective: April 1, 2015
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