HMIS Data Collection Template – CoC Program Rapid Rehousing Supplemental Form
Collection of residential move-in date information will allow RRH projects to differentiate between clients who are in
permanent housing (PH) and those that are waiting for a housing placement. If the client is not in PH as of the entry date,
the residential move-in date should be captured using this form at the time of any entry into PH prior to project exit and the
record must be edited in HMIS to reflect the appropriate residential move in date.
Respond to the following questions for all household members—each adult and child. A separate form should be included
for each household member.
CLIENT (name or other identifier)
STATUS AT PROJECT ENTRY
PROJECT ENTRY DATE (e.g., 08/24/2014)
/
Month
/
Day
Year
Is the client in permanent housing as of the project entry date?



No

Yes

RESIDENTIAL MOVE IN DATE
[IF NO] Enter the date the client moves into permanent housing after project entry
/
Month
/
Day
Year
STATUS AT PROJECT EXIT
PROJECT EXIT DATE (e.g., 08/24/2014)
/
Month
/
Day
Year
Is the client in permanent housing as of the project exit date?



No
Yes

[IF YES] Enter the residential move in date in the field above
HMIS Data: RAPID REHOUSING SUPPLEMENTAL FORM
November 2014
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