NON-CASH BENEFITS Non-cash benefits from any source? No Client doesn’t know   Yes Client refused    [IF YES] Answer or for each non-cash benefit source. (Answer for benefits that have ‘Yes’ ‘No’ ‘No’ been terminated, even if they were received in the past.) No Yes Source of non-cash benefit  Supplemental Nutrition Assistance Program (SNAP)    Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)   TANF Child Care services (or use local name)   TANF transportation services (or use name)   Other TANF-Funded Services (or use local name)   Section 8, Public Housing, or other ongoing rental assistance   Temporary rental assistance Other source:   ______________________________________________________________________
NON-CASH BENEFITS Non-cash benefits from any source?  No  Client doesn’t know  Yes  Client refused  [IF YES] Answer ‘Yes’ or ‘No’ for each non-cash benefit source. (Answer ‘No’ for benefits that have been terminated, even if they were received in the past.) No Yes Source of non-cash benefit   Supplemental Nutrition Assistance Program (SNAP)   Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)   TANF Child Care services (or use local name)   TANF transportation services (or use name)   Other TANF-Funded Services (or use local name)   Section 8, Public Housing, or other ongoing rental assistance   Temporary rental assistance   Other source: ______________________________________________________________________
CoC-HMIS-Data-Collection-Template-Project-Annual-Assessment1.docx