FY2016 Continuum of Care Competition Accessing Mainstream Resources Declaration _____________________________________________________________________ (Agency & Project Name) Indicate Yes or No if your agency is implementing the following activities. Activity Yes or No 1a. Homeless assistance provider collaborates with healthcare organizations to facilitate health insurance enrollment (e.g. Medicaid, Affordable Care Act, etc.) 1b. Please list the healthcare organizations your agency/project collaborate with: 2a. Homeless assistance provider supplies transportation assistance to clients to attend mainstream benefit appointments, employment training, or jobs. 2b. Educational Materials In-Person Trainings None Transportation Other (List) 3a. Homeless assistance provider uses a single application form for four or more mainstream programs. 4a. Homeless assistance providers have staff systematically follow-up to ensure mainstream services are received. 4b. How often does staff follow up? Annually Every 6 Months Other(Explain) 5a. Homeless assistance providers have SOAR-trained staff provide clients with technical assistance with obtaining SSI/SSDI? Print Name of Agency Board of Directors Approved Signature of Agency Board of Directors Approved Signatory: Signatory Title Date
FY2016 Continuum of Care Competition Accessing Mainstream Resources Declaration _____________________________________________________________________ (Agency & Project Name) Indicate Yes or No if your agency is implementing the following activities. Activity Yes or No 1a. Homeless assistance provider collaborates with healthcare organizations to facilitate health insurance enrollment (e.g. Medicaid, Affordable Care Act, etc.) 1b. Please list the healthcare organizations your agency/project collaborate with: 2a. Homeless assistance provider supplies transportation assistance to clients to attend mainstream benefit appointments, employment training, or jobs. 2b. Educational Materials In-Person Trainings None Transportation Other (List) 3a. Homeless assistance provider uses a single application form for four or more mainstream programs. 4a. Homeless assistance providers have staff systematically follow-up to ensure mainstream services are received. 4b. How often does staff follow up? Annually Every 6 Months Other(Explain) 5a. Homeless assistance providers have SOAR-trained staff provide clients with technical assistance with obtaining SSI/SSDI? Print Name of Agency Board of Directors Approved Signatory: Signature of Agency Board of Directors Approved Signatory Title Date
2A4.-Accessing-Mainstream-Resources.docx