Basic Eligibility Verification Form - Veterans Affairs



SSVF Emergency Housing Assistance Verification – COVID-19 RiskThe goal of Emergency Housing Assistance (EHA) is to ensure household safety in the case where shelter beds, transitional housing, or other resources are not available and subsequent rental housing has been identified generally but is not immediately available for move-in by the participant. Emergency housing is temporary housing provided under 38 CFR 62.34(f) in a short-term commercial residence (private residences are not eligible) not already funded to provide emergency shelter and which does not require the participant to sign a lease or occupancy agreement. As per the Memo, issued by the VA on Available Supportive Services for Veteran Families (SSVF) Resources to Place Homeless Veterans at High-Risk of COVID-19, For the next 30 days beginning March 17, SSVF will be modifying guidance it provides to grantees around temporary housing placements. SSVF grantees have the capacity to place enrolled SSVF program participants in temporary housing (motels and hotels) while working towards a permanent housing placement. These temporary placements can extend up to 45 days. Typically, such placements can only occur when no other appropriate HCHV residential, GPD, or community shelter bed is available. In response to the COVID-19 outbreak, grantees have been informed that these placements are allowed even if other temporary housing options are available if those options would place high-risk Veterans into congregate living environments. High-risk veterans would include those Veterans 60 or older and/or Veterans with significant underlying health problems, particularly those with weakened immune system or health problems that impact lung function. Veterans who are symptomatic with COVID-19 should not be referred for these emergency housing placements as SSVF grantees do not have the capacity to place and adequately monitor such patients. The funding for this emergency housing is very limited. It is critical that VA medical centers actively engage area SSVF grantees to understand available capacity and work collaboratively to prioritize referrals for such emergency housing placements. It is also important to work together to determine those Veterans who are vulnerable, and if they are open with HUD VASH, GPD and SSVF, decide who will do the follow up and how often and who is responsible for the permanent housing. SSVF grantees will work with medical centers to estimate demand, cost and resource availability. Grantees are required keep an excel spreadsheet of the number of EHA referrals received and placements made for the period beginning March 18. The SSVF Program Office will be requesting weekly updates to help assess funding needs.In order to expedite appropriate referral, the following certification of key eligibility criteria may be used by programs to provide services. Completed documentation will be required at later date so that grantee have documentation for files. HMIS data may be collected by telephone, once the verbal consent is noted by referrer. Basic Eligibility Verification FormVeteran Name: FORMTEXT ????? This form must be used by GPD TH or HCHV CRS staff to confirm basic eligibility of a Veteran for SSVF assistance. FORMCHECKBOX Yes, this individual is a Veteran eligible for SSVF assistance and has a discharge status that is not Dishonorable or Bad Conduct by general court martial. (Include documentation) FORMCHECKBOX Yes, this Veteran is literally homeless. FORMCHECKBOX Yes, this Veteran household has an annual income not exceeding 50 percent of AMI, as documented in the Referral Form Current AMI Limits can be found here. (Include documentation) FORMCHECKBOX Yes, The Veteran is a High-risk veterans category identified as those Veterans 60 or older and/or Veterans with significant underlying health problems, particularly those with weakened immune system or health problems that impact lung function. FORMCHECKBOX Yes, Veteran is asymptomatic of COVID-19. Note: Veterans who are symptomatic with COVID-19 should not be referred for these emergency housing placements as SSVF grantees do not have the capacity to place and adequately monitor such patients. FORMCHECKBOX Yes, Veteran has given verbal consent for SSVF grantee to enter information into HMISReferring Staff Name: FORMTEXT ????? Date: FORMTEXT ?????Referring Staff Title: FORMTEXT ?????Referring Staff Signature FORMTEXT ?????Supervisor Name: FORMTEXT ????? Date: FORMTEXT ?????Supervisor Title: FORMTEXT ?????Supervisor Signature FORMTEXT ????? ................
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