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California county los angeles 2026

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The document is a verification form from the County of Los Angeles Department of Mental Health, used to certify an individual's homelessness status. It outlines criteria for determining if an applicant is homeless or chronically homeless, including definitions and required documentation for various living situations. The form must be completed by a referring agency and includes sections for signatures and contact information.

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Click ‘Get Form’ to open the Agency Verification of Homelessness document in the editor.
Begin by entering the name of the applicant in the designated field. Ensure that this is accurate as it is crucial for verification.
Next, check the appropriate box under either 'Homeless' or 'Chronically Homeless'. Depending on your selection, you may need to attach additional documentation as specified.
If selecting 'Homeless', ensure to attach a letter acknowledging the current living situation along with a homeless history co-signed by a program head, manager, or director.
For 'Chronically Homeless', provide documentation of continuous homelessness or multiple episodes within the last three years, also requiring co-signature from an authorized individual.
Fill in the referring agency's name and address accurately. This information is essential for processing your application.
Finally, have both the case manager and program head sign and date the form before submitting it through our platform for free.

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