California hmis form 2025

See details

4.9 out of 5

501 votes

The document is a comprehensive intake form used by the Contra Costa Council on Homelessness to collect essential information from individuals seeking assistance. It includes sections for personal details, services requested, living situation, health and disability information, income and employment status, education, dependents, and criminal history. The form aims to assess the needs of homeless individuals and determine their eligibility for various support programs.

Here's how it works

01. Edit your hmis intake form online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send hmis intake form pdf via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out California HMIS Form with Our Platform

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Click ‘Get Form’ to open the California HMIS Intake Form in the editor.
Begin by filling in your personal details, including your first name, last name, and social security number. Ensure that all required fields marked with an asterisk are completed.
Next, indicate the intake date and the name of the intake counselor. This information helps track your application process.
In the 'Services Requested at Intake' section, check all applicable services you are seeking. This includes options like housing assistance, emergency shelter, and health services.
Proceed to answer questions regarding your living situation and any disabilities. Be honest as this information is crucial for determining eligibility for various programs.
Finally, review all entered information for accuracy before submitting. Use our platform's features to save or print a copy of your completed form for your records.

Start using our platform today to fill out your California HMIS form easily and for free!

See more california hmis form versions

We've got more versions of the california hmis form form. Select the right california hmis form version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2015	4.9 Satisfied (501 Votes)
2012	4.1 Satisfied (68 Votes)

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Are HMIS labels required?

It should be noted that OSHA safety regulations do not require use of either the HMIS or NFPA 704 systems; OSHA permits one to use any labeling system as long as it satisfies their requirements for labels and other forms of warning (29 CFR 1910.1200(f)).

What is the purpose of the HMIS?

Who uses HMIS? Hundreds of agencies participate in HMIS, including housing programs, shelters, health centers, behavioral health providers, public agencies, and more.

What is the new homeless law in California 2025?

1:14 3:54 It also provides wraparound case management to support these families for individuals who are notMoreIt also provides wraparound case management to support these families for individuals who are not eligible for federal or state programs theres the general relief GR program this is a county funded

Is HMIS required by law?

The HEARTH Act, enacted into law on May 20, 2009, requires that all communities have an HMIS with the capacity to collect unduplicated counts of individuals and families experiencing homelessness.

Is HMIS required?

HMIS are required by the Homeless Emergency Assistance and Rapid Transition to Housing (HEARTH) Act of 2009 and are used in the administration of several programs administered by the Department of Housing and Urban Development (HUD).

hmis intake

California hmis form pdf California hmis form online California hmis form 2021 Immediate housing assistance for homeless in California Apply for Homeless Assistance online California CalWORKs Homeless Assistance Emergency cash Assistance for homeless in California CalWORKs Homeless Assistance Application

Did California give homeless people $750 a month?

The solution to L.A.s homeless epidemic may lie in a buzzy, divisive, social welfare proposal: universal basic income. Roughly 100 unhoused individuals across Los Angeles County and parts of San Francisco were given $750 a month over a year. The money came in the form of an unconditional paymentno strings attached.