Verification of Chronic Homelessness Documentation Checklist and Summary Preview on Page 1

Verification of Chronic Homelessness Documentation Checklist and Summary 2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering the Head of Household (HoH) name and date at the top of the form. This identifies who is being assessed for chronic homelessness.
  3. In the 'Referring Staff & Organization' section, provide details about the staff member assisting with this documentation, ensuring accurate representation.
  4. Complete the VI-SPDAT Score field if applicable, as this score helps determine service needs.
  5. For disability verification, check the appropriate box indicating the type of disability and attach any required third-party documentation to support your claims.
  6. Fill out the Current Living Situation section by selecting where the HoH stayed prior to entering the program. Ensure that all necessary details are documented.
  7. Document Homeless History by providing a timeline of housing situations over one year or three years, depending on eligibility criteria. Attach supporting documents for each episode.
  8. Finally, ensure both the HoH and staff sign and date their respective sections to certify accuracy before submission.

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This document is to certify the individual or household named below is currently homeless based on the category checked and required documentation.
Discuss various factors that lead to homelessness, such as economic downturns, lack of affordable housing, family breakdown, and mental health issues. Similarly, explore the impact of homelessness on individuals and society, like health problems, social isolation, and economic costs.
Has been continuously homeless for a year or more. (HUD defines homeless as a person sleeping in a place not meant for human habitation (e.g. living on the streets for example) OR living in a homeless emergency shelter.) Has had four (4) episodes of homelessness in the last three (3) years.
Im wishing you peace and renewed hope to find a safe place to stay. When you need an extra dose of encouragement, please remember what a beautiful person you are. Goodness and divine love are within you. May you feel peace that surpasses all understanding.
Note: One documented encounter, physical observation of living situation, or HMIS record indicating homelessness within a month is sufficient to verify homelessness for the entire calendar month as long as there is no other evidence indicating a break in homelessness for that month.

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People also ask

I am [your name], [ relation to client]. (i.e. navigator, case manager, etc.) [Client name] reports to have experienced homelessness continuously from [M/D/Y] to [M/D/Y] (or) [number of times] between [M/Y to M/Y] for a total of [number of months] months in the past 3 years.
An identification (ID) card, driving licence, birth certificate or passport. Evidence youre homeless or facing homelessness. For example, an eviction letter from your landlord or a letter from the person you were living with explaining that you can no longer stay there.

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