0New User 2026

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The document is a User Account Request Form for the Homeless Management Information System (HMIS), detailing the process for new user registration, deletion, and information changes. It includes sections for user information, background check confirmation, authorization and confidentiality agreements, and user responsibilities regarding data security. The form emphasizes the importance of maintaining confidentiality and outlines the necessary steps for agency managers to manage user access.

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Click ‘Get Form’ to open the User Account Request Form in the editor.
Begin by entering today’s date in the designated field at the top of the form.
Fill in your first and last name, organization, office phone number, role/job title, and email address in the HMIS User Information section.
In the Background Check Statement section, ensure that an authorized signature is provided by your Executive Director or Agency Manager.
Complete the Authorization & Confidentiality Statement by having it signed and dated by an authorized individual from your agency.
Provide your organization’s main office address and phone number in the Organization & Program Information section.
List any programs you will need access to and confirm completion of necessary training for CES-HMIS users.
Initial each item under USER’S RESPONSIBILITY STATEMENT to indicate understanding, then sign and date where indicated.

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2018	4.4 Satisfied (24 Votes)

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0New User 2026

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