Loading...
HomeMy WebLinkAboutContract 54405-A1CSC No. 54405-A1 AMENDMENT 1 TO CITY OF FORT WORTH CONTRACT 54405 BETWEEN THE CITY OF FORT WORTH AND TARRANT COUNTY HOMELESS COALITION FOR RENTAL ASSISTANCE AND HOUSING SERVICES This Amendment is made and entered into by and between the City of Fort Worth, a home-rule municipality of the State of Texas (hereinafter referred to as the "City"), acting by and through Fernando Costa, its duly authorized Assistant City Manager, and TARRANT COUNTY HOMLESS COALITION (hereinafter referred to as the "Agency"), acting by and through Lauren King, its duly authorized interim Executive Director, for rental assistance and housing services. Each party shall be individually referred to herein as Party and collectively as Parties. RECITALS WHEREAS, on September 1, 2020, the City entered into an Agreement with the Agency to provide services more specifically described in the agreement, City Secretary Office (CSO) Contract No. 54405, (the "Agreement"); and WHEREAS, the Parties agree to amend the Agreement and Exhibit "A" to change the scope of services to clarify responsibilities of subgrantee and add Exhibit "G" Policies and Procedures to the Agreement. NOW THEREFORE City and Agency do hereby agree to the following: I. AMENDMENT TO AGREEMENT EXHIBIT "A" Scope of Services is hereby amended and replaced in its entirety with the following: EXHIBIT "A" SCOPE OF SERVICES HHSP-YOUTH RAPID REHOUSING SERVICES TARRANT COUNTY HOMELESS COALITION will do the following: Agency shall comply with all requirements in the attached TDHCA contract, except for those that require the City of Fort Worth to submit information to TDHCA — including eligible eXpenses, programmatic and financial reporting, and compliance — as set forth in EXhibit F. Agency shall comply with HHSP Policies and Procedures as set forth in Exhibit G, and as may be amended from time to time. To be eligible for general HHSP, which is dedicated to permanent supportive housing, the client must be chronically homeless (24 CFR 91.5) and referred b Tarrant Amendment 1 to CSC 54405 OFFICIAL RECORD CoFW and TARRANT COUNTY HOMELESS COALITION CITY SECRETARY FT. WORTH, TX County Homeless Coalition using Coordinated Entry System. To be eligible for youth HHSP, which is dedicated to rapid rehousing, client must be literally homeless, between the ages of 18- 24, and referred by Tarrant County Homeless Coalition using Coordinated Entry System. Agency shall submit complete client packets for all clients. Client packets must contain: (1) An HHSP Intake Application including an area for execution by all adult household members (which may include an electronic signature), certifying the validity of information provided and an area to identify the staff person completing the intake application, and must provide a space for applicants to indicate if they are a veteran as required by Section 434.212 of the Texas Government Code. In addition, the application must include the following statement: "Important Information for Former Military Services Members. Women and men who served in any branch of the United States Armed Forces, including Army, Navy, Marines, Coast Guard, Reserves or National Guard, may be eligible for additional benefits and services. For more information please visit the Texas Veterans Portal at https://veterans.portal.texas.gov/; (2) Certification whereby the Applicant certifies whether they meet the definition of Homeless or Homeless Individual or At-risk of homelessness pursuant to 10 TAC 7.2. The certification must include the Program Participant's signature or legally identifying mark (which may include an electronic signature); (3) Documentation which demonstrates that the Program Participant meets income eligibility, if applicable, or, if proof of income is unobtainable, a Declaration of Income Statement as defined in 10 TAC 7.2; (4) Documentation of recertification, as applicable, including income eligibility and that the Program Participant lacks sufficient resources and support networks necessary to retain housing without assistance; (5) Documentation of determination of ineligibility for assistance when assistance is denied. Documentation must include the reason for the determination of ineligibility; (6) Copies of all leases and rental assistance agreements for the provision of rental assistance, documentation of payments made to owners for the provision of rental assistance, and supporting documentation for these payments, including dates of occupancy by Program Participants; (7) Documentation of the monthly allowance for utilities used to determine compliance with the rent restriction; (8) Documentation that applicable waiting lists have been checked for availability at least every siX months as required for Program Participants who have been assisted for more than twenty-four (24) months with rental assistance; and (9) Documentation that the Dwelling Unit for Program Participants receiving rental assistance complies with the Housing Standards in 10 TAC 7.29, Shelter and Housing Standards; Amendment 1 to CSC 54405 Page 2 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION (10) Proof of Fort Worth residency; and (11) Proof of Green River referral from Coordinated Entry. Eligible clients are those who are homeless in the City of Fort Worth and ages 18-24 and referred by Tarrant County Homeless Coalition. Agency will: • Provide appropriate referrals to navigators • Pay rental assistance and other lease up eXpenses to landlords • Provide rental assistance to at least 15 clients during the term of this Agreement. • Sub-contract with a supportive service provider to provide case management to clients housed with rental assistance • Enter client records in Homeless Management Information System (HMIS) within three (3) days of service provision • Submit on time reports Other lease up eXpenses include application fees, apartment administrative fees, security deposits, high risk fees and opportunity fees. High risk and opportunity fees are extra charges for tenants without a rental history, with an eviction history, with a criminal justice history and/or without income. The goal is to provide rental assistance to at least 15 households. And for at least 10 households to maintain housing for three months after exit. Evaluation: Evaluation meetings will be held with Directions Home staff to continually evaluate program and Agency shall comply as necessary and in good faith. Financial reporting: Reimbursement Request and any necessary supporting documentation and reports will be submitted by the 15th of every month in format of Exhibit "C". Programmatic reporting: Monthly reports will be submitted by the 15th of every month in format of Exhibit "D". Quarterly reports will be submitted by the 15th of July, October, January and April in the format of Exhibit "D". Amendment 1 to CSC 54405 Page 3 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION EXHIBIT "G" Policies and Procedures is hereby added: Policies and Procedures Homeless Housing and Services Program: City of Fort Worth December 4, 2020 Table of Contents I. Overview II. Client Eligibility III. Client File IV. Record Keeping V. Inclusive Marketing VI. Client Selection criteria VII. Language Access Plan VIII. Affirmative Outreach IX. Reasonable accommodation X. Reporting Requirements XI. Compliance with Laws XII. Eligible Expenses XIII. Calculating Rent Reasonableness XIV. Housing Standards XV. Calculating Income XVI. DIS and Use XVII. Recertification XVIII. Break In Service XIX. Conflict of Interest XX. Approval or Denial Notification XXI. Revisions to Policies and Procedures Attachments 1. HHSP Intake Form 2. Verification of Homelessness Definitions and Recordkeeping 3. Verification of Homelessness Form 4. Verification of Fort Worth residency 5. Calculation of Income 6. Examples of Income Calculation 7. Declaration of Income Statement Guidance 8. Declaration of Income Statement Form 9. Inspection Form 10. Lead Visual Inspection Form 11. Determining Rent Reasonableness 12. Rent Reasonableness Checklist and Certification 13. Utility Allowance Schedule 14. Approval/Disapproval Form 15. Applying for Other Programs Form Amendment 1 to CSC 54405 Page 4 of 84 CoFW and TARRANT COUNTY HOM LESS COALITION 16. Recertification Form 17. HHSP Monthly Performance Report 18. HHSP Monthly Expenditure Report 19. HHSP Inventory List 20. CFW Monthly Performance Reports 21. CFW Quarterly Reports 22. CFW Reimbursement Request Form 23. CFW Reimbursement Summary I. Overview The Homeless Housing and Services Program (HHSP) is administered by Texas Department of Housing and Community Affairs (TDHCA). The program provides funding to reduce and end homelessness in larger Texas cities. The City of Fort Worth (City) is an HHSP recipient. The City has designated Fort Worth Housing Solutions (FWHS) as a SUB-GRANTEE for general HHSP funds and Tarrant County Homeless Coalition as a SUB-GRANTEE for youth HHSP funds. The specific purpose of the City's general HHSP funds is to pay rental assistance for permanent supportive housing (PSH) clients in order reduce chronic homelessness. The purpose of the youth HHSP funds is to pay rapid rehousing rental assistance and case management for youth (between 18-24 years of age) to reduce youth homelessness. II. Client Eligibility Client must meet appropriate definition of homeless as well as income requirements and be a resident of the City of Fort Worth. In addition: To be eligible for general HHSP which is dedicated to permanent supportive housing, client must be chronically homeless (24 CFR 91.5) and referred by Tarrant County Homeless Coalition using Coordinated Entry system. To be eligible for youth HHSP which is dedicated to rapid rehousing, client must be literally homeless, between the ages of 18-24 and referred by Tarrant County Homeless Coalition using Coordinated Entry system. III. Client File Drawing from: TAC 10 §7.28 SUB-GRANTEE will maintain client files which include the following information: Amendment 1 to CSC 54405 Page 5 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION (1) An HHSP Intake Application including an area for execution by all adult household members (which may include an electronic signature), certifying the validity of information provided and an area to identify the staff person completing the intake application, and must provide a space for applicants to indicate if they are a veteran as required by Section 434.212 of the Texas Government Code. In addition, the application must include the following statement: "Important Information for Former Military Services Members. Women and men who served in any branch of the United States Armed Forces, including Army, Navy, Marines, Coast Guard, Reserves or National Guard, may be eligible for additional benefits and services. For more information please visit the Texas Veterans Portal at https://veterans.portal.texas.�ov/; (2) Certification whereby the Applicant certifies whether they meet the definition of Homeless or Homeless Individual or At-risk of homelessness pursuant to 10 TAC 7.2. The certification must include the Program Participant's signature or legally identifying mark (which may include an electronic signature); (3) Documentation which demonstrates that the Program Participant meets income eligibility, if applicable, or, if proof of income is unobtainable, a Declaration of Income Statement as defined in 10 TAC 7.2; (4) Documentation of recertification, as applicable, including income eligibility and that the Program Participant lacks sufficient resources and support networks necessary to retain housing without assistance; (5) Documentation of determination of ineligibility for assistance when assistance is denied. Documentation must include the reason for the determination of ineligibility; (6) Copies of all leases and rental assistance agreements for the provision of rental assistance, documentation of payments made to owners for the provision of rental assistance, and supporting documentation for these payments, including dates of occupancy by Program Participants; (7) Documentation of the monthly allowance for utilities used to determine compliance with the rent restriction; (8) Documentation that applicable waiting lists have been checked for availability at least every siX months as required for Program Participants who have been assisted for more than twenty-four (24) months with rental assistance; and (9) Documentation that the Dwelling Unit for Program Participants receiving rental assistance complies with the Housing Standards in 10 TAC 7.29, Shelter and Housing Standards; (10) Proof of Fort Worth residency; and (11) Proof of Green River referral from Coordinated Entry. IV. Records Retention Drawing from: 10 TAC §1.409 Amendment 1 to CSC 54405 Page 6 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION SUB-GRANTEE must arrange for the security of all program-related computer files through a remote, online, or managed backup service. Confidential client files must be maintained in a manner to protect the privacy of each client and to maintain the same for future reference. SUB-GRANTEE must store physical client files in a secure space in a manner that ensures confidentiality and in accordance with SUB-GRANTEE organization policies and procedures. To the extent that it is financially feasible, archived client files should be stored offsite from SUB-GRANTEE headquarters, in a secure space in a manner that ensures confidentiality and in accordance with organization policies and procedures. Records of client eligibility must be retained for five years starting from the date the household activity is completed, unless otherwise provided in federal regulations governing the program. V. Inclusive Marketing Drawing from: 10 TAC § 7.10 (a) The purpose of this section is to highlight certain policies and/or procedures that are required to have written documentation. Other items that are required for written standards are included in the federal or state rules. (b) Participant selection criteria: (1) Selection criteria will be applied in a manner consistent with all applicable laws, including the Texas and Federal Fair Housing Acts, program guidelines, and the Department's rules. (2) If the local CoC has adopted priority for certain Homeless subpopulations or a specific funding source has a statutory or regulatory preference, then those subpopulations may be given priority by the SUB-GRANTEE. Such priority must be listed in the participant selection criteria. (3) Notifications on denial, non-renewal, or termination of Assistance must: (A) State that a Person with a Disability may request a reasonable accommodation in relation to such notice. (B) Include any appeal rights the participant may have in regards to such notice. (C) Inform program participants in any denial, non-renewal or termination notice, include information on rights they may have under VAWA (for ESG only, in accordance with the Violence Against Women Reauthorization Act of 2013 ("VAWA") protections). SUB-GRANTEEs may not deny admission on the basis that the applicant has been a victim of domestic violence, dating violence, sexual assault, or stalking. (c) Other policies and procedures: (1) Affirmative Fair Housing Marketing Plan. SUB-GRANTEEs providing project- based rental assistance must have an Affirmative Fair Housing Marketing Plan created in Amendment 1 to CSC 54405 Page 7 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION accordance HUD requirements to direct specific marketing and outreach to potential tenants who are considered "least likely" to know about or apply for housing based on an evaluation of market area data. SUB-GRANTEEs must comply with HUD's Affirmative Fair Housing Marketing and the Age Discrimination Act of 1975. (2) Language Access Plan. SUB-GRANTEEs that interact with program participants or clients must create a Language Access Plan for Limited English Proficiency ("LEP") Requirements. Consistent with Title VI and Executive Order 13166, SUB-GRANTEEs are also required to take reasonable steps to ensure meaningful access to programs and activities for LEP persons. (3) Affirmative Outreach. If it is unlikely that outreach will reach persons of any particular race, color, religion, sex, age, national origin, familial status, or disability who may qualify for those facilities and services, the SUB-GRANTEE must establish policies and procedures that target outreach to those persons. The SUB-GRANTEEs must take appropriate steps to ensure effective communication with persons with disabilities including, but not limited to, adopting procedures that will make available to interested persons information concerning the location of assistance, services, and facilities that are accessible to persons with disabilities. SUB-GRANTEEs must make known that use of the facilities, assistance, and services are available to all on a nondiscriminatory basis. (4) Reasonable Accommodation. The SUB-GRANTEE must comply with state and federal fair housing and antidiscrimination laws. SUB-GRANTEE's policies and procedures must address Reasonable Accommodation, including, but not limited to, consideration of Reasonable Accommodations requested to apply for assistance. See Chapter 1 Subchapter B for more information. VI. Client Selection Criteria Clients for general HHSP funds will be selected from Coordinated Entry Permanent Supportive Housing List. Clients will be further screened by SUB-GRANTEE to ensure that income and residency requirements are met as well as documentation of chronicity and disability. Clients for youth HHSP fund will be selected from Coordinated Entry Rapid Rehousing List. Clients will be further screened by SUB-GRANTEE to ensure that income, residency and age (18-24 at program entry) are met as well as documentation of literal homelessness. Referrals from Tarrant County Homeless Coalition are based on client vulnerability as evidenced by ViSPADT score. Amendment 1 to CSC 54405 Page 8 of 84 CoFW and TARRANT COUNTY HOM LESS COALITION VII. Language Access Plan SUB-GRANTEE must have a language access plan to ensure meaningful access to programs and services for Limited English Proficiency Requirements. VIII. Affirmative Outreach Not applicable because all client referrals are from Tarrant County Homeless Coalition. IX. Reasonable Accommodations Drawing from: 10 TAC §1.204 SUB-GRANTEE must comply with state and federal fair housing and anti-discrimination laws. (a) Applicability. This policy relates to a request for Reasonable Accommodations made by an applicant or participant of a Department program to a Recipient, or made by an applicant or occupant to a property funded by the Department to the property. The policy regarding a request for Reasonable Accommodation by the Department is found at 10 TAC §1.1 of this chapter. (b) General Considerations in Handling of Reasonable Accommodations. An applicant, participant, or occupant who has a disability may request an accommodation and, depending on the program funding the property or activity and whether the accommodation requested is a reasonable accommodation, their request must be timely addressed. (1) When the Department monitors a property or activity for how reasonable accommodation requests have been handled, it will consider such things as whether the person working on behalf of the program or property which the Department is monitoring: (A) Timely received the request and recorded it; (B) Took into consideration how action on the request would impact the person making the request; and (C) Engaged in communication with the requestor to understand the nature of their request and whether there was a reasonable way to make an accommodation. (2) If the person responsible for responding to a request for an accommodation needs assistance or clarification as to how the requirement may apply to their program or property they should contact the Compliance Division immediately to discuss the matter. The Compliance Division cannot provide legal advice or direct the person to respond in any specific manner, but they can, in some instances, point to appropriate federal guidance or other resources such as the Texas Workforce Commission Civil Rights Amendment 1 to CSC 54405 Page 9 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION Division. A person who contacts the Compliance Division or anyone else for such reasons should document such contact in their files because the process of obtaining guidance may impact the timeliness of their response. (3) Unless there is a clear documented need for a lengthier process or there is a controlling federal statute or regulation specifying a different deadline, when a person requests an accommodation they should be given a response as soon as possible but not later than 14 calendar days. (c) To show that a requested Reasonable Accommodation may be necessary, there must be an identifiable relationship between the requested accommodation and the individual's Disability. (d) Responses to Reasonable Accommodation requests must be provided within a reasonable amount of time, not to exceed 14 calendar days. The response must either be to grant the request, deny the request, offer alternatives to the request, or request additional information to clarify the Reasonable Accommodation request. Examples when it would not be reasonable to wait 14 calendar days to provide a response include but are not limited to: moving the due date for rent to coincide with the date the requestor receives their social security disability check; allowing a service animal in an emergency shelter in spite of a no pets policy; or assisting an applicant with a Disability that prevents them from writing legibly when they request help filling out an program or project application. Should additional information be required and an interactive process be necessary, this process must also be completed within a reasonable amount of time. An undue delay in responding to a Reasonable Accommodation request may be deemed by the Department to be a failure to provide a Reasonable Accommodation. (e) When a participant, applicant, or occupant requires an accessible unit, feature, space or element, or a policy modification, or other Reasonable Accommodation to accommodate a Disability, the Recipient must provide and pay for the requested accommodation, unless doing so would result in a fundamental alteration in the nature of the program or an undue financial and administrative burden. A fundamental alteration is an accommodation that is so significant that it alters the essential nature of the Recipient's operations. A Recipient that owns a tax credit or Multifamily Bond Development with no federal or state funds awarded before September 1, 2001, must allow but may not need to pay for the Reasonable Accommodation, except if the accommodation requested should have been made as part of the original design and construction requirements under the Fair Housing Act, or is a Reasonable Accommodation identified by the U.S. Department of Justice or the U.S. Department of Housing and Urban Development with a de minimis cost (e.g., assigned existing parking spot and no deposit for service/assistance animals). (f) A Recipient may not charge a fee or place conditions on a participant, occupant, or applicant in exchange for making the accommodation. Amendment 1 to CSC 54405 Page 10 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION (g) A Reasonable Accommodation request of an individual with a Disability that amounts to an Alteration should be made to meet the needs of the individual with a Disability, rather than being limited to compliance with a particular accessible code specification. However, the Recipient must still follow accessible code specifications, as identified in its Contract or LURA. (1) Recipients are not required to make structural changes where other methods, which may not cost as much, are effective in making programs or activities readily accessible to and usable by persons with Disabilities. (2) In choosing among available methods for meeting the requirements of this section, the Recipient must give priority to those methods that offer programs and activities to qualified individuals with Disabilities in the most integrated setting appropriate. (3) Undue burden. (A) The determination of undue financial and administrative burden will be made by the Department on a case-by-case basis, involving various factors, such as the cost of the Reasonable Accommodation, the financial resources of the Development, the benefits the accommodation would provide to the requester, and the availability of alternative accommodations that would adequately meet the requester's Disability- related needs. (B) In considering whether an expense would constitute an undue burden the Department may, as applicable, consider the following items (though it may consider factors not on this list): (i) payment for Alteration from operating funds, residual receipts accounts, or reserve replacement accounts must be sought using appropriate approval procedures. (ii) the approved amount must generally be able to be replenished through property rental income within one year without a corresponding raise in rental rates. (iii) a projected inability to replenish an operating fund account or the reserve for replacement account within one year for funds spent in providing Alterations under this subsection is some evidence that the Alteration would be an undue financial and administrative burden. (C) If providing accessibility would result in an undue financial and administrative burden, the Recipient must still take other reasonable steps to achieve accessibility. (D) If a structural change would constitute an undue financial and administrative burden, and the tenant/requestor still wants that particular change to be made, the tenant/requestor must be allowed to make and pay for the accommodation. (4) Recipients are not required to install an elevator solely for the purpose of making units accessible as a Reasonable Accommodation. (5) Recipients do not have to make mechanical rooms and similar spaces accessible when, because of their intended use, they do not require accessibility by the public, by tenants, or by employees with physical disabilities. Amendment 1 to CSC 54405 Page 11 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION (6) Recipients are not required to make building alterations that have little likelihood of being accomplished without removing or altering a load-bearing structural member, as a Reasonable Accommodation. (h) If a Recipient refuses to provide a requested accommodation because it is either an undue financial and administrative burden or would result in a fundamental alteration to the nature of the program, the Recipient must make a reasonable attempt to engage in an interactive dialogue with the requester to determine if there is an alternative accommodation that would adequately address the requester's Disability-related needs. If an alternative accommodation would meet the individual's needs and is reasonable, the Recipient must provide it. (i) Examples of reasonable accommodations, while not exhaustive, include moving the due date for rent to coincide with the date the requestor receives their social security disability check; providing a designated accessible parking space from existing parking spaces; creating an accessible parking space to accommodate a wheelchair-equipped van; allowing a service animal in spite of a no pets policy; modifying door knobs to levers; providing assistance in filling out a program application for the activity or unit; in the case of a service provider providing computer lab classes with laptops, providing a loan of the laptop computer with the training software; in the case of a weatherization provider serving a family with a child with asthma, seeing if an alternative sealant could be used when the sealant typically used may trigger an asthma attack; installing grab bars; providing an accessible entrance to a resident's current unit, unless it would be an undue financial and administrative hardship or a fundamental alteration of the program to do so; and providing a ramp in excess of usual specifications for such alternations to accommodate a scooter type wheelchair, unless it would be an undue financial and administrative hardship or a fundamental alteration of the program to do so. (j) Recipients must follow federal and state regulations regarding service/assistance animals. A housing provider may not require an applicant, participant, or occupant to pay a pet deposit if the animal is a service/assistance animal. X. Reporting Requirements SUB-GRANTEE will submit a HHSP Monthly Performance Report, HHSP Monthly Expenditure Report, CFW Monthly Report and CFW Reimbursement Request Form by the 15th of each month for the prior month to Directions Home staff. CFW Quarterly Reports are due the 15th of December, March, June and September. XI. Compliance with Laws Amendment 1 to CSC 54405 Page 12 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION A. FEDERAL, STATE AND LOCAL LAW. SUB-GRANTEE shall comply with the State Act, the HHSP State Rules, and all federal, state, and local laws and regulations applicable to the performance of this Contract, including, but not limited to the program requirements and fair housing laws. Upon request by Department, SUB-GRANTEE shall furnish satisfactory proof of its compliance therewith. SUB-GRANTEE shall not violate any federal, state, or local laws, stated herein or otherwise, nor commit any illegal activity in the perFormance of or associated with the perFormance of this Contract. No funds under this Contract shall be used for any illegal activity or activity that violates any federal, state or local laws. B. DRUG-FREE WORKPLACE ACT OF 1988. SUB-GRANTEE affirms that it is implementing the Drug-Free Workplace Act of 1988 (41 USC §701 et seq). C. LIMITED ENGLISH PROFICIENCY (LEP). SUB-GRANTEE interacts with program participants must create a Language Access Plan to provide program applications, forms, and educational materials in English, Spanish, and any appropriate language, based on the needs of the service area and in compliance with the requirements in Executive Order 13166 of August 11, 2000. To ensure compliance, SUB-GRANTEE must take reasonable steps to insure that persons with LEP have meaningful access to the program. Meaningful access may entail providing language assistance services, including oral and written translation, where necessary. D. REHABILITATION ACT OF 1973. Section 504 of the Rehabilitation Act of 1973 and HUD regulation 24 CFR Part 8 apply to all programs or activities under this Contract. E. PROTECTED HEALTH INFORMATION. If SUB-GRANTEE collects or receives documentation for disability, medical records or any other medical information in the course of administering the HHSP program, SUB-GRANTEE shall comply with the Protected Health Information state and federal laws and regulations, as applicable, under 10 TAC §1.24, Chapter 181 of the Texas Health and Safety Code, the Health Insurance Portability and Accountability Act of 1996 (HIPAA) (Pub.L. 104-191, 110 Stat. 1936, enacted August 21, 1996) the HIPAA Privacy Rules (45 CFR Part 160 and Subparts A and E of 45 CFR Part 164). F. AGE DISCRIMINATION. SUB-GRANTEE must comply with the Age Discrimination Act of 1975 (42 U.S.C. §§ 6101-6107). G. AFFIRMATIVE OUTREACH. SUB-GRANTEE shall affirmatively reach out to populations that are least likely to apply for services as further outlined in 10 TAC §7.10(c)(3). H. LEAD-BASED PAINT. SUB-GRANTEE shall comply with the Lead-Based Paint Poisoning Prevention Act, 42 U.S.C. §4821 et seq. and 24 CFR Part 35. KII. Eligible Expenses Drawing from: 10 TAC §7.27 Amendment 1 to CSC 54405 Page 13 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION (a) Administrative costs include employee compensation and related costs for staff perFormance of management, reporting, and accounting of HHSP activities, including office space. Costs associated with the purchase or licensing of HMIS or an HMIS- comparable databases are eligible administrative costs. (b) Case management costs include staff salaries related to assessing, arranging, coordinating and monitoring the delivery of services related to finding or maintaining housing. Costs include, but are not limited to, Household eligibility determination, counseling, coordinating services and obtaining mainstream benefits for Program Participants, monitoring Program Participant progress, providing safety planning for persons under VAWA, developing a housing and service plan, and entry into HMIS or an HMIS-comparable database. (c) Construction rehabilitation, and conversion costs include, but are not limited to, costs for: (1) Pre-Development, such as environmental review, site-control, survey, appraisal, architectural fees, and legal fees. (2) Development, such as: (A) land acquisition; (B) site work (including infrastructure for service utilities, walkways, curbs, gutters); (C) lot clearance and site preparation; (D) construction to meet uniform building codes, international energy conservation code, or local rehabilitation standards; (E) accessibility features to site and building; (F) essential improvements and energy-related improvements; (G) abatement of lead-based paint hazards; (H) barrier removal/construction for accessibility features for persons with disabilities; and (I) non-luxury general property improvements. (d) Essential services costs are associated with finding and maintaining stable housing, and include, but are not limited to, costs for: (1) out-patient medical services; (2) child care; (3) education services; (4) legal services; (5) mental health services; (6) local transportation assistance; (7) drug and alcohol rehabilitation; and (8) job training. (e) Homelessness prevention and homelessness assistance costs are associated with housing relocation, stabilization and assistance costs. Staff time entering information into HMIS or HMIS-comparable database related to homelessness prevention and homeless assistance is also an eligible cost. Homeless prevention and homelessness assistance Amendment 1 to CSC 54405 Page 14 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION costs include, but are not limited to, hotel or motel costs; transitional housing; rental and utility assistance; rental arrears; utility reconnection fees; reasonable and customary security and utility deposits; and moving costs. (f) Operation costs include rent, utilities, supplies and equipment purchases, food pantry supplies, and other related costs necessary to operate an emergency shelter or Transitional Living Activities, serving individuals experiencing or at-risk of homelessness. XIII. Rent Reasonableness To calculate the gross rent for purposes of determining whether it meets the rent reasonableness standard, consider the entire housing cost: rent plus the cost of any utilities that must, according to the lease, be the responsibility of the tenant. Utility costs may include gas, electric, water, sewer, and trash. However, telephone, cable or satellite television service, and internet service should be excluded. The gross rent also does not include pet fees or late fees that the program participant may accrue for failing to pay the rent by the due date established in the lease. Comparable rents can be checked by using a market study of rents charged for units of different sizes in different locations or by reviewing advertisements for comparable rental units. For example, a program participant's case file might include the unit's rent and description, a printout of three comparable units' rents, and evidence that these comparison units shared the same features (location, size, amenities, quality, etc.). (Use Attachment 11) XIV. Housing Standards Drawing from: 10 TAC 7.29 (b) Minimum standards for housing for occupancy. Housing assisted under HHSP must meet the minimum habitability standards within 30 calendar days after the term of assistance begins. HHSP funds may assist a Program Participant in returning the Dwelling Unit to the minimum habitability standard in cases where the Program Participant is the responsible party for ensuring such conditions. (1) Structure and materials. The structures must be structurally sound to protect residents from the elements and not pose any threat to the health and safety of the residents. (2) Space and security. Each resident must be provided adequate space and security for themselves and their belongings. Each resident must be provided an acceptable place to sleep. Amendment 1 to CSC 54405 Page 15 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION (3) Interior air quality. Each room or space must have a natural or mechanical means of ventilation. The interior air must be free of pollutants at a level that might threaten or harm the health of residents. (4) Water supply. The water supply must be free from contamination. (5) Sanitary facilities. Residents must have access to sufficient sanitary facilities that are in proper operating condition, are private, and are adequate for personal cleanliness and the disposal of human waste. (6) Thermal environment. The Dwelling Unit must have any necessary heating/cooling facilities in proper operating condition. (7) Illumination and electricity. The structure must have adequate natural or artificial illumination to permit normal indoor activities and support health and safety. There must be sufficient electrical sources to permit the safe use of electrical appliances in the structure. (8) Food preparation. All food preparation areas must contain suitable space and equipment to store, prepare, and serve food in a safe and sanitary manner. (9) Sanitary conditions. The housing must be maintained in a sanitary condition. (10) Fire safety. (A) There must be a second means of exiting the building in the event of fire or other emergency. (B) Each Dwelling Unit must include at least one battery-operated or hard-wired smoke detector, in proper working condition, on each occupied level of the unit. Smoke detectors must be located, to the extent practicable, in a hallway adjacent to a bedroom. If the unit is occupied by hearing impaired persons, smoke detectors must have an alarm system designed for hearing-impaired persons in each bedroom occupied by a hearing- impaired person. (C) The public areas of all Dwelling Units must be equipped with a sufficient number, but not less than one for each area, of battery-operated or hard-wired smoke detectors. Public areas include, but are not limited to, laundry rooms, community rooms, day care centers, hallways, stairwells, and other common areas. (c) Lead-based paint remediation and disclosure. The Lead-Based Paint Poisoning Prevention Act (42 U.S.C. 4821-4846), the Residential Lead-Based Paint Hazard Reduction Act of 1992 (42 U.S.C. 4851-4856), and implementing regulations in 24 CFR Part 35, subparts A, B, H, J, K, M, and R apply to all shelters and all Dwelling Units occupied by Program Participants. XV. Calculating Income Determining Annual Household Income Amendment 1 to CSC 54405 Page 16 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION A. Types of Income and Calculation Taken from Chapter 5 of the HUD 4350.3 Handbook Household income is the gross (before any taxes or deductions) amount of anticipated earnings for the next 12 months or any of the following: • Wages • Salaries • Overtime pay • Commissions • Tips • Bonuses • Other compensation of all household adults • UNEARNED income of all members of the household (including dependents and foster children under 18) • Asset income from the sale of real property B. Calculating Annual Household Income Household Income is: • Based on actual household size (all members do not have to be related) • Based on anticipated income for the next 12 months • Certified at initial occupancy and annually thereafter • Based on income limits at the time of initial occupancy or recertification • Based on household members added during the lease term Only income qualified households may be counted in meeting the set-aside requirements. Households not meeting the income qualifications cannot be counted in the minimum set-aside. Tax- exempt bond properties use the most current HUD approved income and rent limits to qualify eligible households. These limits are based upon the county's Area Median Gross Income (AMGI) and are posted annually as they are released by HUD XVI. Declaration of Income Statement Guidance If a client cannot produce documentation of income, a DIS form (Attachment 8) must be used. This form should only be used if all efforts have been exhausted to obtain documentation. SUB-GRANTEE should note in file how documentation was requested and why it is not able to be produced. XVII. Break in Service/ Recertification (e) Recertification. Recertification is required for Program Participants receiving homelessness prevention and homelessness assistance within 12 months of the assistance start date. SUB-GRANTEE's written policies may require more frequent recertification. At a minimum, recertification includes that Program Participants receiving Amendment 1 to CSC 54405 Page 17 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION homelessness prevention or homelessness assistance: (1) meet the income eligibility requirements, if such limits are implemented in the SUB-GRANTEE's policies and procedures and required to be reviewed at recertification; and (2) lack sufficient resources and support networks necessary to retain housing without assistance. (f) Break in service. The SUB-GRANTEE must document eligibility before providing services after a break in service. A break in service occurs when a previously assisted household has exited the program and is no longer receiving services through Homeless Programs. Upon reentry into HHSP, the Household is required to complete a new intake application and provide updated source documentation, if applicable. The SUB-GRANTEE would not need to document further eligibility for HHSP if the Program Participant is currently receiving assistance through ESG. (g) Program participant files. SUB-GRANTEEs or their Subgrantees shall maintain Program Participant files, for non-emergency activities providing direct subsidy to or on behalf of a Program Participant that contains the following: (1) An Intake Application, including the signature or legally identifying mark of all adult Household members certifying the validity of information provided, an area to identify the staff person completing the intake application, and the language as required by Tex. Gov't Code §434.212; XVIII. Conflict of Interest Drawing from: 10 TAC 7.26 (a) SUB-GRANTEE shall maintain written standards of conduct governing the perFormance of its employees engaged in the award and administration of Contracts. Failure to maintain written standards of conduct and to follow and enforce the written standards is a condition of default and may result in termination of the Contract or deobligation of funds. (b) No employee, officer, or agent of SUB-GRANTEE shall participate in the selection, award, or administration of a contract supported by funds if a real or apparent conflict of interest would be involved. Such a conflict would arise when the employee, officer, or agent, any member of his or her immediate family, his or her partner, or an organization which employs or is about to employ any of the listed parties, has a financial or other interest in the firm selected for an award. (c) The officers, employees, and agents, including consultants, officers, or elected or appointed officials of the SUB-GRANTEE or its Subgrantees shall neither solicit nor accept gratuities, favors, or anything of monetary value from contractors, or parties to sub agreements. SUB-GRANTEE may set standards for situations in which the financial interest is not substantial or the gift is an unsolicited item of nominal value. The standards of conduct shall provide for disciplinary actions to be applied for violations of such standards by officers, employees, or agents of the SUB-GRANTEE. Amendment 1 to CSC 54405 Page 18 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION (d) The provision of any type or amount of direct HHSP assistance may not be conditioned on a Program Participant's acceptance or occupancy of emergency shelter or housing owned by the SUB-GRANTEE or Subgrantee, or a parent or subsidiary of the SUB-GRANTEE or Subgrantee. (e) No SUB-GRANTEE may, with respect to Household occupying a Dwelling Unit owned by the SUB-GRANTEE or Subgrantee, or any parent or subsidiary of the SUB- GRANTEE or Subgrantee, carry out the initial intake required for Program Participant files. (f) For transactions and activities other than the procurement of goods and services, no officers, employees, and agents, including consultants, officers, or elected or appointed officials of the SUB-GRANTEE, Subgrantee, or Subcontractor who exercises or has exercised any functions or responsibilities with respect to activities assisted under HHSP, or who is in a position to participate in a decision-making process or gain inside information with regard to activities assisted under the program, may obtain a financial interest or benefit from an assisted activity; have a financial interest in any contract, subcontract, or agreement with respect to an assisted activity; or have a financial interest in the proceeds derived from an assisted activity, either for him or herself or for those with whom he or she has family or business ties, during his or her tenure or during the one-year period following his or her tenure. XXII. Notification of Denial, Non-Renewal or Termination SUB-GRANTEE must inform client in writing whether they have been approved or denied for HHSP assistance. If client is denied, the letter must clearly state which criteria was not met (income, residency, proof of homelessness etc.) An appeal process must be mentioned with clear contact information and timeline for appeal to be heard. Subgrantee will keep a record of all approval and denial letters as well as appeal letters and documentation showing appeal process results. Notification must: (A) State that a Person with a Disability may request a reasonable accommodation in relation to such notice. (B) Include any appeal rights the participant may have in regards to such notice. (C) Inform Program Participants in any denial, non-renewal or termination notice, information on rights they may have under VAWA (for ESG only, in accordance with the Violence Against Women Reauthorization Act of 2013 (VAWA) protections). SUB- GRANTEE may not deny admission on the basis that the applicant has been a victim of domestic violence, dating violence, sexual assault, or stalking. Amendment 1 to CSC 54405 Page 19 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION XXIII. Revisions to Policies and Procedures These Policies and Procedures will be revised on an ongoing basis to account for changes in standards for area median income, rent reasonableness etc. Revisions will also be made to continue to strictly align with all TDHCA and specifically HHSP program regulations or other applicable regulations referenced herein. Amendment 1 to CSC 54405 Page 20 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION Attachments for HHSP Policies and Procedures 1. HHSP Intake Form 2. Verification of Homelessness Definitions and Recordkeeping 3. Verification of Homelessness Form 4. Verification of Fort Worth residency 5. Calculation of Income 6. Examples of Income Calculation 7. Declaration of Income Statement Guidance 8. Declaration of Income Statement Form 9. Inspection Form 10. Lead Visual Inspection Form 11. Determining Rent Reasonableness 12. Rent Reasonableness Checklist and Certification 13. Utility Allowance Schedule 14. Approval/Disapproval Form 15. Applying for Other Programs Form 16. Recertification Form 17. HHSP Monthly PerFormance Report 18. HHSP Monthly Expenditure Report 19. HHSP Inventory List 20. CFW Monthly Performance Reports 21. CFW Quarterly Reports 22. CFW Reimbursement Request Form 23. CFW Reimbursement Summary Amendment 1 to CSC 54405 Page 21 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION Attachment 1: HHSP Intake Form Amendment 1 to CSC 54405 Page 22 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION HHSP Intake Application HHSP General HHSP Youth To be eligible for HHSP General assistance, the apPlicant household mush To be eligible for HHSP Youth assistance, the applicant household must: 1. Reside in the City of Fort Worth, and 1. Reside in the City of Fort Worth, and 2. Have documentation of chronic homelessness; and 2. Have documentation of chronic homelessness; and 3. Have documentation of a disability; and 3. Be between the ages of 18-24 at program entry; and 4. Have income at or below 50% of the Area Median Income 4. Have income at or below 50% of the Area Median Income 5. Be referred by Tarrant County Homeless Coalition 5. Be referred by Tarrant County Homeless Coalition ti ti Head of Household Name: Address: Phone number: Email: Are you receiving Housing Choice Voucher assistance? ❑ Yes ❑ No Citizenship: ❑ U.S. Citizen ❑ Eligible Non-Citizen ❑ Ineligible Non-Citizen Race: ❑ White ❑ Black or African-American ❑ Asian ❑ American Indian or Alaska Native ❑ Native Hawaiian or Other Pacific Islander ❑ American Indian/Alaska & White ❑ Asian and White ❑ Black/African American & White ❑ American Indian/Alaska Native & Black/African American ❑ Other Multi-Racial Veteran: ❑ Yes ❑ No Important Information for Former Military Services Members. Women and men who served in any branch of �the United States Armed Forces, including Army, Navy, Marines, Cost Guard, Reserves or National Guard, may be eligible for additional benefits and services. For more information please visit with the Texas Yeterans Portal at https://veterans.portal.texas.gov/. INCOME VERIFICATION Income Category Amount Received (monthly) Wages or Salary before deductions $ Unemployment pay $ Worker's Compensation $ TAN F $ Social Security (SS) $ Amendment 1 to CSC 54405 Page 23 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION Supplemental Security Income (SSI) $ Social Security Disability Income (SSDI) $ Alimony/Child Support/Foster Care Income $ VA benefits $ Retirement/Pension $ Federal non-cash benefit (Medicare/caid, Food Stamps) Other (specify): $ Total Monthly Income $ List information for ALL persons in the household (including the Head of Household): Name: (first, last) Relationship Date of Gender Social Type of To Head of Birth Security Citizenship Household Number -U.S. Citizen -Eligible Non- Citizen -Ineligible Non-Citizen WARNING: TITLE 'I H, SECTION 'I OO'I OF THE U.S. CODE STATES THAT A PERSON IS GUILTY OF A FELONY FOR KNOWINGLY AND WILLINGLY MAKING FALSE OR FRAUDULENT STATEMENTS TO ANY DEPARTMENT OF THE UNITED STATES GOVERNMENT. Signature I certify that the information I am providing is true and could be subject to verification at any time by a third party. I also acknowledge that the provision of false information could leave me subject to the penalties of Federal, State and local law. Date --------------For Office Use Only Calendar Year 2020 50% Area Median Income by Household Size Amendment 1 to CSC 54405 Page 24 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION To be eligible for services, the applicant must have income at or below 50% Area Median Income (Very Low Income) 1 Person Person 3 Person 4 Person 5 Person 6 Person 7 Person 8 Person $ 28,550 $32,600 $36,700 $40,750 $44,050 $47,300 $50,550 $53,800 I certify that the above applicant has provided the necessary documentation and: � Meets Income Requirements Case Manager Signature � Does Not Meet Income Requirements Amendment 1 to CSC 54405 CoFW and TARRANT COUNTY HOMELESS COALITION Date Page 25 of 84 Attachment 2: Homeless Definitions and Recordkeeping Amendment 1 to CSC 54405 Page 26 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION •... �� •.. � � � ^Y � � i �7 r ! 1 i = � I ■ I ■ ■ I i } ■� I . i � � • � � . * ��� � � � � ����� �� {lj Individual orfarnilyvrho la�ksa fixed, regular, and adequate nighttime residen�e, rneaning: �.�t���� Literally fij Has a primary nighttime residen�e that is a pu61i� cr i Homeless private pla�e not rneantfor human hahitation; fiij Is liti•ing in a publi€1p�or pritiately operated shehter designated ta proa�ide temporar}+ living areangeme�� linduding �ongregate shelters, transitionai housing, and hctels and rnntels paidfor byehari#able organizai�ans or hyfederal, state and lo�al government prograrns]; or (iii} Is exiting an institution vrhere Is�he has resided for 90 days or less and vrho resided in an emergen�y shelter oe pla�e not meant fcr human habitation immediately before entering that instituticn {!-i � �2 Individual orfarnily� vrho suill imminentl Icse th�ie nma � , � Y P � �r' � J nighttime residen�e, provided that: � W ��t���� Imminent Risk of [ij kesiden�ewill be lartwithin 14 daysafthe date of � � � Homelessness ap�li�ation #or homeless assistance; � fiij No subsequent residence has been iden�ified; and � � fiii} The indiuidual oriamily lacks the resour�es orsu�port � netvrorks needed to obtain other perrnanenx #rousing LJJ �] � � �;3j Una��ompaniedyouth under 25 years of age, orfamilieswith C� � �hildren and youth, whado r�ot otherwise qualify as hameless � _ ��t���� Hamelessunder underth�sdefinition,butvrho: L.L � ather Federal fij Are defined as homeless under the other listed federal w sta#utes s[atutes; � fiij Have no# had a iease, ovrnership interest, or o�cupan�y agreement in permanent hausing during the 60 datis peior tothe horneless assistan�e applicatton; fiii! Have experien�ed persistent instability as measured h�• tv:c moves or rnore durir�g in the pre�eding 60 days; and (it�; Can he expertedm �ontin�e in such statusforan extended period oftirne dueto spe�ial needsar barriers {4j Any individual or family vrho: (ij Isfleeing,arisattemptingtoflee,domesti�4�iolen�e; ��t���� Fleein�j fiij Has no other residen�e; and ¢ ,�tterr pting to fiii} La�ks the resources or support networks to o4tain otf�er Flee DV R�rmanent hcusing Amendment 1 to CSC 54405 Page 27 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION ��i■ a � .�� . � 3 `r � � � 7 + [ 1 i ! � i ■ I J � [ i � ■. � � i• • i r i� f • * ��� � � � � ����� �� . Wrixten obsenation bythe outrea�h worker, or . Written referral b�� another hous3ng or senri�e provider; or Categoryr 1 Literall�y . Certifi�ation b}r the individual or �ead of household seeking Homeless assistan�e stating ihat (s}he was liti�ng on the streets or in shelter; . Far irrdividuals exiting an in�itution—cne of the formscf eviden�e above and: _ dis€harge papervror�c or wri#�en}aral referral, cr � written recard of intaice worke�sdue diligence to ohtain abave eviden�e and �ertifi€ation hy individual that theyexited institution � . A�curt order resultingfrcm an evi�tion ac#ion nctif��ingthe f--� indivitlual or famii}� that they musi leave; or � Ca#egoryr 2 Imminent Risk of . For individual and families leaving a hotel ar motel—eti•iden�e W Homelessness thatthey la€kthefinancial resour�es to stay; or � . A do�umented and 4�erified oral statement; and w . Certifi�ation that no suhsequent residen�e has been identified; � and � . Self-�ertifi�ation orother written do�umentation thatthe [� individual la�k the fnan�iai resources and support ne�essaryta w cbtain peernanent housing � . Certifi�ation bythe no�profitar state or lo�ai gouernmentthat � the individual or head of househcld seeking assistan�e rnet the � Homeless under �riteria of hornelessness under anotherfederal statute; and �s#eg�� � other Federal � . Certifi�ation of no PH in last 60 days; and w statu�es . Certif�ation bythe individual or head of household, and any w available supporting documentation, that Is�he hasmovedtwc cr � more tirnes inthe past 60 dati�s; and � . Documentation af spe�ial needs or 2 or more harri�rs � � . for rk�rm serwice praviders: � = An oral statement h}� the individual or head of household W �S{eg�� � Fleeingf seeking assistan�e vrhi�h states: they arefleeing; they hawe nc � Attempting to subsequent residen�e; and t�rey la�k resour�es. Staterner�t Flee �V must be documented bya self-�ertifi[ation ora �ertification hy the intake worker_ — . for nan-v.�rY�rn se n+rre yravi ders= fl v Oral statement b}�the andividual or head cf household seeking I , assistan�ethattheyarefleeing. This�statement isdo�umented by� a self-�ertrfi�ation or by the �aseworker. Where the safety _ ��,rr of the individual ar Tarnily is notjeopardized, the oral staterner�t must be verrfied; and � Certificatian by the individual or hea� of hausehald t#�at nv subsequent residen�e has heen iden�ified; and v 5elf-�ertificatio�, ar other written do�umentation, that the individual oe family la�ksthefinan�ial resour�es and support networksto obtain other permanerrt housiryg. Amendment 1 to CSC 54405 Page 28 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION Attachment 3: Verification of Homelessness Form Amendment 1 to CSC 54405 Page 29 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION Verification of Homelessness Form Please check the box that describes your circumstances. ❑1. An individual or family who lacks a fixed, regular, and adequate nighttime residence, meaning: a. An individual or family with a primary nighttime residence that is a public or private place not designed for or ordinarily used as a regular sleeping accommodation for human beings, including a car, park abandoned building, bus or train station, airport, or camping ground b. An individual or family living in a supervised publicly or privately-operated shelter designated to provide temporary living arrangements; or c. An individual who is exiting an institution where he or she resided for 90 days or less and who resided in an emergency shelter or place not meant for human habitation immediately before entering that institution; ❑2. An individual or family who will imminently lose their primary nighttime residence, provided that: a. The primary nighttime residence will be lost within 14 days of the date of application for homeless assistance; b. No subsequent residence has been identified; and c. The individual or family lacks the resources or support networks needed to obtain other permanent housing; ❑3. Unaccompanied youth under 25 years of age, or families with children and youth, who do not otherwise qualify as homeless under this definition, but who: a. Are defined as homeless under other federal programs as described in 24 CFR 576.2 b. Have not had a lease, ownership interest, or occupancy agreement in permanent housing at any time during the 60 days immediately preceding the date of application for homeless assistance; c. Have experienced persistent instability as measured by two moves or more during the 60-day period immediately preceding the date of applying for homeless assistance; and d. Can be expected to continue in such status for an extended period of time because of chronic disabilities, chronic physical health or mental health conditions, substance addiction, histories of domestic violence or childhood abuse, the presence of a child or youth with a disability, or two or more barriers to employment, which include the lack of a high school degree or GED, illiteracy, low English proficiency, a history of incarceration or detention for criminal activity, and a history of unstable employment; or ❑4. Any individual or family who: Amendment 1 to CSC 54405 Page 30 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION Is fleeing, or is attempting to flee, domestic violence, dating violence, sexual assault, stalking, or other dangerous or life-threatening conditions that relate to violence against the individual or family member, including a child that has either taken place within the individual's or family's nighttime residence or has made the individual or family afraid to return to their primary nighttime residence; Has no other residence; and Lacks the resources or support networks to obtain other permanent housing. I hereby certify that the information I have provided herein is true, complete and correct. Printed Name of Applicant Date Signature of Applicant Amendment 1 to CSC 54405 CoFW and TARRANT COUNTY HOMELESS COALITION Page 31 of 84 Attachment 4: Verification of Fort Worth Residency Amendment 1 to CSC 54405 Page 32 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION Verification of Fort Worth Residency Documentation SUB-GRANTEE must add proof of Fort Worth residency to Client File. Residency can be documented by: - Print out of screenshot of Green River/HMIS/ETO/CAS report or notes showing documented homelessness in Fort Worth Amendment 1 to CSC 54405 Page 33 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION Attachment 5: Calculation of Income Amendment 1 to CSC 54405 Page 34 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION INCOME Calculation WORKSHEET T pe of income Monthl amount Em lo ment income Other Earned income SPECIFY: Additional income: SSI/SSDI TANF SNAP VA benefits Alimony/child support Workers compensation Pension/retirement Total Monthl Income Total Annual Income Amendment 1 to CSC 54405 Page 35 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION Attachment 6: Examples of Income Calculation Amendment 1 to CSC 54405 Page 36 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION Haurl�� bv 2�8a i L�: Jahn ti.srns 5?,(1(1 pwr li�,��r ai�lsi vvarks 40 liotiri p4r t.���k) �7.Q0 x 2{��0 — �1�S�5Q.QQ (John'� annual incomeon his lncoine C'erlifca[ian would be 5l�#,Sb{�) 1'4�'eeklr� h�� S2 i��: f��1.�r�� Lc�u carns Sb,�* ptr h��ur anti �� c�rk� 3* ht�ur� p�r kw r�k� $fi.75 x 35 x 52 = $12,2�5.00 {Mary Lau'� annual incomc on herIncome Certi�calic�n �;ould bc 51�.�#�5.00) Bi-v4�eeklv bv 2G (Ex; Taylor earn� $8.50 per hour ancj t.�arks �(} huurs_ T��ylor has brouglii in �-Cy currcni consecuti�e check slu�s [U be used fc�r incr�me veri�caliUn} $340.OD — �380,00 — 5347,[}[1— $1,057.00 r' 3 = 5355.6i x ?6 — 59,?47.42 fTa��lor'::�nnua] income on hi� Zn�omc Ccrlificalian �;�oulc� bc 59.?�?.�?1 Semi manthlv hv 2� (Ex; A4ar�ha Ray�"s cmplo}'er has �•crificd lliaii �he carns 51.750.[}[} 4cmi-inonllily .ind is p��id o�i lhe Jsl and ihe I Sih ol' each �nr�nth} � i ,�s�.�� � ?� = s�?,aa�.aa {1�9artha Ra.��'s annual income c�n her income Certi�caiion vvou]€j be S�?.000.00� h�lnnthlv hv 12 {Ex: Trc�� i4 cmployed is paid inon�hlv. [�is �ross monlhly cai�in��� �lEik t bi.:n L�crilitci tis S?,�SQ.aQ} 5?,45�.�� x L'? = S?9,4�Q.�[} (Trey's annual incaane on his ]ncome C'ertificatian would bc 529,�#00,00) Amendment 1 to CSC 54405 Page 37 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION Attachment 7: Declaration of Income Statement (DIS) Guidance Amendment 1 to CSC 54405 Page 38 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION Declaration of Income Statement (DIS) Guidance • Household income must be collected from the 30-day period prior to the date of application for assistance. • Documentation of income must be collected from all sources for all household members, age 18 and older, for the entire 30-day period prior to the date of application. • To annualize income, take income for all income sources that must be included and calculate based on guidance in Texas Administrative Code, Title 10, Part 1, Chapter 6, Subchapter A, Rule §6.4. • If proof of income is unobtainable, the applicant must complete and sign a Declaration of Income Statement (DIS). • The DIS must also be used for households needing to declare that they have zero income. The DIS form must be used only as a last resort when all ways of verifying income have been exhausted or when the client has no income. Sub-grantee must document agency and client efforts to obtain documentation before the decision to use the DIS is taken. The posted DIS form includes a description of why no income documentation is available, and also includes a requirement to list the gross amount of income earned during the 30-day period prior to the date of application for each member of the household 18 years and older. The form must be signed by the applicant. Amendment 1 to CSC 54405 Page 39 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION Attachment 8: Declaration of Income Statement (DIS) Form Amendment 1 to CSC 54405 Page 40 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION DECLARATION OF INCOME STATEMENT Applicant Name Applicant Last Name Suffix Applicant Address City Zip Code State the gross income for household members, 18 years and older, who have no documentation of the income received in the 30-day period prior to the date of application for assistance: Name Gross Income Received Name Gross Income Received Name Gross Income Received Name Gross Income Received My household has no documented proof of income due to the following situation: I certify that the above information is true and correct to the best of my knowledge and belief. I understand that the information will be verified to the extent possible, and that I may be subject to prosecution for providing false or fraudulent information. Head of Household Signature Spouse or Other Adult Amendment 1 to CSC 54405 CoFW and TARRANT COUNTY HOMELESS COALITION Date Date Page 41 of 84 Attachment 9: Inspection Form Amendment 1 to CSC 54405 Page 42 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION Housing Habitability Standards Inspection Checklist The habitability standards are different from Housing Quality Standards (HQS) used for HUD programs. In contrast to HQS inspections, the habitability standards do not require a certified inspector. As such, subgrantee program staff could conduct the inspections, using a form such as this one to document compliance. Instructions: Mark each statement as `A' for approved or "D" for deficient. The property must meet all the standards in order to be approved. A copy of this checklist should be placed in the client file. Amendment 1 to CSC 54405 Page 43 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION Approved or Element Deficient Structure and materials: The structures must be structurally sound so as not to pose any threat to the health and safety of the occupants and so as to protect the residents from hazards. Access: The housing must be accessible and capable of being utilized without unauthorized use of other private properties. Structures must provide alternate means of egress in case of fire. Space and security: Each resident must be afforded adequate space and security for themselves and their belongings. Each resident must be provided with an acceptable place to sleep. Interior air quality: Every room or space must be provided with natural or mechanical ventilation. Structures must be free of pollutants in the air at levels that threaten the health of residents. Water Supply: The water supply must be free from contamination Sanitary Facilities: Residents must have access to sufficient sanitary facilities that are in proper operating condition, may be used in privacy, and are adequate for personal cleanliness and the disposal of human waste Thermal environment: The housing must have adequate heating and/or cooling facilities in proper operating condition Illumination and electricity: The housing must have adequate natural or artificial illumination to permit normal indoor activities and to support the health and safety of residents. Sufficient electrical sources must be provided to permit use of essential electrical appliances while assuring safety from fire. Food preparation and refuse disposal: All food preparation areas must contain suitable space and equipment to store, prepare, and serve food in a sanitary manner. Sanitary condition: The housing and any equipment must be maintained in sanitary condition. Fire safety: Both conditions below must be met to meet this standard. Each unit must include at least one battery-operated or hard-wired smoke detector, in proper working condition, on each occupied level of the unit. Smoke detectors must be located, to the extent practicable, in a hallway adjacent to a bedroom. If the unit is occupied by hearing- impaired persons, smoke detectors must have an alarm system designed for hearing-impaired persons in each bedroom occupied by a hearing-impaired person. Amendment 1 to CSC 54405 Page 44 of 84 CoFW and TARRANT COUNTY HOM LESS COALITION b. The public areas of all housing must be equipped with a sufficient number, but not less than one for each area, of battery- operated or hard-wired smoke detectors. Public areas include, but are not limited to, laundry rooms, day care centers, hallways, stairwells, and other common areas. CERTIFICATION STATEMENT I certify that I am not a HUD certified inspector and I have evaluated the property located at the address below to the best of my ability and find the following: ❑Property meets all of the above standards. ❑Property does not meet all of the above standards. Therefore, I make the following determination: ❑Property is approved. ❑Property is not approved Tenant Name: Unit Street Address: Apartment: City: Evaluator's Signature: Date: State: Zip: Evaluator's Name Printed Name: **************************************************************************************************** **************************** Landlord Name: Landlord Phone Number: Landlord Address: Amendment 1 to CSC 54405 Page 45 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION Attachment 10: Visual Lead Inspection Form Amendment 1 to CSC 54405 Page 46 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION LEAD SCREENING FOR ASSISTED UNIT Part 1: Determine Whether the Unit is Subject to a Visual Assessment If the answer to one or both of the following questions is `no,' a visual assessment is not triggered for this unit and no further action is required at this time. Place this screening worksheet and related documentation in the program participant's file. If the answer to both of these questions is `yes,' then a visual assessment is triggered for this unit and program staff should continue to Part 2. Was the leased property constructed before 1978? ❑ Yes ❑ No Will a child under the age of six be living in the unit occupied by the household receiving HPRP assistance? ❑ Yes ❑ No Part 2: Document Additional Exemptions If the answer to any of the following questions is `yes,' the property is exempt from the visual assessment requirement and no further action is needed at this point. Place this screening sheet and supporting documentation for each exemption in the program participant's file. If the answer to all of these questions is `no,' then continue to Part 3 to determine whether deteriorated paint is present. Is it a zero-bedroom or SRO-sized unit? ❑ Yes ❑ No Has X-ray or laboratory testing of all painted surFaces by certified personnel been conducted in accordance with HUD regulations and the unit is officially certified to not contain lead-based paint? ❑ Yes ❑ No Has this property had all lead-based paint identified and removed in accordance with HUD regulations? ❑ Yes ❑ No Is the client receiving Federal assistance from another program, where the unit has already undergone (and passed) a visual assessment within the past 12 months (e.g., if the client has a Section 8 voucher and is receiving HPRP assistance for a security deposit or arrears)? ❑ Yes (Obtain documentation for the case file.) ❑ No Amendment 1 to CSC 54405 Page 47 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION Does the property meet any of the other exemptions described in 24 CFR Part 35.115(a). ❑ Yes ❑ No Please describe the exemption and provide appropriate documentation of the exemption. Part 3: Determine the Presence of Deteriorated Paint If no problems with paint surFaces are identified during the visual assessment, then no further action is required at this time. Place this screening sheet and certification form (Attachment A) in the program participant's file. If any problems with paint surfaces are identified during the visual assessment, then continue to Part 4 to determine whether safe work practices and clearance are required. Has a visual assessment of the unit been conducted? ❑ Yes ❑ No Were any problems with paint surFaces identified in the unit during the visual assessment? ❑ Yes ❑ No (Complete Attachment A— Lead-Based Paint Visual Assessment Certification Form) Part 4: Document the level of identified problems All deteriorated paint identified during the visual assessment must be repaired prior to clearing the unit for assistance. However, if the area of paint to be stabilized exceeds the de minimus levels (defined below), the use of lead safe work practices and clearance is required. If deteriorating paint exists but the area of paint to be stabilized does not exceed these levels, then the paint must be repaired prior to clearing the unit for assistance, but safe work practices and clearance are not required. Does the area of paint to be stabilized exceed any of the de minimus levels below? 20 square feet on exterior surfaces ❑ Yes ❑ No 2 square feet in any one interior room or space ❑ Yes ❑ No 10 percent of the total surFace area on an interior or exterior component with a small surFace area, like window sills, baseboards, and trim ❑ Yes ❑ No If any of the above are `yes,' then safe work practices and clearance are required prior to clearing the unit for assistance. Part 5: Confirm all identified deteriorated paint has been stabilized Program staff should work with property owners/managers to ensure that all deteriorated paint identified during the visual assessment has been stabilized. If the Amendment 1 to CSC 54405 Page 48 of 84 CoFW and TARRANT COUNTY HOM LESS COALITION area of paint to be stabilized does not exceed the de minimus level, safe work practices and a clearance exam are not required (though safe work practices are always recommended). In these cases, the HPRP program staff should confirm that the identified deteriorated paint has been repaired by conducting a follow-up assessment. If the area of paint to be stabilized exceeds the de minimus level, program staff should ensure that the clearance inspection is conducted by an independent certified lead professional. A certified lead professional may go by various titles, including a certified paint inspector, risk assessor, or sampling/clearance technician. Note, the clearance inspection cannot be conducted by the same firm that is repairing the deteriorated paint. Has a follow-up visual assessment of the unit been conducted? ❑ Yes ❑ No Have all identified problems with the paint surfaces been repaired? ❑ Yes ❑ No Were all identified problems with paint surFaces repaired using safe work practices? ❑ Yes ❑ No ❑ Not Applicable — The area of paint to be stabilized did not exceed the de minimus levels. Was a clearance exam conducted by an independent, certified lead professional? ❑ Yes ❑ No ❑ Not Applicable — The area of paint to be stabilized did not exceed the de minimus levels. Did the unit pass the clearance exam? ❑ Yes ❑ No ❑ Not Applicable — The area of paint to be stabilized did not exceed the de minimus levels. Note: A copy of the clearance report should be placed in the program participant's file. Amendment 1 to CSC 54405 Page 49 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION LBP VISUAL ASSESSMENT CERTIFICATION — ATTACHMENT A I, , certify the following: I have completed HUD's online visual assessment training and am a HUD-certified visual assessor. I conducted a visual assessment at on No problems with paint surFaces were identified in the unit or in the building's common areas. (Signature) (Printed Name) (Date) Amendment 1 to CSC 54405 Page 50 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION Attachment 11: Determining Rent Reasonableness Amendment 1 to CSC 54405 Page 51 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION SUB-GRANTEES must ensure that rental assistance paid on behalf of a client meets standards of rent reasonableness. After rent amount is combined with utility cost, this total amount should not exceed Fair Market Rent for the area. If the lease will explicitly state the cost of utilities — such as $11 for water — and that amount is less than utility allowances listed in Attachment 13, then use the amount listed in lease for calculation. If the lease will not explicitly state the cost of utilities, use the utility allowances in Attachment 13 for the calculation. Amendment 1 to CSC 54405 Page 52 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION Attachment 12: Rent Reasonableness Checklist and Certification Amendment 1 to CSC 54405 Page 53 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION RENT REASONABLENESS CHECKLIST AND CERTIFICATION Proposed Unit #1 Unit #2 Unit #3 Unit Address Number of Bedrooms Square Feet Type of Unit/Construction Housing Condition Location/Accessi b i I ity Amenities Unit: Site: Neighborhood: Age in Years Utilities (type) Unit Rent Utility Allowance Gross Rent Handicap Accessible? CERTIFICATION: A. Compliance with Payment Standard Proposed Contract Rent + Utility Allowance = Proposed Gross Rent Approved rent does not exceed applicable Payment Standard of � Amendment 1 to CSC 54405 Page 54 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION B. Rent Reasonableness Based upon a comparison with rents for comparable units, I have determined that the proposed rent for the unit []is [] is not reasonable. Name: Signature: Date: Amendment 1 to CSC 54405 Page 55 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION Attachment 13: Utility Allowance Schedule Amendment 1 to CSC 54405 Page 56 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION Utili#yAllowance S�Itiedule U.S Departinenk of Hot�sing and Oh,93,�pproval No_ 2577-0159 5ee Puhli� Reporting and Inrtru�tions on ba€k. Urban Deuelaprnenk exp. 7J31f24�2 OfF�e of Publi� and Indian Hausing The fallawing allowances are used ta determine the total cost of tenant-fur�ished utiliti�s a�d applia�rces, Lo�liky.fPHR Un it T`�pe date Immr'ddfr,�y:; F�rt UV�rth Housing �oluti�ns �lulti-Famil}r �1�1�0�� U#ility or Servi�e Fuel Type 0 BR 1 BR 2 BR 3 BR 4 BR 5 BR Heating Natural �as �i B $ 9 1� 12 3attled Gas Electri� '�� '�� '�� '�� �'� �� Electri� — Heat Pump 7 9 1� 1� 15 16 Fuel Dil 4ther Cooking Natural Gas � � � 3attled Gas Electri� � � � Other Gther Electri� '� � '� � '� � Air Canditioning � �J � � �� Water Heating Natural �as � � �i 3attled Gas Electri� '� �� '�� '� � Fuel Dil Water '� �J '� $ �� Sewer '� '� '� � �� Trash Colleckian '� $ '� $ '� $ Other—spe�ify+ '� � '� $ '� $ �����������tiV��� � a � a � o kefrigerator '� � '� � '� Q Attual Family �Ilov.�ances —Mak� be used bp�the family to �o�•put� allcv.anc� whil� sear�hingfora unit_ Head cf Hcusehold Name Unit Addr�ss Number a= Bedreorns F.':'FL' Representativ�e � � � � � � �� �� �� �� �� �� � � �� �� �� �� �� �� �� �� �� �']� �� �� �� �� �� �� �a �o �ia �� �� �� U�ilitl��;`Sen�i��;�Appliar�e � lawan�e I,eating Cooking Other Ele�tri� Air Conditioning Water Heating Water 5ewer Trash Cclle�tion Other RangefMi�rcvla4�e Refrigerator Total Amendment 1 to CSC 54405 Page 57 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION Attachment 14: Approval/ Disapproval Form Amendment 1 to CSC 54405 Page 58 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION Approval/Disapproval Notification Memo Form SUBGRANTEE Name Address Date Dear , This is to inform you that you have been: Approved Denied for assistance from HHSP general HHSP youth. If denied, the denial was based on: Not meeting income requirements Not meeting residency requirements Not meeting homelessness verification requirements. If you were denied assistance, you have the right to appeal. You may appeal by contacting ....................... at ........................by (date). If you have a disability and were denied assistance, you may request a reasonable accommodation by contacting ................. at ........................... Sincerely, Staff Name Amendment 1 to CSC 54405 Page 59 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION Attachment 15: Applying for Other Programs Form Amendment 1 to CSC 54405 Page 60 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION Applying for Other Programs Assistance Form I certify that I have attempted to obtain housing at the locations listed below: Family or Friends Name of Friend/Relative: Location of Home: Reason this housing is not an option for your family: Rental Unit without assistance Name of Apartment Complex:_ Location of Unit: Monthly rent: Number of Bedrooms: Reason this housing is not an option for your family: Housing Authority Waitlist I have contacted one or more of the housing authorities listed below and applied for their open Housing Choice voucher (formerly known as Section 8) wait list ❑ Arlington Housing Date applied: ❑ Grand Prairie Housing: Date applied: ❑ Fort Worth Housing Date applied: ❑ Grapevine Housing: Date applied: ❑ Tarrant County Date applied:_ applied: ❑ Weatherford Housing Date applied ❑ Haltom City Housing ❑ Other: Date Date applied: ❑ All waiting lists are currently closed I acknowledge the information above is true and accurate to the best of my knowledge. Signature of Program participant Amendment 1 to CSC 54405 CoFW and TARRANT COUNTY HOMELESS COALITION Date Page 61 of 84 Attachment 16: HHSP Recertification Form Amendment 1 to CSC 54405 Page 62 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION HHSP Recertification Form Please Check One: HHSP General HHSP Youth Name of Client: Date of program entry: Date of re-certification: Verification: Other housing opportunities were checked (if applicable) (Attachment 14) Income Eligible (Attachment 7) Name of staff Signature of staff Amendment 1 to CSC 54405 CoFW and TARRANT COUNTY HOMELESS COALITION Date Date Page 63 of 84 Attachment 17: HHSP Monthly Performance Report Amendment 1 to CSC 54405 Page 64 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION Texas Department of Housing and Community Affairs Supplemental HHSP Monthly Report Collection Form 7tsir Otiirlitr4 �F H�virw ir� C�ii�rilr /YFFiiri �+rrl.�..�.1 HHSP N.rt�lx R.r.rt C.Il.cti.. F.r� HH5P Monthly Pertormance Repart Total Com onents Undu lieated HH5P To[al Co�porcr[s Pcrsors for Pcrsors Erkcri■ 0 Er[cri■ o T4tiI CO�P4\!\t5 f4f H4�5[`4Id5 Ho�sciolds Ertcri■ 0 Ertcri■ o Llndu lieated Raee lJndu licated Ethnieit Llnd f5lfiCfl{�ry Ih�l�hi{SI�:k� NOh-HI'.P�hICiNOh- Nakivc 0 Lakino 0 Malc A:ian O HI:��hl{+��klh0 0 Femalc 6ender LI 0 Undcr 18 0 18-24 �hlkC � �OhfOflfilh � f5 C UhkhOWh � R�{{� UhILhOWh O GCh�Cf UhILhOWh O Total Racc 0 Total Et�ricit� 0 To[al Gcrdcr 0 To[al Agc 0 HH3P General 5et-Aside Re rtin Unduplieated Speeial Components b� Components b� Populatians Persons Households �uteomes NeY Beds E::ChkI�I $CfVI{C: - PCf:Oh: Ih �k IC�:k OhC Es:enkial 3crvicc: - Homcic:; Homcless Pcrsons 3hclkcr Bed: : C{I�� O 4I�klOh O HOIfiCIC'.'. PCf:Oh: O H04:ChOI�: O M�Ihk�lht� �+ MOhkh: O COh:kf4{kC� � Vickim: oF Oomc:kic Es:enkial 8crvicc: - E;:enkial 8crvicc: - Nomcless Nou:chold: 8hclkcr Bed: Violcncc 0 AS Ri:k Pcr-.on. 0 At Ri:k Hou:chold: 0 Maintainsd 3* Month: 0 Rchabilitatcd 0 Unacco-mpanicd Children AS Ri:k Pcrco-nc Shcltcr Bedc Uh�Cf 1� O HA Ptf:Oh: O HA H04:ChOI�: O M�Ihk�lht� �+ MOhkh: O COhVCfkCd � Unaccompanicd Youkh (18- HP A;:i:tancc HP A;:i:kancc At Ri;k Houscholds 24 0 Pcrsans 0 Hou:chold: 0 Maintained 3+ Month: 0 TL Bed: Constructed 0 P�fChklh� Chll�fth �h� PCf:Oh: U:Ih� Hou:chold: U:ing Y04Sh �� �hd 4h�Cf 0 da 1Ni ht 8hcltcr 0 da 1Ni ht 8hcltcr 0 TL Bed: Rchabilitated 0 Children of Parcnting Youth Ci:t MaM1a�tlM1tM1k- CS:t MiM1a�tlM1tM1k- Undcr 18 0 Homclec. Pcrconc 0 Homclec: 0 TL Bedc ConVcrted 0 Ca:c Managemenk- Ca:c Managemenk- Vekcren: 0 At Ri;k Pcrsons 0 At Ri:k Hou;chold; 0 HH3P Youth 3et-Aside Reporting Llnduplicated Speeial Campanents far Children�Yauth in YHH Headed Househalds Children�Youth in Populations- Youth in YHH Children�Youth in YHH �yVV1 �Ot��m¢� a,uu Pcr�an� in at Icast anc E.�ential ScrVicc� - Es�ential ScrVicc� - Hamcic�. Pcr�an� Shcltcr Bed� Tf�h:IkIOh�I LIVIh O Tf�h'.IkIOh�I LIVIh{ Pcr-.an-. U:ing Hou:chold: U:inc dav7Niaht Shcltcr 0 dsv7Niaht Shcltcr 4 Convcrked 4 0 TL Bedc Constructed 0 0 TL Bed: Rchabilitated 0 TL Bed: Convcrted 0 Vekcran: Amendment 1 to CSC 54405 CoFW and TARRANT COUNTY HOMELESS COALITION Page 65 of 84 Attachment 18: HHSP Monthly Expenditure Report Amendment 1 to CSC 54405 Page 66 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION Texas Department of Housing and Community Affairs Supplemental HHSP Monthly Expenditure Report Collection Form HHSP Manthly Expenditure Repork I[em Budgeted Available To[al Monthl� Non-Program This Orar * Categar� pmount Orarn To Oate g��anee Es endi[ures Fund Credit Amount 1 Administration $ $ $ $ $ $ 2 Case Mana ement Salar $ $ $ $ $ $ 3 ConstruotionfReha6ilitationlConuers $ $ $ $ $ $ 4 Essantial Sar4ioas $ $ $ $ $ $ 5 Homelessness Assistance $ $ $ $ $ $ 8 Homelessness Preuention $ $ $ $ $ $ 7 Shelter 0 erations $ $ $ $ $ $ TOTAL: Amendment 1 to CSC 54405 Page 67 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION Attachment 19: HHSP Inventory Report Form Instructions Amendment 1 to CSC 54405 Page 68 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION HHSP Inventory Report Guidance HHSP Subrecipients are required to abide by the following procedures during the closeout of the current contract. An inventory report must be completed for each TDHCA HHSP funding source. If HHSP tools and equipment have been purchased having a unit acquisition cost of $5,000.00 or more and a useful life of more than one year or more, the enclosed HHSP inventory forms must be completed and submitted no later than 45 days after the original end date of the contract, and yearly thereafter until the tools or equipment are worth less than $5,000.00. This provision also applies to vehicles purchased in whole or in part with HHSP funds. All tools, equipment, and vehicles purchased in whole or in part with HHSP funds regardless of the year purchased must be listed. HHSP INVENTORY LIST: TOOLS AND EQUIPMENT (Provide a form for each HHSP Funding Source) Funding Source 1. Subrecipient: 2. Executive Director: 3. Contract Number: 4. Contact Name: 5. Title: 6. Telephone Number: 7. Address: 8. City, State, Zip: 9. Reporting Period (MM/DD/YYYY): From: To: 12. 13. I 14. I 15. I 16. I 17. I 18. I 19. I 20. % O F OF PROPEIRTY I S�ITIO I S�ITIO I AL #I I DIOT O I TUS I AOTIO I LE I E�NTARTM DATE I COST I I N Amendment 1 to CSC 54405 CoFW and TARRANT COUNTY HOMELESS COALITION N PARTICIPA TION/ FUNDING SOURCE Page 69 of 84 12. 13. 14. 15. 16. 17. 18. 19. 20. % O F DESCRIPTION ACQU ACQU SERI CON STA LOC TIT DEPARTM OF PROPERTY ISITIO ISITIO AL # DITIO TUS ATIO LE ENT N N N N PARTICIPA DATE COST TION/ FUNDING SOURCE Amendment 1 to CSC 54405 Page 70 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION 12. 13. 14. 15. 16. 17. 18. 19. 20. % O F DESCRIPTION ACQU ACQU SERI CON STA LOC TIT DEPARTM OF PROPERTY ISITIO ISITIO AL # DITIO TUS ATIO LE ENT N N N N PARTICIPA DATE COST TION/ FUNDING SOURCE CERTIFICATION: I certify that the information provided herein is true and accurate to the best of my knowledge. NAME TITLE SIGNATURE DATE Amendment 1 to CSC 54405 Page 71 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION Attachment 20: CFW Monthly Reports Amendment 1 to CSC 54405 Page 72 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION CFW Monthly Report General HHSP — If GreenRiver system at Tarrant County Homeless Coalition is able to pull data included in monthly reports included herein and Directions Home staff confirms and agrees in writing, those reports can be substituted for reports included herein. Enter all new clients on this report. Date Date Date Applicatio receive Applicatio n vouche Date of Date First Last Agenc n Complete r Inspectio Moved Name Name y Received d n In Youth HHSP- If GreenRiver system at Tarrant County Homeless Coalition is able to pull data included in monthly reports included herein and Directions Home staff confirms and agrees in writing, those reports can be substituted for reports included herein. Enter all new clients on this report. Amendment 1 to CSC 54405 Page 73 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION rvamefxmis lo [ase oa[e Enrolled oa[e xoused oaysro xoused Inrome at Inrome at wmount oa[e � Manaeer � � � � Enrollment � �ischaree increase � disch Amendment 1 to CSC 54405 CoFW and TARRANT COUNTY HOMELESS COALITION �enc( Retumsat3 Retu�nsat6 Retu�nsatl �ate � months months � vr � Returned � Page 74 of 84 Attachment 21: CFW Quarterly Reports Amendment 1 to CSC 54405 Page 75 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION CFW Quarterly Report General HHSP Quarterly Report Current Reporting Quarter Submitting Agency Contact Name Phone Number and Email Remit Address Please include outcome narrative that describes how measure was accomplished for each quarter. Effectiveness Measures and Quarterly Outcomes Measure Agency will complete the application-to-voucher process within seven (7) 1 business days for a minimum of 90% of clients Outcome I have reviewed this report and certify that the measures provided are accurate and appropriately reflect the Directions Home goals set forth in the contract. Authorized Signatory Signatory Title Date Amendment 1 to CSC 54405 Page 76 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION CFW Quarterly Report Youth HHSP Quarterly Report Current Reporting Quarter Submitting Agency Contact Name Phone Number and Email Remit Address Please include outcome narrative that describes how measure was accomplished for each quarter. Effectiveness Measures and Quarterl Outcomes Measure Less than 15% returns to homelessness within one year 1 Outcome Measure At least 90% of clients are housed within 30 days 2 Outcome 1 have reviewed this report and certify that the measures provided are accurate and appropriately reflect the Directions Home goa/s set forth in the contract. Authorized Signatory Signatory Title Date Amendment 1 to CSC 54405 Page 77 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION Attachment 22: CFW Reimbursement Request Form Amendment 1 to CSC 54405 Page 78 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION REIMBURSEMENT REQUEST FORM Expenses Name of employee Amount Date Check or client Invoiced No. Expense: Personnel Salary Salary Salary Salary Total: FICA (Medicare/Social Security) FICA (Medicare/Social Security) FICA (Medicare/Social Security) Health Insurance Health Insurance Health Insurance Dental Insurance Dental Insurance Dental Insurance Life Insurance Life Insurance Life Insurance Disability Insurance Disability Insurance Disability Insurance Retirement Retirement Retirement Unemployment Insurance Unemployment Insurance Unemployment Insurance Workers Compensation Workers Compensation Workers Compensation Total of all Benefits: Mileage Mileage Amendment 1 to CSC 54405 Page 79 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION Mileage Mileage Total: Cell phone Cell phone Cell phone Cell Phone Total: Type of Client Expense/Vendor Client Expense Total: Operations/Vendor: Operations Total: Other Other Total: Total Invoiced Amount Attestation Contractor: Program: Name of Person submitting report: Date Range Covered by this report: I have reviewed this report and certify that it is a complete, accurate, and up-to-date reflection of the services rendered under the terms of our Agreement with the City of Fort Worth. Signature: Tota I Amendment 1 to CSC 54405 Page 80 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION Attachment 23: CFW Reimbursement Summary Amendment 1 to CSC 54405 Page 81 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION CFW Reimbursement Summary Total Previous This Total Remaining Budget Reimbursements Month's Request to Balance Budget Category Amount Requested Request Date (B+D) Available (A-D) Personnel Fringe Benefits Mileage Cell phone/Equipment Client Costs Other Total Amendment 1 to CSC 54405 Page 82 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION Exhibit A of the Agreement is herebv amended and replaced in their entirety with the attached Exhibit A. Exhibit G is herebv added. III. This amendment is effective as of the Effective Date of this Amendment. IV. All terms and conditions of the Contract not amended herein remain unaffected and in full force and effect, are binding on the Parties and are hereby ratified by the Parties. Capitalized terms not defined herein shall have the meanings assigned to them in the Contract. [THE REMAINDER OF THIS PAGE IS INTENTIONALLY LEFT BLANK] [SIGNATURE PAGE FOLLOWS] Amendment 1 to CSC 54405 Page 83 of 84 CoFW and TARRANT COUNTY HOMELESS COALITION IN WITNESS WHEREOF, the parties hereto have executed this agreement, to be effective this day of , 20_ FOR CITY OF FORT WORTH: T-.-1 LL-- Fernando costa (Jan 11, zoz11454 csr) Fernando Costa Assistant City Manager Date: Jan 11, 2021 APPROVAL RECOM r°�G�� Tara Perez (Jan 11, 202114:53 CST) Date: Jan 11, 2021 NDED APPROVED AS TO FORM AND LEGALITY � �.,,�� � - Taylor Paris, Assistant City Attorney Jan 11, 2021 Date: Contract Compliance Manager: By signing I acknowledge that I am the person responsible for the monitoring and administration of this contract, including ensuring all performance and reporting requirements. r��,.��� Tara Perez (Jan 11, 202114:53 CST) Tara Perez Manager, Directions Home Amendment 1 to CSC 54405 CoFW and TARRANT COUNTY HOM LESS COALITION FOR AGENCY: 6 //� Lauren King Interim Executive Director Jan 11, 2021 Date: ATTEST: � �I/ � / . � � I i ,d�p,UU�� a �� �bo�oFoRr��a �o d > o °�'p � �� o -� �i vo 0 0 , o � ?�I�� �o 00 � *� �C� ���0000a_ p Mary J. Kayser, City Secretary Jan 11, 2021 Date: M&C No.: OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX City of Fort Worth, Mayor and DATE: 06/16/20 Texas Council Communication M&C FILE NUMBER: M&C 20-0382 LOG NAME: 02HOMELESS HOUSING AND SERVICES PROGRAM - GENERAL AND YOUTH SUBJECT Authorize Acceptance of Grants from the Texas Department of Housing and Community Affairs for Homeless Housing and Services Program Funds for $486,499.00 and HHSP-Youth Set Aside for $136,139.00, Authorize Execution of Related Agreements, Authorize Execution of SubGrant Agreements with Housing Authority of the City of Fort Worth DBA Fort Worth Housing Solutions to Provide Rental Assistance and with Tarrant County Homeless Coalition to Provide Youth Rental Assistance and Case Management and Adopt Attached Appropriation Ordinances (ALL COUNCIL DISTRICTS) RECOMMENDATION: It is recommended that the City Council: 1. Authorize acceptance of grants and execution of contracts with the Texas Department of Housing and Community Affairs (TDHCA) for the Homeless Housing and Services funds for $486,499.00 (HHSP-General) and $136,139.00 (HHSP-Youth); 2. Authorize the execution of subgrant agreement with Fort Worth Housing Solutions in the amount of $486,499.00 to provide rental assistance to at least 60 permanent supportive housing clients (HHSP-General); 3. Authorize the execution of subgrant agreement with Tarrant County Homeless Coalition in the amount of $136,139.00 to provide rental assistance and case management to at least 15 youth (HHSP-Youth); and 4. Adopt the attached appropriation ordinances increasing estimated receipts and appropriations in the Grants Operating State Fund in the amounts of $486,499.00 and $136,139.00 upon notification of award and receipt of funds. DISCUSSION: The State of Texas provides grant funding for the Homeless Housing and Services Program (HHSP) administered by the Texas Department of Housing and Community Affairs (TDHCA) to nine municipalities with a population of 285,500 or greater, including the City of Fort Worth. The HHSP funds may be used to provide rental assistance, case management and other services or housing options to reduce homelessness. The HHSP grant funds are currently used by Fort Worth Housing Solutions to provide rental assistance to 60 persons for permanent supportive housing annually. The Texas Legislature passed an increase in funding for HHSP over the 2020-2021 biennium with additional funds to address homelessness among young adults 18 to 24 years of age. The HHSP-Youth amount allocated to the City of Fort Worth is $136,139.00. Eligible services include case management, emergency shelter, street outreach and transitional living. The HHSP-Youth grant funds are currenly used by Tarrant County Homeless Coalition to provide rental assistance and case management for 15 youth annually. TCHC will provide rental assistance and will partner with a supportive services provider to provide case management for youth in the program. Upon acceptance, the grant will begin on September 1, 2020. The City's Directions Home unit will administer the HHSP and HHSP-Youth funds and monitor the sub-recipients, Fort Worth Housing Solutions and Tarrant County Homeless Coalition. The subgrant agreements will be from September 1, 2020 to August 31, 2021. An assistant city manager is authorized to execute the contracts. A Form 1295 is not required for these contracts because: These contracts will be with a governmental entity, state agency or public institution of higher education: TDHCA and Fort Worth Housing Solutions. A Form 1295 is required for Tarrant County Homeless Coalition. FISCAL INFORMATION / CERTIFICATION: The Director of Finance certifies that, upon acceptance of the above recommendations, receipt of the grant funding and adoption of the attached appropriation ordinance, funds will be available in the Grant Operating State Fund, as appropriated. This is a reimbursement grant. The Directions Home unit will be responsible for the verification and submission of documents for these funds. Prior to expenditure being made, the Directions Home unit has the responsibility to validate the availability of funds. Submitted for City Manager's Office bk Fernando Costa 6122 Originating Business Unit Head: Tara Perez 2235 Additional Information Contact: Tara Perez 2235