Balance of State Continuum of Care
Homeless Planning Region 16
The Community Action Commission of Fayette County, in partnership with homeless planning region 16, presents the Coordinated Entry process on this page. The purpose of this page is to serve as a starting point for any individuals and service providers seeking information on how to access the homeless crisis response system in Clinton, Fayette, Highland, Pickaway, and Ross Counties. Please continue to visit this website for details and updates.
These programs serve all households regardless of race, color, national origin, religion, sexual orientation, gender identification, age, familial status, or disability.
Community Resources for the Homeless & At-Risk
Region 16 Housing Inventory Chart 2017
Available Housing List
Clinton County Specific Resources
Fayette County Specific Resources2.20
Fayette County Housing Resource
Fayette County Private Landlord Directory
Highland County Specific Resources
School Homeless Liaison Contact Information
Pickaway County Specific Resources
Ross County Specific Resources
Region 16 Management & Structure
Policies & Notices
**COVID-19 RESPONSE PLAN FOR CAC of FAYETTE COUNTY**
CACFC IDOR Plan 4.2020
HMIS Data Privacy Notice 2.2019
Region 16 Policy and Procedure Manual Update March 2019
Case Closeout and Termination of Assistance
Domestic Violence Policy
Grievance & Appeal
Region 16 Grievance Policy – To be posted in office and can be provided to clients enrolled in HCRP programs.
Diversion Assessment- (completed by Access Point)
HMIS Diversion Form 2.2019 – This form is completed by the Access Point for the Head of Household (HOH) ONLY. If Diversion is NOT successful, this form must be included in the CE File.
Diversion-Data-Release-Forms Oct 2019– This is completed for the HOH ONLY by the Access Point. In-Person Consent Form or Verbal Consent Form are both provided, use accordingly.
*If the household is NOT diverted, the Diversion Assessment MUST BE PRESENT in the Coordinated Entry File.
Coronavirus (COVID-19) Screening Tool 5.13.20– This form is to be used during the Diversion Assessment. Information collected is NOT entered into HMIS. Use this form until further notice. (effective 3-17-2020)
Coordinated Entry (CE) File- (completed by Access Point)
The Coordinated Entry (CE) File is the common file shared among ALL Homeless Service Providers in the region & is required to be completed for ALL referrals.
- CE Checklist– This form is to track required documents needed for the CE File. When completed, referral to Homeless Provider can be sent.
- Diversion Form- This was completed by Access Point during the Diversion Assessment & must be included in the CE File.
- Referral for ES/RRH/PSH (as applicable)- Will be completed & printed off of HMIS by Access Point when the SPDAT is completed & HOH provides verification of homelessness to Access Point
- Regional-Universal-Release-Form – This form must be completed by Access Point.
- Diversion Data Release Forms – This form was completed for the HOH during the Diversion. If children are present in the HH, they MUST BE ADDED NOW.
- Homeless Status Documentation – This form must be completed by Access Point & be accompanied with verification of homelessness.
- HMIS Intake Form All Programs – This is completed in HMIS by the Access Point through Unsheltered, & can be printed out via HMIS, or use the paper copy provided here.
- HMIS Intake Form ES SH Oct 2019 – This is completed in HMIS by Emergency Shelters & can be printed out via HMIS, or use the paper copy provided here.
- Income Verification Forms – These forms must be completed by Access Point & be accompanied with required income documents if applicable.
- Copies of the entire HH’s Personal Identifying Information.
- PSH-Forms Update 2019 ONLY completed by Access Point when referring HH to PSH.
- Single, Family & TAY VI-SPDAT – This link provides a printable version of the various VI-SPDAT’S. Emergency Shelter’s MUST complete the VI-SPDAT within 5-8 days of HH enrollment into their homeless emergency shelter program & maintain a signed copy of the completed VI-SPDAT in the HH’s file. All referrals require the completed VI-SPDAT score, which is provided through HMIS when completing referral.
Rapid Re-Housing (RRH) Forms
- TAB 2 – ENROLLMENT
- Ansell Casey Life Skills Assessment Y3_Version 4.0– This assessment is to be competed by clients enrolling in the TAY RRH Expansion program.
- TAB 3 – HOUSING INSPECTION
- Protect Yourself from Lead Brochure – If Applicable, a copy must be provided to client & landlord during Housing Inspection.
- TAB 4 – FINANCIAL ASSISTANCE
- TAB 5 – RECERTIFICATION
- TAB 6 – CASE MANAGEMENT
- TAB 6- HOME VISIT LOG
Permanent Supportive Housing (PSH) Forms
- PSH Documentation for PSH Programs
- TAB 2 ENROLLMENT-PSH
- TAB 3 HOUSING -PSH
- TAB 4 FINANCIAL-PSH
- TAB 5 – RECERTIFICATION PSH
- TAB 6 – CASE MANAGEMENT PSH
- CAC PSH Programs
Risk Mitigation Funding (RMF) Forms
- Risk Mitigation Policy & Procedure
- RMF Landlord Application
- RMF Claim Form
- Risk Mitigation Case Plan
- Risk Mitigation Packet
Brochures & Flyers
Region 16 is comprised of Clinton, Fayette, Highland, Pickaway, and Ross Counties. In the document below, you will find basic information regarding the economic and demographic conditions in the area. Regional and community partners may utilize this information in the development of proposals for funding.