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 individual and service providers seeking information on how to access the homeless crisis response system in Clinton, Fayette, Highland, Pickaway, and Ross Counties. As the 2017 coordinated entry planning process is underway, please continue to visit this website for details and updates.
Community Resources for the Homeless & At-Risk
Region 16 Housing Inventory Chart 2017
Available Housing List
Clinton County Specific Resources
Fayette County Community Resource Guide
Fayette County Available Housing List
Highland County Specific Resources
Pickaway County Specific Resources
Ross County Specific Resources
Region 16 Management & Structure
Coordinated Intake File Documents
The Coordinated Intake File is the common file shared among all homeless service providers in the region.
- Diversion Form & Script – This form is completed once on the HoH. This form should be included in referrals.
- 2018 HMIS Unsheltered form – This form is completed if the household cannot be diverted from homelessness, but there are no shelter beds and/or the individual refuses services. (HMIS or paper)
- 2017 HMIS Intake Form All Programs – This form is completed either in HMIS or on the paper copy provided here.
- Regional Universal Release Form – This form must be completed by each homeless service provider.
- HMIS Release & Consent Forms – This form must be completed by each homeless service provider.
- Housing Status Form – This form must be completed by referring agencies.
- Verification of Income Forms – These forms must be completed by RRH and PSH Providers for program eligibility.
- PSH Forms – These forms must be completed by agencies referring participants to PSH.
- Single, Family & TAY VI-SPDAT
Rapid Re-Housing Forms
TAB 2 – ENROLLMENT Revised March 2017
TAB 3 – HOUSING INSPECTION TAB Revised January 2016 No Change March 2017
TAB 4 – LANDLORD AND ASSISTANCE TAB March 2017
TAB 5 – RECERTIFICATION Revised March 2017
TAB 6 – SERVICES PLANS CASE NOTES Revised March 2017
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.