Homeless Crisis Response Program

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 Community Resource
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

Bylaws & Operating Procedures
Regional Committees & Membership Rosters

Policies & Notices

HMIS Data Privacy Notice 2.2019
.Region 16 CE Plan 6.4.19
Region 16 Policy and Procedure Manual Update March 2019
Case Closeout and Termination of Assistance
Domestic Violence Policy
Grievance & Appeal

Coordinated Entry (CE) Documents

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.

  1. CE Checklist– This form is to track required documents needed for the CE File.
  2. Diversion Data Release Forms– These are HMIS Data Releases, to be used during Diversion. In-Person & Verbal consent are both provided, use accordingly.
  3. HMIS Diversion Form 2.2019 – This form is completed once, for the HoH only, by the access point. This form must be included with ALL referrals.
  4. 2018 HMIS Intake Form ES SH – This is completed by Emergency Shelters in HMIS, & can be printed out via HMIS, or use the paper copy provided here.
  5. Single, Family & TAY VI-SPDAT – This link provides a printable paper version of the SPDAT’s. The required SPDAT score will be present on the HMIS referral required in the CE File.
  6. HMIS-Intake-Form-All-Programs – This is completed in HMIS through Unsheltered, & can be printed out via HMIS, or use the paper copy provided here.
  7. Regional-Universal-Release-Form – This form must be completed by access point or homeless service provider.
  8. HMIS Release Consent forms– These forms must be completed by access point or homeless service provider.
  9. Homeless Status Documentation This form must be completed by access point or referring homeless service provider.
  10. Income Verification Forms – These forms must be completed by access point or homeless service provider.
  11. PSH-Forms Update 2019 – These forms must be completed by agencies referring participants to PSH.
  12. Case Closeout and Termination of Assistance – Copy must be included in file and given to client.
  13. Region 16 Grievance Policy – Copy should be posted and given to client.
  14. Protect Yourself from Lead Brochure – Copy should be given to client and documented in Housing Inspection tab if applicable.
  15. Landlord Benefits– Copy should be given to client to give to prospective landlords.

Rapid Re-Housing Forms

TAB 2 – ENROLLMENT
TAB 3 – HOUSING INSPECTION
TAB 4 – FINANCIAL ASSISTANCE
TAB 5 – RECERTIFICATION
TAB 6 – CASE MANAGEMENT
TAB 6- HOME VISIT LOG

Permanent Supportive Housing Forms

PSH Documentation for PSH Programs
CE Checklist
TAB 2 – ENROLLMENT PSH
Tab 3 – Housing Inspection PSH Tab 3 – Housing Inspections Updated March 2017
TAB 4 – FINANCIAL ASSISTANCE PSH
TAB 5 – RECERTIFICATION PSH
TAB 6 – CASE MANAGEMENT PSH
CAC PSH Programs

Brochures & Flyers

HCRP RRH Info sheet
SSVF Brochure 2017
Clinton County SSVF Brochure
Destination Home Brochure
Fayette County Homeless Shelter

Regional Profile

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.

Region 16 Economic & Demographic Profile