Form Hud-40110-C - Annual Progress Report (Apr) - Housing Opportunities For Persons With Aids (Hopwa) Program Page 15

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Section 3. Access to Care and Support: Assessment of Client Outcomes on Access to Care and Support
1A. Status of Households Accessing Care and Support by Project Sponsors delivering HOPWA Housing
Assistance/Housing Placement/Case Management
Use Table 1A for project sponsors that provide housing assistance/housing placement with or without case management
services. In Table 1A, identify the number of client households receiving any type of HOPWA housing assistance that
demonstrated improved access or maintained connections to care and support within the program year by: having a housing
plan; having contact with a case manager/benefits counselor; visiting a primary health care provider; accessing medical
insurance/assistance; and accessing or qualifying for income benefits. Note: For information on types and sources of income
and medical insurance/assistance, refer to Charts 1C and 1D.
Categories of Services Accessed
Households Receiving Housing
Outcome
Assistance within the Operating Year
Indicator
1. Has a housing plan for maintaining or establishing stable on-going housing
Support for
Stable Housing
2. Has contact with case manager/benefits counselor consistent with the schedule
Access to
specified in client’s individual service plan.
Support
3. Had contact with a primary health care provider consistent with the schedule
Access to
specified in client’s individual service plan.
Health Care
4. Has accessed and can maintain medical insurance/assistance.
Access to
Health Care
5. Successfully accessed or maintained qualification for sources of income.
Sources of
Income
1B. Number of Households Obtaining Employment
In Table 1B, identify the number of recipient households that include persons who obtained an income-producing job during the
operating year that resulted from HOPWA funded: job training, employment assistance, education or related case
management/counseling services. Note: This includes jobs created by this project sponsor or obtained outside this agency.
Categories of Services Accessed
Number of Households that
Outcome
Obtained Employment
Indicator
Total number of households that obtained an income-producing job
Sources of
Income
Chart 1C: Sources of income include, but are not limited to the following (Reference only)
•
•
Earned Income
Veteran’s Pension
•
•
Unemployment Insurance
Pension from Former Job
•
•
Supplemental Security Income (SSI)
Child Support
•
•
Social Security Disability Income (SSDI)
Alimony or other Spousal Support
•
•
Veteran’s Disability Payment
Retirement Income from Social Security
•
•
General Assistance, or use local program name
Private Disability Insurance
•
•
Temporary Assistance for Needy Families
Worker’s Compensation
(TANF) income, or use local program name
Chart 1D: Sources of medical insurance and assistance include, but are not limited to the following (Reference only)
•
•
MEDICAID Health Insurance Program, or use local program
MEDICARE Health Insurance Program, or use local
name
program name
•
•
Veterans Affairs Medical Services
AIDS Drug Assistance Program (ADAP)
•
•
State Children’s Health Insurance Program (SCHIP), or use local
Ryan White-funded Medical or Dental Assistance
program name
Previous editions are obsolete
Page
12
form HUD-40110-C (Expiration Date: 12/31/2010)

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