information has been misused, I can contact my HMIS systems administrator at (206) 444-4001 x2. Baltimore City HMIS Information Sharing Consent form (Spanish) Baltimore City HMIS Information Sharing Revocation of Consent form (Spanish) HMIS Participating Agencies include housing programs and service providers throughout the City of Baltimore who contribute data to the HMIS. Please bear in mind that these documents were created by organizations based on their specific needs and objectives, See Washington State HMIS forms here. Capacity Building. Updated November 09, 2022. There was a problem submitting your feedback. all ages. Confidentiality of client information is of utmost importance in data collection. Every person and agency that is authorized to read or enter information into the HMIS Minnesotas HMIS is a collaborative project of the 10 Minnesota Continuums of Care, the Minnesota Tribal Collaborative to Prevent and End Homelessness, the State of Minnesota, the Institute for Community Alliances, and participating partner agencies. This information will help increase participation and collaboration among agencies, as well as a sense of ownership and trust in the efforts to reduce homelessness. WHAT IS HMIS? EIN # 84-1705573 Data sharing is intended to meet identified needs with principles for implementation locally defined and need-based. A current list of Partner Agencies is at HMIS Consent Forms Confidentiality of client information is of utmost importance in data collection. Governance. may be made locally by the CoC, working in conjunction with the HMIS Lead, and should also consider possible state or other local requirements. Annual Assessment for Children under 18, 2021 CNY HMIS Update. The posting of these documents on the HUD Exchange is not intended as an endorsement of the documents by HUD or any of its contractors. Account status change request. We serve as the community coalition to address homelessness and housing vulnerability. Meet SAP BusinessObjectsThis video introduces SAP BusinessObjects, a software program used to build and store the reports that help make HMIS data actionable. The information they collect helps to run programs, improve services, and better understand your needs. For a privacy notice, an agency must post a sign at each intake desk (or comparable location) that explains generally the reasons for collecting HMIS information, and the uses and disclosures allowable. 2023 US Department of Housing and Urban Development, Client Consent Form: Informed Consent (Sample), HMIS Client Consent Form: Informed Consent Agreement (Sample). Click HERE to download the videos PowerPoint slides, HMIS Standard Reporting Terminology Glossary, Household DHS HS Exit - Housing and Supportive Services, Family and Youth Services Bureau (FYSB)Website, HUD- ESG HMIS User Guide for Night-by-Night Emergency Shelter, Homework Starts with Home Data Entry Demo. stream Find point of contact information for HUD's grantees. Client consent will end seven years after the signaturedate by default; however, clients may also changetheir consent to share at any time. Form 1119 - Consent To Share Protected Personal Information (English) Share: . A consent form gives written permission to another party to perform an activity or host an event, indicating that the signatory understands the associated terms and cannot hold the other party liable for any injury or harm. Copyright 2020 Institute for Community Alliances. EGMS (LAHSA staff) EGMS All . Kitsap's data-sharing system provides benefits such as improved client . Ask a basic policy or reporting system question. Meeting Attendance Policy, FAQ for Service Providers who do not administer the VI-SPDAT, FAQ for Victim Service Providers (VSPs) who administer the VI-SPDAT, FAQ for Providers who administer the VI-SPDAT, Housing Problem Solving HMIS Quick Guide (, HPS Summary Form Participant Check Request (, Housing Problem Solving Minimal Intake Form (. Legislative Affairs MyOrg. All Rights Reserved. A list of agencies participating in HMIS that may have access to your information if you sign this authorization is at . Guidance included in the following documents aligns with HMIS requirements as stated by the Substance Abuse and Mental Health Services Administration (SAMHSA): The following entry/assessment and corresponding exit forms are intended to capture specific program requirements in each category: adults, youth and children. I consent to allow my basic identifyinginformation, and that of my minor children (if applicable, as listed below), to be shared via the GA HMIS; however, I wish to limit the sharing of other information as specified in the Client Consent to Share Information - Supplemental form. Household DHS HS Entry - Housing and Supportive Services, Household DHS HS Interim - Housing and Supportive Services, Household DHS HS Exit - Housing and Supportive Services, Single DHS HS Entry - Housing and Supportive Services, Single DHS HS Interim- Housing and Supportive Services, Single DHS HS Exit - Housing and Supportive Services, Household DHS HS Entry - Emergency Shelter, Household DHS HS Exit - Emergency Shelter, Instructions: Last Updated August 15, 2022, DHS-HS HMIS User Guide for Housing and Supportive Services, DHS-HS HMIS User Guide for Emergency Shelter, Maia Uhrich: Housing and Support Services, Household LTHSSF Entry: Doc | Fillable PDF, Household LTHSSF Interim: Doc | Fillable PDF, Household LTHSSF Exit: Doc | Fillable PDF, Single LTHSSF Interim: Doc | Fillable PDF, Household SOR Entry - Street Outreach Projects: Doc | Fillable PDF, Household SOR Entry - Services Only Projects: Doc | Fillable PDF, Household SOR Interim: Doc | Fillable PDF, Single SOR Entry - Street Outreach Projects: Doc | Fillable PDF, Single SOR Entry - Services Only Projects: Doc | Fillable PDF, Instructions: Last Updated August 17, 2022, Household ESP Entry - Emergency Shelter & Street Outreach Projects: Doc | Fillable PDF, Household ESP Entry - All Other Project Types: Doc | Fillable PDF, Household ESP Interim: Doc | Fillable PDF, Single ESP Entry - Emergency Shelter & Street Outreach Projects: Doc | Fillable PDF, Single ESP Entry - All Other Project Types: Doc | Fillable PDF, DHS-OEO ESP HMIS User Guide for Rapid Rehousing and Homelessness Prevention, DHS-OEO ESP HMIS User Guide for Emergency Shelter and Street Outreach, Katelyn Warburton, State Program Administrator: katelyn.warburton@state.mn.us, Rabya Hassen,Homeless Grant Program Manager: Rabya.N.Hassen@state.mn.us, Household THP Interim: Doc | Fillable PDF, Instructions: Last Updated August 12, 2022, Annie McCabe, Homeless Grant Program Manager: Ann.E.McCabe@state.mn.us, PATH Street Outreach (SO) Entry-Exit Form: Doc | Fillable PDF, PATH Street Outreach (SSO) Entry-Exit Form: Doc | Fillable PDF, RHY Single Entry/Exit Combined - BCP-Prevention/TLP/MGH Programs: Doc | Fillable PDF, RHY Single Entry/Exit Combined - BCP-Emergency Shelter Programs: Doc | Fillable PDF, RHY Single Entry/Exit Combined - Street Outreach Programs: Doc | Fillable PDF, Family and Youth Services Bureau (FYSB)Website, Household HUD CoC Entry: Doc | Fillable PDF, Household HUD CoC Interim: Doc | Fillable PDF, Household HUD CoC Exit: Doc | Fillable PDF, Single HUD CoC Interim: Doc | Fillable PDF, Household ESG Entry - Emergency Shelter & Street Outreach Projects: Doc | Fillable PDF, Household ESG Entry - All Other Project Types: Doc | Fillable PDF, Household ESG Interim: Doc | Fillable PDF, Single ESG Entry - Emergency Shelter & Street Outreach Projects: Doc | Fillable PDF, Single ESG Entry - All Other Project Types: Doc | Fillable PDF, Instructions: Last Updated November 2, 2022, HUD-ESG HMIS User Guide for Homelessness Prevention and Rapid Rehousing, HUD-ESG HMIS User Guide for Emergency Shelter and Street Outreach, HUD- ESG HMIS User Guide for Night-by-Night Emergency Shelter , Household HOPWA Entry - Emergency Shelter & Street Outreach Projects: Doc | Fillable PDF, Household HOPWA Entry - All Other Project Types: Doc | Fillable PDF, Household HOPWA Interim: Doc | Fillable PDF, Singles HOPWA Entry - Emergency Shelter & Street Outreach Projects: Doc | Fillable PDF, Singles HOPWA Entry - All Other Project Types: Doc | Fillable PDF, Singles HOPWA Interim: Doc | Fillable PDF, Hennepin County Single YHDP Entry/Exit Combined, Household VASH Entry/Exit Combined: Doc | Fillable PDF, Household VASH Interim: Doc | Fillable PDF, Single VASH Entry/Exit Combined: Doc | Fillable PDF, Household FHPAP Entry: Doc | Fillable PDF, Household FHPAP Interim: Doc | Fillable PDF, Household FHPAP Entry/Exit Combined: Doc | Fillable PDF, Single FHPAP Entry/Exit Combined: Doc | Fillable PDF, Street Outreach Single FHPAP Entry/Exit Combined: Doc | Fillable PDF, Instructions: Last Updated September 27th, 2022, Minnesota Homeless Prevention Assessment Tool (M-PAT) Guide, Household HSWH Interim: Doc | Fillable PDF, Instructions: Last Updated November 7, 2022, Homework Starts with Home HMIS User Guide, Videos: Homework Starts with Home Data Entry Demo, Household LTH Interim: Doc | Fillable PDF, High-Priority Homeless Form Instructions (video), Instructions:Last Updated August 15, 2022, Household MN Universal Entry - Emergency Shelter and Street Outreach Projects: Doc | Fillable PDF, Household MN Universal Entry - All Other Project Types: Doc | Fillable PDF, Household MN Universal Interim: Doc | Fillable PDF, Household MN Universal Exit: Doc | Fillable PDF, Single MN Universal Entry - Emergency Shelter and Street Outreach Projects: Doc | Fillable PDF, Single MN Universal Entry - All Other Project Types: Doc | Fillable PDF, Single MN Universal Interim: Doc | Fillable PDF, Single MN Universal Exit: Doc | Fillable PDF, Hennepin Single Adult Shelter Instructions: Last Updated November 1st 2022, HCC Shelter Training: Checking-in a Client with an ASC Reservation, HCC Shelter Training: Managing Clients in ShelterPoint, Hennepin Single Adult Shelters (for both night-by-night and extended stay programs), General ShelterPoint Instructions: Last Updated January 7th, 2022. Information collected in the HMIS database is protected in compliance with the standards set forth in the Health Insurance Portability and Accountability Act (HIPAA) and the U.S. Department of Housing and Urban Development HMIS Data Standards. Register for upcoming training, webinars, conferences, and more. For technical support contact nevada@bitfocus.com. This document can be used as a community example, but it has not been approved or endorsed by HUD. Health Management Information Systems (HMIS) are one of the six building blocks essential for health system strengthening. San Diego uses the software Clarity (distributed by . Click here to see examples of completed ROIs. HMIS Administrative Documents - Use and Bookmark our ServicePoint link hmisncceh.servicept.com! This means the agency representative signature must still be present. Consent' form with this agency. KING COUNTY HMIS - CLIENT CONSENT TO DATA COLLECTION AND ROI- Jan 2020 King County Homeless Management Information System (HMIS) . All people have a home. Client Consent and the HPAT: What can I enter into HMIS? Click here to fill out a new Provider Request Form. Veterans By Name. See our Training page for more details on how to sign up for HMIS trainings. Continuum of Care. FileShare. HMIS Privacy Policy- The goal of HMIS Privacy Policies and Procedures is to ensure confidentiality and security of all client data captured in HMIS in conformity with all current regulations related to privacy and data confidentiality rights. There is a clear purpose, as well as use limitations. and my refusal to consent does not disqualify me from receiving services. While the general HMIS ROI does not require a written signature, there may be other data privacy and sharing requirements in effect that are specific to your agency. Find answers to frequently asked questions. WI HMIS includes your demographic information and other essential personal information needed to best determine your service needs. A Client Consent to Data Collection and Release of Information (ROI) must be completed for each client who consents to have their personally identifying information (PII) entered into the King County HMIS System. A signature is not required on the generalHMIS ROIand agencies can document that verbal consent has been obtained from the client by indicating this on the signature line. The client cannot be denied services based on refusal to share data. Homeless Count. The amount of information shared can also vary from provider-to-provider within one community depending on the needs of the agencies involved and the wishes of the clients they serve. Client Informed Consent is a blanket document that indicates the client wishes to share all identifying information . 'Client Revocation of Consent' form with this agency. HMIS Help Desk. Tourist Development Forms. Resource Management System. Client-level data: Data about an individual HMIS client. In place of the client signature, the words "Verbal Consent" must be written or typed. Partners In Care, 200 N Vineyard Blvd Suite A-210, Honolulu. PA HMIS Collaborative Client Consent Release of Information via PA HMIS If I decline to release my information, it will be hidden from all other PA HMIS participating agencies, except in the case of a referral. Forms & Documents for Agency Administrators, Santa Clara County CoC Continuous Data Quality Improvement Process, VI-SPDAT (Replaces H1K Vulnerability Index), Justice Discharges VI-SPDAT (JD-VI-SPDAT), SPDAT Forms (Replaces Self-Sufficiency Matrix), Homeless Prevention Assessment Tool (HPAT), Homeless Prevention Services Program (HPS), HHS Runaway and Homeless Youth Program (RHY), SAMHSA Projects for Assistance in Transition from Homelessness (PATH), Clarity HMIS: HUD-CoC Congregate NCV Program Intake (Back Data Entry), Santa Clara County Community Queue Referrals - Standard Location Practices, Domestic Violence, Sexual Assault, and Human Trafficking Pre-Screening Tool and Referral Guide, How to Create an Anonymous Client Profile, How To Fix Common Annual Assessment Errors, Victim Services Screening Tool and Training, How to ask well-being questions in PSH Enrollment, Bed and Unit Inventory (BUI) Update Form (2021), 2022 HMIS Data Standards- Data Dictionary, HMIS Standard Operating Procedures (SOPs), SCC HMIS Partner Agency Privacy and Data Sharing Agreement, Technical Administrator and Security Officer Agreement, SCC HMIS Quarterly Compliance Certification Checklist, SCC HMIS Quarterly Compliance Self Certification, Santa Clara County Agency Admin. Effective Wednesday, July 5, 2017, all Homeless Providers contributing data into HMIS are required to use this new form. BTG Client Informed Consent Form (Jun 2018) BTG Authorized Agency List (Apr 2021) HUD FAQ HMIS Sample Forms Clarity Human Services Help Center 2022 Data Standards 2022 Data Standards HMIS Sample Forms The HMIS sample forms below are specific to each program listed. Policy. Before a request is made, please review the reports page of this website and the set of existing reports that are currently available in the system. For system administration questions contact nevada-admin@bitfocus.com. Explore featured publications and browse regulations, policy guidance, toolkits, and other resources. Client Informed ConsentEach client must sign this form to consent to, or deny, the collection of his or her personally identifying information; form should be available in other languages as needed. Ask a basic policy or reporting system question. ICAs latest ShelterPoint videos can be found on our Moodle site or by clicking on this link. The Housing and Homeless Coalition of Central New York (HHC) serves the City of Syracuse, the County of Onondaga, the City of Auburn, the County of Cayuga and the County of Oswego. Form 1119 - Consent To Share Protected Personal Information (English) Share: . KMNH has developed an extensive collection of reports and dashboards that may already meet your needs. www . Your consent allows your record to be updated by any participating organization with which you interact without you being required to sign another consent form. When does client consent end? The document informs clients about services, fees, records, and limitations that may affect the client. Welcome to HMIS! There are well-defined data collection procedures and limitations. Explore featured publications and browse regulations, policy guidance, toolkits, and other resources. Dependent children under 18 in household, if any (Please print first and last names): . HMIS -Homeless Management Information System. Homeless Programs Reporting ScheduleCheck out this resource for information on upcoming report deadlines. food pantry. In general, client consents requiring amendments would necessitate obtaining client consent (again) for the amended sections. 1 MB Download. All requests are subject to review by KMNH and the BTG BOD to assess complexity, feasibility, and to ensure that BTGs privacy standards are upheld. It can mean HMIS system visibility that is very focused and specific or very general and broad. A In general, HMIS standards do not stipulate what form of consent must be obtained to share data within HMIS. CNY HMIS Policy and Procedures Updated 2018, HMIS Agency Partnership Agreement Updated 2017, CNYHMIS Client Consent Form Updated 7-2019, CNYHMIS User License Request / Training Request, Intake Assessment Forms Updated 10/2021, PDF Format. You have the right to receive a copy of this consent form. Procedure: Projects, unless otherwise exempted, must obtain a signed Client Informed Consent to Share and Release of Information form from every head of household who will be entered into HMIS. This is an example of an informed consent agreement. 2016 The Housing and Homeless Coalition of Central New York. 2. Policy. 7.2020 Forms & Documents for Agency Administrators SCC HMIS Partner Agency Privacy and Data Sharing Agreement Revised 01.12.2023 Technical Administrator and Security Officer Agreement version 10.21.2021 Electronic End User Agreement version 01-29-2020 Learn through self-paced online trainings, recorded webinars, and more. Learn about what HUD grantees are doing across the nation. The document informs clients about services, fees, records, and limitations that may affect the client. End User Best Practices Cheat SheetTips and reminders for HMIS users. This copy is a sample. Approval of data requests and applicable fees will be determined by the BTG BOD. ICA's . MEASURE Evaluation worked in Ethiopia to implement a HMIS in the Southern . *, If a project will operate in more than one Continuum of Care (CoC), you will need to complete one form for EACH CoC of service.*. Download the Client Consent and Supplemental Form. $('.panel-collapse').on('show.bs.collapse', function () {
Homeless Management Information System (HMIS). DCED Library Homeless Management Information System (HMIS) - Intake Form. HMIS Policies and Procedures Manual(Revised 03/2022), *If your agency already participates in HMIS and needs to add an additional project to HMIS, use the New Agency/Program Set-Up Form and select Yes for Is your agency already participating in the Orange County HMIS?, Erin DeRycke HMIS Documents | The Housing and Homeless Coalition of Central New York HMIS Documents For assistance with HMIS, email HMIS@unitedway-cny.org E-Forms: User License Request Form New User Ethics Agreement Policies and PDF Forms CNY HMIS Policy and Procedures - Updated 2018 HMIS Agency Partnership Agreement - Updated 2017 Homeless Count. - Click HERE to download the videos PowerPoint slides. Client Informed Consent FY 2021-2022. Learn about what HUD grantees are doing across the nation. Explore collections of guided learning opportunities on a variety of topics. CNYHMIS Client Consent Form Client Name: _____ Date of Birth:_____ Agency: _____Program: _____ I know that this agency is part of the CNY HMIS (Homeless Management information System). I can receive a copy of this Consent and the Client Information Sheet I may refuse to sign this Consent. Continuum of Care. HMIS Resource If you would like to get more technical support on the Homeless Management Information System (HMIS) please visit the OC HMIS Help Desk Knowledge Base . HMIS Client Informed Consent Client Release of Information and Informed Consent IMPORTANT: Do not enter personally identifying information into HMIS for clients who are: 1) in DV agencies or; 2) currently fleeing or in . Below are some of the aspects of data sharing: If data are shared with the goals below, it is anticipated that agencies will be able to see how the network of services are working and performing, where improvements are needed, and whether households are becoming stable. The documents have not been reviewed by HUD or its contractors for applicability, legality, or compliance with federal statutory and regulatory guidelines. Either the Client Informed Consent form or the Client Release of Information form is required to be completed by clients who are allowing their information to be shared in Pinellas HMIS. Data sharing is the ability to transfer data from one agency to another electronically through HMIS. Decisions regarding permitted types of consent (inferred, written, verbal, etc.) Helpdesk - Homeless Management Information System (HMIS) Privacy Policy and Client Consent Form Privacy Policy and Client Consent Form Each client receiving services from an agency using HMIS must have access to the privacy policy and client consent for data sharing form. With your consent, your personal information, including historical information in HMIS, will be made available to other agencies providing services to you through HMIS. People New. You have the right to see your information in the HMIS, ask for changes, or ask for a printed copy upon request. To download the consent form, you can simply click on the preview pictures below. 2 The FY 2022 HMIS Data Standards have an effective date of 10/1/2021. Phone: 502-564-7630; (800) 633-8896 (KY only); ext. }), Presidents Day - Mon, Feb 20, 2023Prince Kuhio Day - Fri, Mar 24, 2023 (Observed)Memorial Day - Mon, May 29, 2023, Copyright 2023 Bridging The Gap Hawaii |, Prince Kuhio Day - Fri, Mar 24, 2023 (Observed), BTG Client Informed Consent Form (Jun 2018), BTG Custom Data or Report Request Form (Apr 2019), HPO Memo Re: Consent to Share Privacy Forms - 11.1.17, BTG HMIS New User Agreement and Training Request Form (Feb 2020), BTG Duplicate Client ID Merge Form (Jul 2018), FY 2022 HMIS Data Standards Manual (Sep 2021), PATHHMISProgram Specifications (Jun 2019), Adult - TH, RRH, Non-CoC Program Funded PSH & HP, Adult - ES, TH, RRH, & Non-CoC Program Funded PSH, BTG Additional Family Member Form (Sep 2021), BTG SPDAT Individual Assessment (Nov 2020), BytePages Content Management System Powered by Byte Productions. HMIS Privacy & Data Sharing Overview - Client Consent Form attached at the bottom What does it mean to share data? A Homeless Management Information System (HMIS) is a secure online database that stores data on all homelessness services that are provided in Santa Clara County. We are the organized body of informal networking and formal linkages between homeless services providers and other public and private human service providers. The Vulnerability Index Service Prioritization Decision Assistance Tool (VI-SPDAT) was developed by OrgCode Consulting and is a triage survey administered to homeless individuals and families that helps to determine acuity of need and prioritization of BTG's housing resources and supportive services. Housing Extension. Request to waive penalty. Online Fillable Client Consent to Data Collection and ROI (2020) Client Revocation of Consent (2019) (Click here to also access this form in other languages). Intergovernmental Review-EO 12372. Capacity Building. Identifying Information stored in the HMIS will not be given to anyone outside the system without written consent, except as required by law through a court order or in the event of a public health emergency. HMIS Project Set Up Form HMIS Grant Set Up Form HMIS Bed & Unit Inventory Update Form HMIS User Access Request Form New User Request Form User Policy Responsibility Statement HMIS Client Consent & ROI Client Informed Consent & Release of Information (English) Client Informed Consent & Release of Information (Spanish) HMIS CES Verification Form The HMIS team is a funded as a project through the collaborative COC grant funds received from HUD. SAP BusinessObjects User SettingsThis video demonstrates how all users should configure their BusinessObjects account settings. HMIS Client Consent Form: Informed Consent Agreement (Sample) Print ShareThis Date Published: June 2011 Description This is an example of an informed consent agreement. All questions must have an answer in order to save - please choose N/A where needed. The form can be signed two ways: 1. Grantees and their partners should go through their own process to develop Signing this consent form does not guarantee you services. The following forms must be completed and submitted to the HMIS admin team if new users require access to the system or if duplicate clients require merging. wisp@icalliances.org Log into Service Point . Request in-depth assistance with implementing a HUD-funded program. System Administration provided by Bitfocus, Inc. contact the HMIS System Administrator at 425-388-3270. One of these forms must be completed for EACH funding source/grant within the agency project that will be using HMIS. I understand that I may obtain a copy of my signed consent . FileShare. })
Funding. While the general HMIS ROI does not require a written signature, there may be other data privacy and sharing requirements in effect that are specific to your agency. If you have any further questions, please contact ourHelpdesk! Data sharing is a comprehensive term used differently in each community where it is implemented. Mailing address change. Welcome to the Housing Contract Administration Partner Agency Portal. Don't Miss: Corpus Christi Food Bank Donation. Categories: Homeless Management Information System (HMIS) File Type: Download: 290: Size: 0.00 KB: Create Date: January 1, 1970: Last Updated: November 15, 2016: File Action; HMIS_Client_Consent_Form_10-26-2016 Connections for the Homeless (Connections) is a partner in the Northeast Illinois Homeless Management Information System . If you have any questions, please submit a request and a Training and Development Specialist or KYHMIS Specialist will respond. Visit the FY 2022 HMIS Data Standards Changes page. Register for upcoming training, webinars, conferences, and more. This consent form expires in three (3) years, meaning that any data collected after that time will require an updated consent form before that data will be shared. View our Bed and Unit Number Calculation Guide. It allows the Agency to use HMIS, assigning rights to user licenses. The Statewide HMIS Data Committee and HMIS Lead recently approved the use of a new HMIS consent to share form. LB HMIS Consent & LB ROI Page 1 of 4 Revision 20201110v5 . The Homeless Management Information System, or HMIS, is an electronic data management system that provides vital insights on homelessness to our agency partners, while helping Calgary Homeless Foundation allocate resources for highest impact and outcomes. `RQ$7;k+g?Ew?J?=T'{z%QqRdO}EI;a[mq]l[ Find award and allocation amounts for grantees by year, program, and state. HMIS Client Informed Consent Client Release of Information and Informed Consent IMPORTANT: Do not enter personally identifying information into HMIS for clients who are: 1) in DV agencies or; 2) currently fleeing or in danger . Tourist and convention development tax return (for registered taxpayers only) Once completed and signed, please fax or mail to the number or address on the form. If you have any questions and/ or are a part of a participating agency that needs assistance utilizing HMIS, please contact the HMIS Help Desk at 410.396.HMIS (4647) or email HMIS Support. The Baltimore City Mayor's Office of Homeless Services serves as the HMIS Lead Agency for the Baltimore City Continuum of Care. This form allows the Institute for Community Alliances (ICA) to configure data collection appropriately for agencies in the database. HMIS. Housing Extension. HMIS Other than Other Exits - Exit Destinations for HMIS projects are varied, but can generally be captured by one of the 30+ available destinations.