Form HUD-PRL Participant Record-level Report

Office of Strategic Planning and Management

Grants Management and Oversight

OMB Control Number xxxx-xxxx
Expiration Date xx/xx/xxxx

U.S. Department of Housing and Urban Development
Participant Record-level Report (PRL)
General Reporting Instructions and Specifications for Discretionary
Grants

2016

This reporting requirement is approved under the Paperwork Reduction Act of 1995, OMB Control No.
xxx-xxxx, expiring xx/xx/xxxx. Persons are not required to respond to this collection of information
unless it displays a currently valid OMB number. Public reporting burden for this collection is estimated
to average xxx,xxx hours per year. This estimate includes the burden to collect data that the respondent
would not otherwise collect as part of its usual and customary practice or as part of its EEO requirements.
The respondent’s obligation to reply to this information request is codified in "Administrative Provisions"
located at 42 USC 3535(r). The reasons for the collection and reporting of information are general program
oversight, evaluation, and performance assessment. Send comments regarding this burden estimate or
any other aspect of this collection, including suggestions for reducing this burden, to the U. S. Department
of Housing and Urban Development, Office of Strategic Planning and Management, Grants Management
and Oversight, 451 7th Street, S.W., Room 3156, Washington, D.C. 20410 (Paperwork Reduction Project
xxxx-xxxx).

Page 1

Office of Strategic Planning and Management

I.

Grants Management and Oversight

GENERAL INSTRUCTIONS
Using the instructions included in this document, respondent grantees are
required to maintain record-level reports containing characteristics, services,
benefits, and outcome information for all individuals who receive services or
benefits financially assisted by U.S. Department of Housing and Urban
Development (HUD) programs funded on a competitive basis. These
competitively awarded grants are also referred to as discretionary grants in
this document.
The primary purposes of the Participant Record-level report (PRL) are to:
1. Establish a standardized set of data elements, definitions, and
specifications that can be used to describe the characteristics, activities,
benefits, and outcomes of individuals who directly benefited from or were
served by HUD discretionary grant-funded programs;
2. Improve the comparability of the resulting information through the use of
common definitions;
3. Facilitate the collection and reporting of accurate, consistent, and complete
information on an individual in order to support the overall management,
evaluation, and continuous improvement of the programs at the grantee,
sub-grantee, and Federal levels; and
4. Share program performance results with taxpayers, Congress, and other
stakeholders with an interest in HUD discretionary grant programs in
order to demonstrate the accountability of Federal stewardship of
taxpayer resources.
Additionally, standardized data collection and reporting helps HUD justify
programs and their costs when developing budgets sent to Congress for
consideration. The public, Congress, and Office of Management and Budget
(OMB) are increasingly taking a more "results-oriented" look at government
programs, and the cost-effectiveness of program expenditures is increasingly
being called into question. In an era of shrinking Federal budgets,
demonstration of good performance and sustainable public impacts with
positive results help justify programs and their costs.
In developing the PRL, every effort has been made to establish common data
element definitions and formats while minimizing the collection burden to
respondent grantees. The PRL provides each discretionary grantee with the
Page 2

Office of Strategic Planning and Management

Grants Management and Oversight

opportunity to better inform the Administration, Congress, and other
stakeholders about the numbers of individuals being served or directly
benefiting from the grant, the types of services and benefits received, and the
outcomes and impacts of grant participants. The record-level report
establishes a core set of data that must be collected and maintained by
grantees.
II.

COVERED PROGRAMS
Respondent grantees administering competitively awarded HUD grants that
receive funding for fixed or known periods to carry out specific projects that
serve or benefit grant-eligible individuals must utilize the PRL specifications
and general reporting instructions. These competitively awarded grant funds
include fellowships, scholarships, research grants, training grants,
traineeships, experimental and demonstration grants, evaluation grants,
planning grants, technical assistance grants, capacity building grants, survey
grants, and construction grants.
Competitively awarded grants made through the following HUD programs
are covered under the PRL reporting requirements:












Titles I [42 U.S.C. 1437 et seq.] and II of the United States Housing Act
of 1937;
Section 202 of the Housing Act of 1959 [12 U.S.C. 1701q];
Section 106 of the Housing and Urban Development Act of 1968 [12
U.S.C. 1701x];
The Fair Housing Act [42 U.S.C. 3601 et seq.];
Title I [42 U.S.C. 5301 et seq.] and section 810 1 of the Housing and
Community Development Act of 1974;
Section 201 of the Housing and Community Development
Amendments of 1978 [12 U.S.C. 1715z–1a];
The Congregate Housing Services Act of 1978 [42 U.S.C. 8001 et seq.];
Section 222 of the Housing and Urban-Rural Recovery Act of 1983;
Section 3616a of 42 USC;
Title IV of the McKinney-Vento Homeless Assistance Act [42 U.S.C.
11360 et seq.]; and
Titles II [42 U.S.C. 12721 et seq.], III and IV and section 811 [42 U.S.C.
8013] of the Cranston-Gonzalez National Affordable Housing Act.

Each respondent grantee should review the HUD Notice of Award to become
familiar with the specific programmatic reporting requirements outlined in
Page 3

Office of Strategic Planning and Management

Grants Management and Oversight

the Terms and Conditions that apply to the grant program. The Terms and
Conditions will provide more detailed information on the applicable required
data elements to be collected and reported as part of the grant award.
Individuals Included in the PRL
It is important to underscore that an individual data record must be created
and submitted for each grant-eligible individual who directly receives benefits
and/or services financially assisted by one or more competitively awarded
HUD discretionary grants. A grant-eligible individual is an adult, youth who
is 14 years of age or older, or an unaccompanied homeless youth at the time of
service initiation who receives grant-funded services and/or benefits and who
is determined to meet the eligibility criteria outlined in the grant award.
Please note that some grants may provide universally-accessible services
available to all individuals. The individuals receiving universally-accessible
services through these grants are also considered to be eligible for services and
are to be included in the PRL. Parents or guardians are to provide information
for children under the age of 18 receiving grant-funded services.
Exclusions from the PRL
HUD-funded research or technical studies grants, planning grants, technical
assistance, and capacity building grants not providing direct benefits or
services to individuals are excluded from the PRL reporting requirement. For
a grant required to submit a PRL, individuals who receive information-only
services under the grant are excluded from the PRL. For the purposes of the
PRL, information-only services are products and activities delivered to
individuals that are designed to inform and educate an individual about HUD
programs and benefits only (e.g., outreach materials and related activities,
application or registration activities, and eligibility determination services).
Continuum of Care discretionary grants authorized under the Mc KinneyVento Homeless Assistance Act and Choice Neighborhood discretionary
grants subject to section 24 of the United States Housing Act of 1937 are also
excluded from the PRL requirements.

Page 4

Office of Strategic Planning and Management

III.

Grants Management and Oversight

REPORT LAYOUT SPECIFICATIONS
The PRL follows a comma separated value (CSV) format, an extensible markup
language (XML) format, or an Excel format. See Appendix A for details
regarding data elements, definitions, coding values, and data element field
lengths included in an individual PRL report.
As shown in Appendix A, the respondent grantee’s collection and reporting
of the required data elements depends on the type and nature of the grant
and on the types of services received by individuals. For each PRL data
element there is a name, description, response option (coding value), and
listing of applicable HUD programs.
Data collection and reporting requirements increase according to the type of
customer, intensity of services, or the extent of benefits received by the
individual. In other words, the data included in the PRL only expands as the
customer receives additional services and benefits in order to achieve
desired performance outcomes. Coding values and the applicability
contained within Appendix A (Chart B) are essential components that place
each data element in its proper context. Additional guidance regarding the
collection and reporting of equal opportunity information can be found in
Appendix B.

IV.

DUE DATE
Electronic PRL files are due to HUD no later than 30 days after the end of
each report period. The final PRL submission is due no later than 90 days
after the end of the grant’s period of performance. The table below shows
the expected due dates.
Report Period

Due Dates

October - September

October 30

Final Submission

Within 90 Days of the
End of the Grant

Should the date of the report fall on a Saturday or Sunday, the PRL files are
due the Friday before the due date.

Page 5

Office of Strategic Planning and Management

V.

Grants Management and Oversight

SUBMISSION PROCEDURES
Information contained in the PRL files must be submitted or inputted directly
to an online portal via technical instructions available through the appropriate
Regional Office or the HUD website.
Individuals must be tracked annually until the grant ends. Updated reports
must be provided in each subsequent submission until all relevant outcome
information is completed or the end of the grant has been achieved.
A PRL must be provided annually. The final submission is due within 90 days
of the end of the grant.

Page 6

Office of Strategic Planning and Management

Grants Management and Oversight

APPENDIX A
PARTICIPANT RECORD-LEVEL REPORT SPECIFICATIONS

Page 7

OMB Approval Number: 2501-XXXX
Expiration Date: MM/DD/YYYY

Participant Record-level Information
Key for Applicable HUD Programs: Family Self-Sufficiency (FSS); Jobs Plus (Jobs+), Juvenile Re-entry Assistance
Program (JRAP), Housing Counseling (HC), Housing Opportunities for Persons with AIDS (HOPWA), Lead Based
Paint Hazard Control (LBPHC), Lead Hazard Reduction Demo (LHRD), Multifamily Housing Service Coordinator (MFSC),
Resident Opportunity and Self-Sufficiency Service Coordinators Program (ROSS), Section 202 Supportive Service Demo
(202).
Indicator
1
Number

Data Element
Name

Data Element Description

Response Options

N/A

Grant Number

The unique number identifying the
grant.

N/A

Grantee DUNS
Number

N/A

Grant
Appropriation
Fiscal Year

The unique number identifying
the grants as listed in award
document.
The unique, non-indicative
identifier issued by D&B and
used by sam.gov to verify
business entity.
The year of appropriation for the
Federal funds awarded.

The year of appropriation in a YYYY
format.

FSS, Jobs+, JRAP, HOPWA,
202, ROSS, HC, LBPHC,
LHRD, MFSC

N/A

Catalog of Federal
Domestic
Assistance Number
Reporting Period
Beginning Date

The 5-digit CFDA number for the
grant award.

The CFDA number in a XXXXX
format. Omit the period (.)

The begin date for the reporting
period.

The beginning date for the
reporting period in YYYY-MM-DD
format.

FSS, Jobs+, JRAP, HOPWA,
202, ROSS, HC, LBPHC,
LHRD, MFSC
FSS, Jobs+, JRAP, HOPWA,
202, ROSS, HC, LBPHC,
LHRD, MFSC

N/A

Reporting Period
End Date

The end date for the reporting
period.

The ending date for the reporting
period in a YYYY-MM-DD format.

FSS, Jobs+, JRAP, HOPWA,
202, ROSS, HC, LBPHC,
LHRD, MFSC

N/A

Person Identifier

The unique record identification
code for the individual person
(participant) assigned by the
grantee.

Grantee assigned alpha-numeric
identifier. Do not use SSNs or a
combination of personally
identifying characters.

FSS, Jobs+, JRAP, HOPWA,
202, ROSS, HC, LBPHC,
LHRD, MFSC

N/A

Household
Identifier

The unique record identification
code for the individual's
household assigned by the
grantee.

The alpha-numeric identifier
assigned to the individual's
household by the grantee.

FSS, Jobs+, JRAP, HOPWA,
202, ROSS, HC, LBPHC,
LHRD, MFSC

N/A

Applicable HUD Programs

The 9-digit DUNS number assigned
to the grantee's business. Omit
dashes (-).

FSS, Jobs+, JRAP, HOPWA,
202, ROSS, HC, LBPHC,
LHRD, MFSC
FSS, Jobs+, JRAP, HOPWA,
202, ROSS, HC, LBPHC,
LHRD, MFSC

A household includes all the people who occupy a housing unit. (People not living in households are classified as living in group
quarters.) A housing unit is a house, an apartment, a mobile home, a group of rooms, or a single room that is occupied (or if
vacant, is intended for occupancy) as separate living quarters. Separate living quarters are those in which the occupants live
separately from any other people in the building and which have direct access from the outside of the building or through a
common hall. The occupants may be a single family, one person living alone, two or more families living together, or any other
group of related or unrelated people who share living arrangements.
Data Collection
The date that data is collected
The date that data is collected in a
FSS, Jobs+, JRAP, HOPWA,
Date
for the individual record.
YYYYMMDD format.
202, ROSS, HC, LBPHC, LHRD,
MFSC
Age
The age in years of the
The age in years of the individual as
FSS, Jobs+, JRAP, HOPWA,
individual as of the data
of the data collection date.
202, ROSS, HC, LBPHC, LHRD,
collection date.
MFSC

N/A

N/A

1

N/A includes demographic and other descriptive attributes of interest.

1
HUD XXXX - Approved MM/DD/YYYY

OMB Approval Number: 2501-XXXX
Expiration Date: MM/DD/YYYY

Indicator
1
Number

Data Element
Name

Data Element Description

Response Options

Applicable HUD Programs

N/A

Gender Code

The gender for the participant.

1 = Male.
2 = Female.
3 = Transgendered Male to Female.
4 = Transgendered Female to Male.
5 = Other.
88 = Individual refused.
99 = Individual does not know.

FSS, Jobs+, JRAP, HOPWA,
202, ROSS, HC, LBPHC, LHRD,
MFSC

N/A

Ethnicity Code

The self-identified ethnicity of
the participant

FSS, Jobs+, JRAP, HOPWA,
202, ROSS, HC, LBPHC, LHRD,
MFSC

N/A

Race Code

The self-identified race of the
participant. Multiple choices
may be selected.

1 = Hispanic/Latino.
2 = Not Hispanic/Latino.
88 = Individual refused.
99 = Individual does not know.
1 = American Indian or Alaska
Native
2 = Asian
3 = Black or African American. 4 =
Native Hawaiian or Other Pacific
Islander
5 = White
88 = Individual refused
99 = Individual does not know.

FSS, Jobs+, JRAP, HOPWA,
202, ROSS, HC, LBPHC, LHRD,
MFSC

American Indian or Alaska Native = person having origins in any of the original peoples of North America and South America
(including Central America), and who maintains cultural identification through tribal affiliation or community recognition.
Asian = person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent (e.g.,
India, Pakistan, Bangladesh, Sri Lanka, Nepal, Sikkim, and Bhutan).
Black or African American = person having origins in any of the black racial groups of Africa.
Native Hawaiian or Other Pacific Islander = person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other
Pacific Islands. It includes people who indicate their race as “Native Hawaiian,” “Guamanian or Chamorro,” “Samoan,” and
“Other Pacific Islander” or provide other detailed Pacific Islander responses.
White = person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
N/A

N/A

N/A

Head of Household
Code

The individual is an adult who is 1 = Yes.
FSS, Jobs+, JRAP, HOPWA, 202,
considered the head of
2 = No.
ROSS, HC, LBPHC, LHRD, MFSC
household for purposes of
88 = Individual refused.
determining income eligibility
99 = Individual does not know.
and rent.
The head of household is responsible for ensuring that the household fulfills all of its responsibilities under the program, alone
or in conjunction with a co-head or spouse. The household may designate any qualified household member as the head of
household. The head of household must have the legal capacity to enter into a lease under state and local law. A minor who is
emancipated under state law may be designated as head of household.
Residence Census
The 11-digit census tract
The 11-digit code for the
FSS, Jobs+, JRAP, HOPWA, 202,
Tract
number for the residence of
census tract for the
ROSS, HC, LBPHC, LHRD, MFSC
the individual.
individual's residence.
The Census Bureau has developed an online tool for converting physical addresses to census tract numbers
(http://factfinder2.census.gov/faces/nav/jsf/pages/searchresults.xhtml?ref=addr&refresh=t#none). Homeless individuals may
designate a fixed location as their residence for identification purposes. This location may be a homeless shelter, or other
location where a homeless individual may spend time or return to for sleep.
Veteran Status
The individual who initiated
1 = Yes
FSS, Jobs+, JRAP, HOPWA, 202,
Code
services under this grant is a
2 = No
ROSS, HC, MFSC
person who served on active
88 = Refused.
duty in the armed forces and
99 = Does not know
was discharged or released
from such service under
conditions other than
dishonorable.

2
HUD XXXX - Approved MM/DD/YYYY

OMB Approval Number: 2501-XXXX
Expiration Date: MM/DD/YYYY

Indicator
1
Number

Data Element
Name

Data Element Description

Response Options

Applicable HUD Programs

N/A

Years in Subsidized
Housing Number

The number of years.

N/A

Disability Status
Code

Total number of years
individual has lived in publicly
or privately subsidized housing.
County all time even if not
consecutive.
The disability status of the
individual.

1 = Yes, individual indicates a
disability as defined in ADA
2 = No, individual indicates no
disability as defined by ADA.
88 = Individual refused.
99 = Individual does not know.
ADA = Section 3(2) (a) of the Americans with Disabilities Act of 1990 (42 U.S.C. 12102).

FSS, Jobs+, JRAP, 202, ROSS, MFSC

N/A

Disability Category
Code

The category of disability for
the individual.

ROSS, MFSC

N/A

Disability Requires
Assistance Code

The individual with a disability
who received services funded
under the grant demonstrated
a need for assistance with
activities of daily living,
including eating, bathing,
grooming, and dressing and
home management activities.

N/A

Hard to House
Code

The household is at high risk of
losing housing. Choose all that
apply.

N/A

Returning
Citizen/Ex-Offender

The individual is currently an
offender with an active criminal

1 = Impairment is primarily
physical, including mobility
and sensory impairments.
2 = Impairment is primarily
mental, including cognitive
and learning impairments.
3 = Impairment is both
physical and mental
88 = Individual refused.
99 = Individual does not know.
1 = The disabled individual
requires services to manage
home activities.
2 = The disabled individual
does not require services for
home management.
3 = The disabled individual was
not assessed for this criteria.
88 = Individual refused.
99 = Individual does not know.
1 = Head of household has
lived in public housing for
more than 10 years.
2 = Head of household does
not have a high-school
diploma or GED.
3 = Three or more minors in
the household.
4 = One or more household
members has a criminal
record.
5 = The head of household is
not disabled, but one or more
other household members is
disabled.
6 = The head of household is a
single, elderly adult who is the
primary caregiver for one or
more children.
88 = Individual refused.
99 = Individual does not know.
1 =Individual is currently a
subject involved in the CJS.

FSS, Jobs+, JRAP, HOPWA, 202,
ROSS, MFSC

ROSS, MFSC

HOPWA, 202, ROSS, MFSC

FSS, Jobs+, JRAP, MFSC

3
HUD XXXX - Approved MM/DD/YYYY

OMB Approval Number: 2501-XXXX
Expiration Date: MM/DD/YYYY

Indicator
1
Number

N/A

N/A

N/A

N/A

N/A

Data Element
Name

Data Element Description

Code

record in the justice system, or
has committed or been
charged with committing
criminal acts in the previous 12
months.

Response Options

Applicable HUD Programs

2 = The individual is not
currently subject to any phase
of the CJS, but has been in the
previous 12 months.
3 = The individual is not
currently subject to any phase
CJS = criminal justice system
of the CJS, and has not been in
the previous 12 months.
88 = Individual refused.
99 = Individual does not know.
Earned Income Tax
The individual received the
1 =Individual reported receipt
FSS, Jobs+, JRAP, ROSS, MFSC
Credit Recipient
Earned Income Tax Credit
of the EITC in most recent tax
Code
(EITC) for the most recent tax
year.
year.
2 = Individual reported no
receipt of the EITC in most
recent tax year.
88 = Individual refused.
99 = Individual does not know.
The Earned Income Tax Credit, EITC or EIC, is a benefit for working people with low to moderate income. To qualify, persons
must meet certain requirements and file a tax return, even if no taxes are owed or the person is not required to file. EITC
reduces the amount of tax a person owes and may provide a refund to the person.
Financial Account
The individual has a checking,
1 = Individual has a checking
FSS, Jobs+, JRAP, MFSC
Creation Code
savings, individual
or savings account.
development account (IDA) or
2 = Individual has an IDA.
escrow account.
3 = The individual has an FSS
escrow account.
88 = Individual refused.
99 = Individual does not know.
Supplemental
The individual received SNAP
1 = Yes.
FSS, Jobs+, JRAP, HOPWA, 202,
Nutrition
benefits at the time of data
2 = No
ROSS, MFSC
Assistance Program
collection.
88 = Individual refused.
(SNAP) Code
99 = Individual does not know.
Temporary
The individual received cash or
1 =Yes
FSS, Jobs+, JRAP, HOPWA, 202,
Assistance to
other support services under
2 = No
ROSS, MFSC
Needy Families
TANF at the time of data
88 = Individual refused.
(TANF) Code
collection.
99 = Individual does not know.
TANF is federally
funded but is
administrated by
each state. TANF is
a financial
assistance program
for low income
families that have
children and for
pregnant women in
their last three
months of
pregnancy.
Supplemental
The individual received SSI at
1 =Yes
FSS, Jobs+, JRAP, HOPWA, 202,
Security Income
the time of data collection.
2 = No
ROSS, MFSC
(SSI) Code
88 = Individual refused.
99 = Individual does not know.
SSI is a Federal
income supplement
program funded by

4
HUD XXXX - Approved MM/DD/YYYY

OMB Approval Number: 2501-XXXX
Expiration Date: MM/DD/YYYY

Indicator
1
Number

N/A

Data Element
Name
general tax
revenues (not
Social Security
taxes). It is
designed to help
aged, blind, and
disabled people
who meet income
and asset
thresholds.
Social Security
Disability Insurance
(SSDI) Code

N/A

Substance Abuse
Treatment Code

N/A

Acquired Immune
Deficiency
Syndrome
(AIDS)/Human
Immunodeficiency
Virus (HIV) Status
Code

N/A

N/A

Data Element Description

The individual received SSDI at
the time of data collection.

The individual is being treated
by a medical professional or a
treatment facility for substance
abuse or dependence.
Substance abuse is defined as a
maladaptive (i.e., harmful to a
person's life) pattern of
substance use marked by
recurrent and significant
negative consequences related
to the repeated use of
substances. These substances
may be legal, such as alcohol,
or an illicit drug such as
hashish, cocaine hallucinogens,
heroin, or prescription–type
drug used non-medically.

Response Options

Applicable HUD Programs

1 =Yes
2 = No
88 = Individual refused.
99 = Individual does not know.
1 = The individual is being
treated for substance abuse or
dependence.
2 = The individual is not being
treated for substance abuse or
dependence, but did receive
treatment in past 12 months.
3 = The individual was not
treated for substance abuse or
dependence in past 12
months, but did receive such
treatment over a year ago.
4 = The individual never
received treatment for
substance abuse or
dependence.
88 = Individual refused.
99 = Individual does not know.
1 = The individual identified as
being infected with HIV/AIDS.
2 = The individual identified as
not being infected with
HIV/AIDS.
88 = Individual refused.
99 = Individual does not know.

FSS, Jobs+, JRAP, HOPWA, 202,
ROSS, MFSC

HOPWA, 202, ROSS, MFSC

The individual was diagnosed
HOPWA
by a medical professional as
being infected with AIDS/HIV.
AIDS is an infectious disease
caused by the human
immunodeficiency virus or HIV.
Both variants of the HIV virus,
HIV-1 and HIV-2, cause AIDS.
Activities of Daily
If assessed, individual demonThe number of ADLs that the
202, ROSS, MFSC
Living (ADL) Count
strated need for assistance in
individual is able to perform.
completing one or more ADLs.
Record number of ADLs
individual could complete at
time of initial assessment.
Activities of Daily Living (ADL) means eating, dressing, bathing, grooming, and transferring, as further described below:
(1) Eating—May need assistance with cooking, preparing, or serving food, but must be able to feed self;
(2) Bathing—May need assistance in getting in and out of the shower or tub, but must be able to wash self;
(3) Grooming—May need assistance in washing hair, but must be able to take care of personal appearance;
(4) Dressing—Must be able to dress self, but may need occasional assistance;
(5) Transferring—Actions such as going from a seated to standing position and getting in and out of bed; and
(6) Other such activities as HUD deems essential for maintaining independent living.
Instrumental
If assessed, individual demonThe number of IADLs that the
202, ROSS, MFSC
Activities of Daily
strated need for assistance in
individual is able to perform.
Living (IADL) Count
completing one or more IADLs.

5
HUD XXXX - Approved MM/DD/YYYY

OMB Approval Number: 2501-XXXX
Expiration Date: MM/DD/YYYY

Indicator
1
Number

N/A

N/A

3

12

Data Element
Name

Data Element Description

Response Options

Applicable HUD Programs

Record number of IADLs
individual could complete at
the time of initial assessment.
Instrumental Activities of Daily Living (IADLs) are activities that are more complex than ADL activities including, but not limited
to, handling personal finances, meal preparation, shopping, traveling, doing housework, using the telephone, taking or
managing medications, or other such activities as HUD deems essential for maintaining independent living.
Service start date
The date the individual enrolled Service start or initiation date
FSS, Jobs+, JRAP, HOPWA, 202,
in or first received grantin YYYY-MM-DD format.
ROSS, HC, LBPHC, LHRD, MFSC
funded services or benefits,
defined as the start or initiation
of services.
Service end date
The date that grant-funded
Service end, completion or
FSS, Jobs+, JRAP, HOPWA, 202,
services were completed or
termination date in YYYY-MM- ROSS, HC, LBPHC, LHRD, MFSC
terminated. The last date the
DD format.
individual received grantfunded service.
Service End Reason
Record the primary reason for
0 = Active participant.
FSS, Jobs+, JRAP, HOPWA, 202,
Code
ending services.
1 = Individual completed the
ROSS, HC, MFSC
planned service/activity or
service strategy.
2 =Individual voluntarily ended
services
3 = Individual discontinued
services due to dissatisfaction
4 = Individual transferred to a
higher level of care.
5 = Deceased.
6 = Incarcerated in jail or
prison.
7 = Involuntary separation
initiated by the service
provider. The individual was
separated for administrative
reasons.
8 = Other involuntary reason.
9 = Cannot locate the
individual.
Opportunity Area
The census tract is identified as 1 = Yes
FSS, Jobs+, JRAP, HOPWA, 202,
Census Tract
an area of opportunity in the
2 = No
ROSS, HC, LBPHC, LHRD, MFSC
community’s Regional Fair
Housing Equity Assessment
(FHEA).

6
HUD XXXX - Approved MM/DD/YYYY

OMB Approval Number: 2501-XXXX
Expiration Date: MM/DD/YYYY

Indicator
1
Number

Data Element
Name

Data Element Description

19

Housing Status
Code

The current housing status of
the individual.

1 = Identifies as a public
housing resident.
2 = Receives a tenant-based
rental voucher.
3 = Receives a project based
rental voucher.
4 = Privately subsidized
housing.
5 = Unsubsidized (market rate)
housing.
6 = Owns a home.
7 = Homeless.
8 = Refused.
99 = Does not know.

FSS, Jobs+, JRAP, HOPWA, MFSC

13,14,15

Primary Health
Care Provider Code

1 = Yes
2 = No
88 = Individual refused.
99 = Individual does not know.

FSS, Jobs+, JRAP, HOPWA, 202,
ROSS, MFSC

13,14,15

Health Coverage
Code

The individual has a personal
primary health care provider (a
general doctor, a specialist
doctor, nurse practitioner or
physician’s assistant)
The individual was covered by a
private or public health
insurance plan. Please note
that a person having only a
private plan that paid for one
type of service, such as
accidents or dental care, is
considered uninsured.

1 = Yes, covered through
employer or union (current or
former)
2 = Yes, purchased insurance
from insurance company
3 = Medicare
4 = Medicaid/Medical
Assistance,
5 = TRICARE or other military
health care
6 = VA health care
7 = Indian Health Service
8 = Other health insurance or
health coverage plan
9= No coverage
88 = Individual refused.
99 = Individual does not know.
1 = Yes
2 = No
88 = Individual refused.
99 = Individual does not know.

FSS, Jobs+, JRAP, HOPWA, 202,
ROSS, MFSC

Insurance coverage may held or
purchased by this individual or
any family member.

13,14,15

Medical
Examination Status
Code

The individual received a
routine medical examination
within the last 12 months. This
includes well-baby visit, wellchild visit, well-woman visit,
physical exam performed by a
health care provider and
annual wellness visit covered
through Medicare.

Response Options

Applicable HUD Programs

FSS, Jobs+, JRAP, HOPWA, 202,
ROSS, MFSC

7
HUD XXXX - Approved MM/DD/YYYY

OMB Approval Number: 2501-XXXX
Expiration Date: MM/DD/YYYY

Indicator
1
Number

Data Element
Name

Data Element Description

9,10,11

Highest Education
Level Code

The highest degree or level of
education completed by the
individual.

0 = No schooling completed,
Nursery school, or
Kindergarten.
1 - 11 = Grade 1 through 11.
12 = 12th grade, no diploma.
13 = High school diploma.
14 = GED or alternative
credential.
15 = Less than 1 year of
college credit.
16 = 1 or more years of college
credit, no degree.
17 = Associate's degree
18 = Bachelor's degree
19 = Master's degree).
20 = Professional degree
(e.g., MD, DDS, DVM, LLB, JD).
21 = Doctorate degree
88 = Individual refused.
99 = Individual does not know.

FSS, Jobs+, JRAP, HOPWA, ROSS,
MFSC

9,10,11

Enrollment in
Educational or
Vocational Program

Individual’s current enrollment
in educational or vocational
training.

FSS, Jobs+, JRAP, HOPWA, ROSS,

9,10,11

License or
Certificate
Attainment Code

9,10,11

Degree Attainment
Code

Individual’s attainment of a
vocational/occupational license
or certificate while receiving
grant-funded services. The
license or certificate must have
been attained between the
start and the completion or
termination of grant-funded
services.
Individual’s attainment of a
degree while receiving grantfunded services. The degree
must have been attained
between the start and the
completion or termination of
grant-funded services.

1 =Individual is enrolled in
educational training.
2 = Individual is enrolled in
vocational training.
3 = Not enrolled in educational
or vocational training.
1 = Occupational skills license.
2 = Occupational skills
certificate.
3 = Other license or certificate
recognized by state.
4 = Individual did not attain a
license or certificate.
88 = Individual refused.
99 = Individual does not know.
1 = High school diploma/ GED.
2 = AA or AS diploma.
3 = BA or BS diploma.
4 = Other degree.
5 = No degree attained
88 = Individual refused.
99 = Individual does not know

1,2

Employment Status
Code

1 = Employed
2 = Not employed at any time
in the last month and actively
seeking work.
3 = Not employed at any time
in the last month and not
actively seeking work.
88 = Individual refused.
99 = Individual does not know.

FSS, Jobs+, JRAP, HOPWA, ROSS,

Individual’s employment status
during the prior month,
including, the date of
collection. An individual is
considered "employed" if he or
she did any work for pay during
the last month even for just for
a few hours)

Response Options

Applicable HUD Programs

FSS, Jobs+, JRAP, HOPWA, ROSS,

FSS, Jobs+, JRAP, HOPWA, ROSS,

8
HUD XXXX - Approved MM/DD/YYYY

OMB Approval Number: 2501-XXXX
Expiration Date: MM/DD/YYYY

Indicator
1
Number

Data Element
Name

Data Element Description

1,2

Employment Type
Status Code

The type of employment,
classified as full-time or parttime.

1,2

1,2

Response Options

Applicable HUD Programs

1 = Full-time worker employed
in the last month.
2 = Part-time worker
employed in the last month.
88 = Individual refused.
99 = Individual does not know

FSS, Jobs+, JRAP, HOPWA

Full-time includes people at least 16 years old who worked or who were scheduled to work 35 hours or more per week.
Part-time includes people at least 16 years old who worked or who were scheduled to work less than 35 hours per week.
Entered
The date the individual entered The date entered employment FSS, Jobs+, JRAP, HOPWA
Employment Date
employment. When multiple
in YYYY-MM-DD format.
instances of entering
employment exist, use the
current or most recent job.
Occupation Code
The SOC Based Occupation
1 = Management Occupations
FSS, Jobs+, JRAP, HOPWA
Group that best describes the
2 = Business and Financial
individual's occupation.
Operations Occupations
3 = Computer, Engineering,
and Science Occupations
4 = Education, Legal,
Community Service, Arts, and
Media Occupations
5 = Healthcare Practitioners
and Technical Occupations
6 = Healthcare Support
Occupations
7 = Protective Service
Occupations
8 = Food Preparation and
Serving Related Occupations
9 = Building and Grounds
Cleaning and Maintenance
Occupations
10 = Personal Care and Service
Occupations
11 = Sales and Related
Occupations
12 = Office and Administrative
Support Occupations
13 = Farming, Fishing, and
Forestry Occupations
14 = Construction and
Extraction Occupations
15 = Installation, Maintenance,
and Repair Occupations
16 = Production Occupations
17 = Transportation and
Material Moving Occupations
88 = Individual refused.
99 = Individual does not know
For additional instructions and
examples, see supplement.

9
HUD XXXX - Approved MM/DD/YYYY

OMB Approval Number: 2501-XXXX
Expiration Date: MM/DD/YYYY

Indicator
1
Number

Data Element
Name

Data Element Description

Response Options

Applicable HUD Programs

1,2

Monthly Paid
Earnings Amount

Reported gross monthly
earnings in whole (rounded
U.S. dollars.

18

The individual's gross earnings
from all employment for the
prior 4 weeks leading up to,
and including, the collection
date.
The household's self-reported
annual gross income.

Household Annual
Estimated annual income in
FSS, Jobs+, JRAP, HOPWA
Gross Income
whole (rounded) U.S. dollars.
Amount
For the purposes of determining included and excluded income in the calculation of household income, please refer to definition
of "adjusted gross income" as used in the Internal Revenue Service's 1040 long form. Go to
http://portal.hud.gov/hudportal/HUD?src=/program_offices/comm_planning/affordablehousing/training/web/calculator/defini
tions/irs#inclusions for sources of income to be included and excluded in this calculation.

5,6,7

Homeless Status
Code

The individual's homeless or
runaway status.

1 = Homeless.
2 = Runaway youth.
3 = Neither homeless or a
runaway youth.
88 = Individual refused.
99 = Individual does not know.

FSS, Jobs+, JRAP, HOPWA

HOPWA

A "homeless" person lacks a fixed, regular, adequate night time residence. This definition includes any individual who has a
primary night time residence that is a publicly or privately operated shelter for temporary accommodation; an institution
providing temporary residence for individuals intended to be institutionalized; or a public or private place not designated for or
ordinarily used as a regular sleeping accommodation for human beings; or a person under 18 years of age who absents himself
or herself from home or place of legal residence without the permission of his or her family (i.e., runaway youth). This definition
does not include an individual imprisoned or detained under an Act of Congress or State law. An individual who may be sleeping
in a temporary accommodation while away from home should not, as a result of that alone, be recorded as homeless.
5,6,7

Weeks Homeless
Count

5,6,7

Chronically
Homeless Status
Code

The number of weeks the
homeless person lacked a fixed,
regular, adequate night time
residence in the past 12 month
or 52 week period. The weeks
do not have to be consecutive
to count.
The individual meets definition
of chronically homeless person.

The number of weeks
homeless.

HOPWA

1 = Yes.
2 = No.
3 = Individual was not
assessed for this condition
88 = Individual refused.
99 = Individual does not know

HOPWA

HUD defines a chronically homeless person as an unaccompanied homeless individual with a disabling condition who has either
been continuously homeless for a year or more, or has had at least four episodes of homelessness in the past three years, where
each homeless occasion was at least 15 days. To be considered chronically homeless, persons must have been sleeping in a
place not meant for human habitation (e.g., living on the streets) and/or in an emergency homeless shelter during that time.
Disabling conditions include substance use disorder, serious mental illness, developmental disability (as defined in section 102 of
the Developmental Disabilities Assistance Bill of Rights Act of 2000 (42 U.S.C. 15002)), post-traumatic stress disorder, cognitive
impairments resulting from brain injury, or chronic physical illness or disability. An individual who has been residing in an
institutional care facility, including a jail, substance abuse or mental health treatment facility, hospital, or other similar facility,
for fewer than 90 days and met all of the criteria in the above paragraph before entering that facility is considered chronically
homeless. A family with an adult head of household (or if there is no adult in the family, a minor head of household) who meets
all of the criteria in the above paragraph of this definition, including a family whose composition has fluctuated while the head
of household has been homeless.

10
HUD XXXX - Approved MM/DD/YYYY

OMB Approval Number: 2501-XXXX
Expiration Date: MM/DD/YYYY

Indicator
1
Number

Data Element
Name

Data Element Description

5,6,7

Prior Night
Residence Code

For homeless individuals,
indicate the type of living
arrangement the night before
the individual received services
funded by the grant. If the
individual was residing in an
institution (hospital, jail, etc.)
for less than 30 days, then
select where he or she was
staying before the entering the
institution.

19

Intermediate
Housing Status
Code

The intermediate housing
outcome achieved by the
individual.

18

Household Housing
Cost Amount

Monthly household housing
costs including rent, mortgage,
utilities, fees and property
taxes.

Response Options

Applicable HUD Programs

1 = Emergency shelter
including hotel/ motel voucher
.2 = Foster care home or foster
care group home.
3 = Hospital or other
residential non-psychiatric
medical facility.
4 = Hotel or motel paid for
without emergency shelter
voucher.
5 = Jail, prison or juvenile
detention facility.
6 = Long-term care facility or
nursing home.
7 = Owned by individual, no
ongoing housing subsidy.
8 = Owned by individual, with
ongoing housing subsidy.
9 = Permanent housing for
formerly homeless persons
10 =Place not meant for
habitation
11 =Psychiatric hospital or
other psychiatric facility.
12 =Rental by individual, no
ongoing housing subsidy.
13 =Rental by individual, with
ongoing housing subsidy.
14 =Safe Haven.
15 =Staying or living in a
family member's room,
apartment or house.
16 =Staying or living in a
friend's room, apartment or
house.
17 =Substance abuse
treatment facility or detox
center.
18 =Transitional housing for
homeless persons (including
homeless youth).
88 = Individual refused.
99 = Individual does not know.
1 = Avoided eviction from
rental property.
2 = Obtained a Home Equity
Conversion Mortgage (HECM).
3 = Prevented or resolved a
mortgage default
88 = Individual refused.
99 = Individual does not know.

HOPWA

The household’s average
monthly housing costs in
whole (rounded) U.S. dollars.

FSS, Jobs+, JRAP, HOPWA, 202,
ROSS, MFSC

HC

11
HUD XXXX - Approved MM/DD/YYYY

OMB Approval Number: 2501-XXXX
Expiration Date: MM/DD/YYYY

Indicator
1
Number

Data Element
Name

Data Element Description

18

Household
Transportation Cost
Amount

16

Asthma Condition
Code

Monthly transportation costs
including car payments, vehicle
insurance and public
transportation cost. Exclude
vacations and other rare
instances of travel.
The individual has been
diagnosed with asthma by a
medical professional.

16

Asthma-related
Emergency Room
Visit Code

17

Blood-Lead Test
Code

17
5,9,10,11

5

1,2,5

1,2,5

The individual was treated in
the emergency department or
hospitalized for an asthmarelated condition within the
last 12 months.
A blood level test was
performed for a child under
age 6 in the household in last
12 months.
Blood level test result was
elevated (>= 5 μg/dL).
The individual received training
(e.g. uses textbooks and
handouts) to improve his/her
literacy and numeracy skills.

Response Options

Applicable HUD Programs

The household’s average
monthly transportation costs
in whole (rounded) U.S.
dollars.

FSS, Jobs+, JRAP, HOPWA, 202,
ROSS, MFSC

1 = Yes
2 = No
88 = Individual refused.
99 = Individual does not know.
1 = Yes
2 = No
88 = Individual refused.
99 = Individual does not know.

LBPHC, LHRD

LBPHC, LHRD

1 = Yes
LBPHC, LHRD
2 = No
88 = Individual refused.
99 = Individual does not know.
Blood-Lead Test
1 = Yes
LBPHC, LHRD
Result
2 = No
Adult Basic
1 = Received service directly
FSS, Jobs+, JRAP, HOPWA, ROSS,
Education Service
through the grant.
Code
2 = Received service through
grant-facilitated referral.
3 = Both 1 and 2.
Literacy skills training develops critical reading, writing, listening, speaking, and viewing skills and knowledge necessary to
function productively in school, the workplace or society in general. This may take the form of classes or one-on-one tutoring.
Examples include: basic reading, writing, literacy, math skills, pre-admission college prep courses and other adult continuing
education classes (non-credit). This does not include ESL, GED prep, enrollment in post-secondary education, occupational skills
training, or work readiness classes.
ESL Class Service
Code

Individual with limited English
proficient individual (LEP) (e.g.
non-native English speaker)
received English as a second
language (ESL) instruction

1 = Received service directly
through the grant.
2 = Received service through
grant-facilitated referral.
3 = Both 1 and 2.

FSS, Jobs+, JRAP, HOPWA, MFSC

English as a Second Language is the use of English by speakers with different native languages. The individual participated in one
or more programs and activities designed to help the individual learn English. ESL instruction reduces language barriers that can
preclude meaningful access by LEP persons to important government programs, services, and employment. This may take the
form of classes or one-on-one tutoring.
Career Guidance
The individual received career
1 = Received service directly
FSS, Jobs+, JRAP, HOPWA, ROSS,
Service Code
guidance services.
through the grant.
2 = Received service through
grant-facilitated referral.
3 = Both 1 and 2.
Career guidance services include the provision of information, materials, suggestions, or advice which are intended to assist the
job seeker in making occupation or career decisions.
Self-Directed Job
Search Assistance
Service Code

The individual received job
search activities.

1 = Received service directly
through the grant.
2 = Received service through
grant-facilitated referral.
3 = Both 1 and 2.

FSS, Jobs+, JRAP, HOPWA

12
HUD XXXX - Approved MM/DD/YYYY

OMB Approval Number: 2501-XXXX
Expiration Date: MM/DD/YYYY

Indicator
1
Number

Data Element
Name

Data Element Description

Response Options

Applicable HUD Programs

Job search activities help an individual plan and carry out a successful self-directed job hunting strategy and include resume
preparation, application preparation, interviewing skills, job lead development, job finding clubs, and development of a job
search plan.
1,2,5

1,2,5

1,2,5

1,2,5

Work Readiness
Assistance Service
Code

The individual received work
readiness assistance.

1 = Received service directly
FSS, Jobs+, JRAP, HOPWA
through the grant.
2 = Received service through
grant-facilitated referral.
3 = Both 1 and 2.
Work readiness includes specific work-related skills that young people and adults need in order to be successful as entry-level
workers in any formal sector business or industry or in any informal sector livelihood. These skills are generally thought of as life
skills with a strong work focus, and include work-related health and safety at work, work habits and conduct, personal
leadership at work, communicating with others at work, team work and collaboration at work, rights and responsibilities of
workers and employers, and customer service. This may include business communications, computer literacy, financial literacy,
employment counseling.
Occupational Skills
The individual received
1 = Received service directly
FSS, Jobs+, JRAP, HOPWA
Training (OST)
occupational skills training
through the grant.
Service Code
(OST). OST may be conducted
2 = Received service through
in the classroom or on-the-job
grant-facilitated referral.
in the workplace or a
3 = Both 1 and 2.
combination of approaches.
The OST curriculum is designed to meet the technical needs of the workplace. OST provides participants with the technical skills
necessary to perform a specific job or group of jobs. The duration of OST activities varies based on many factors. This could be
to retain an existing job, for a new job, for advancement in a current field, or for employment in a new/different field. This could
be training provided by an employer.
Job Development
The individual received job
1 = Received service directly
FSS, Jobs+, JRAP, HOPWA
Service Code
development services. Job
through the grant.
development is contacting an
2 = Received service through
employer directly for the
grant-facilitated referral.
purpose of obtaining possible
3 = Both 1 and 2.
employment for a specific
individual.
Job Retention
The individual received job
1 = Received service directly
FSS, Jobs+, JRAP
Service Code
retention services.
through the grant.
2 = Received service through
grant-facilitated referral.
3 = Both 1 and 2.
Job retention services include a Job coach works with participant on managing challenges in the workplace or works with
employer to create a remediation plan for employee, etc. Occupational skills training (OST), employer sponsored “in-service
training” and certifications needed to maintain employment are excluded.

5

Fair Housing and
Civil Rights
Assistance Service
Code

The individual received services
or participated in programs
that promotes racially,
ethnically, and economically
diverse communities and
integrated living patterns and
avoid patterns where persons
are forced to live in high
poverty areas, or in areas
suffering from a lack of
accessible services, or a lack of
integration in terms of income,
race, or ethnicity, or disability
status.

1 = Received service directly
through the grant.
2 = Received service through
grant-facilitated referral.
3 = Both 1 and 2.

HOPWA, HC, MFSC

13
HUD XXXX - Approved MM/DD/YYYY

OMB Approval Number: 2501-XXXX
Expiration Date: MM/DD/YYYY

Indicator
1
Number

Data Element
Name

Data Element Description

5

Tax Preparation
Service Code

The individual received tax
preparation services while
participating in grant-funded
activities.

5

Response Options

Applicable HUD Programs

1 = Received service directly
FSS, Jobs+, JRAP, MFSC
through the grant.
2 = Received service through
grant-facilitated referral.
3 = Both 1 and 2.
Tax preparation services include assistance with obtaining information about low- or no-cost tax preparation services; arranging
no-cost tax preparation services at the property; assistance with organizing tax documents, paperwork, and other supporting
materials for individuals; and assistance with preparing and/or filing of senior/disabled age/income-based specific tax rebates
including property tax rebate programs and/or food sales tax rebate programs. These services may be provided by an IRS
Volunteer Income Tax Assistance (VITA) center or a reputable (not refund-anticipation loan-type) private service. This does not
include the use of tax software by individuals unless facilitated by the PHA or a partner.
Financial Account
The individual was assisted
1 = Received service directly
FSS, Jobs+, JRAP, MFSC
Creation Service
with credit activities or to
through the grant.
Code
create a financial account
2 = Received service through
(savings/ checking), FSS escrow, grant-facilitated referral.
Individual Development Acct.
3 = Both 1 and 2.
The Individual Development Account (IDA) is created through an Assets for Independence Program, an alternative program at
the housing authority or another IDA through a partner. IDAs are matched savings accounts that help people with modest
means to save towards the purchase of a lifelong asset, such as a home.

5

Legal Assistance
Service Code

The individual received legal
assistance in civil or criminal
matters during participation in
the grant-funded activities.

5

Legal Assistance
Type Service Code

The type of legal assistance
received during participation in
the grant-funded activities.

5

5, 19

1 = Received service directly
FSS, Jobs+, JRAP, HOPWA, MFSC
through the grant.
2 = Received service through
grant-facilitated referral.
3 = Both 1 and 2.
Legal assistance includes receiving legal aid or counsel as well as participating in community legal clinics. Counsel includes
providing basic information on services such as end of life decision making, advanced directives, or wills.
1 = Will preparation, advanced FSS, Jobs+, JRAP, HOPWA, MFSC
directives, end of life decisions
2 = ID theft and credit Issues
3 = Foreclosure prevention
4 = Eviction prevention
5 = Custody, divorce and child
support
6= Fair housing assistance
7 = Assistance to victims of
domestic violence
8 = Expunging criminal records
9 = Other
Financial Education
The individual participated in
1 = Received service directly
FSS, Jobs+, JRAP, HOPWA, ROSS,
Service Code
financial literacy, budgeting or
through the grant.
MFSC
credit education activities
2 = Received service through
grant-facilitated referral.
3 = Both 1 and 2.
This financial management assistance is designed to help low-income families increase income, build savings, and gain assets to
improve financial stability. It provides adults practical tips to manage debt, avoid quick fixes, and plan to resolve financial
trouble. It also helps homebuyers understand the basics of handling new homeowner expenses.
Pre-Housing
Prior to purchase or rental, the
1 = Received service directly
FSS, Jobs+, JRAP, HOPWA, HC,
Counseling Service
individual was counseled
through the grant.
MFSC
Code
and/or received service related 2 = Received service through
to buying a home or renting.
grant-facilitated referral.
3 = Both 1 and 2.
Bank-sponsored mortgage seminars open to the general public or simply going to a bank and being guided through the process
are excluded. Sweat-equity programs that offer homeownership counseling, such as Habitat for Humanity, are also excluded.

14
HUD XXXX - Approved MM/DD/YYYY

OMB Approval Number: 2501-XXXX
Expiration Date: MM/DD/YYYY

Indicator
1
Number

Data Element
Name

5, 19

Post-Housing
Counseling Service
Code

5

5

5

5

5

5

Data Element Description

Response Options

Applicable HUD Programs

After purchase or rental, the
1 = Received service directly
FSS, Jobs+, JRAP, HOPWA, HC,
individual was counseled
through the grant.
MFSC
and/or received service related 2 = Received service through
to renting, default, foreclosure
grant-facilitated referral.
avoidance, credit issues or
3 = Both 1 and 2.
reverse mortgages.
Food and Nutrition
The individual received food
1 = Received service directly
HOPWA, MFSC
Service Code
and nutrition services to
through the grant.
prevent and/or end a period of
2 = Received service through
hunger or a period of
grant-facilitated referral.
malnutrition.
3 = Both 1 and 2.
These services include participation the Women, Infant and children (WIC) nutrition program, in congregate meal sites such as
Meals on Wheels programs, using emergency food programs and food banks, grocery shopping or cooking services or other
means of access including family, friends, and individuals within the community, and receiving donated food items from
community-based sources. The Supplemental Nutrition Assistance Program (SNAP) is not included.
Conflict Resolution
The individual received
1 = Received service directly
HOPWA, 202, ROSS, MFSC
Service Code
counseling and/or other
through the grant.
services related to conflict
2 = Received service through
resolution.
grant-facilitated referral.
3 = Both 1 and 2.
Conflict resolution services include assistance to resolve conflict by helping to clarify, educate, mediate, and propose
compromises or alternative solutions to parties who are contesting some mutual objectives. Conflict may be between
individuals or between individuals and property management, service providers, or other parties. This includes court ordered
participation.
Translation/
Individual with no or limited
1 = Received service directly
FSS, Jobs+, JRAP, HOPWA, HC,
Interpretation
English speaking ability or with
through the grant.
MFSC
Service Code
hearing or visual impairments
2 = Received service through
received translation or
grant-facilitated referral.
interpretation services to
3 = Both 1 and 2.
participate in the program.
Housing Retention
The individual received housing 1 = Received service directly
HOPWA, 202, ROSS, MFSC
Service Code
retention assistance.
through the grant.
2 = Received service through
grant-facilitated referral.
3 = Both 1 and 2.
This assistance includes Informing individuals of lease provisions and/or of behaviors/problems that could lead to lease
violations, such as noise, odors, unsanitary or unsafe conditions in apartments (hoarding and clutter) or common areas.
Activities can include assistance with eviction prevention; assistance with preparing, organizing and understanding documents
for lease recertification; and assistance with apartment inspection compliance. Includes linking individuals with a member of the
property management team for assistance with understanding their lease and house rules. Working with property management
staff to provide reasonable accommodation as defined by 1973 Rehabilitation Act when an individual's mental, physical, or
social disability is impeding compliance with the lease.
Household
The individual participated in a
1 = Received service directly
202, ROSS, MFSC
Skills/Life Skills
course or training regarding
through the grant.
Service Code
household or life skills.
2 = Received service through
grant-facilitated referral.
3 = Both 1 and 2.
Household or life skills services may include Good Neighbor trainings, household management, food prep, civic engagement,
navigating community resources, citizenship classes, driver’s education, etc.
Needs Assessment
Service Code

The individual received a
documented assessment or
Individual Services and Training
Plan (ITSP) that identifies
housing and supportive service
needs.

1 = Received service directly
through the grant.
2 = Received service through
grant-facilitated referral.
3 = Both 1 and 2.

FSS, Jobs+, JRAP, HOPWA, 202,
ROSS, MFSC

15
HUD XXXX - Approved MM/DD/YYYY

OMB Approval Number: 2501-XXXX
Expiration Date: MM/DD/YYYY

Indicator
1
Number

4,5

5,8

5,8

Data Element
Name

Data Element Description

Response Options

Applicable HUD Programs

Assessment is the process that reveals the past and current details of a service seeker’s strengths, and needs, in order to match
the client to appropriate housing and supportive services. The results of the assessment are documented in the individual's case
record and are typically used in providing counseling services, making referrals and in developing an individual service plan.
Assessment can occur either at primary screening or at entry to a housing program.
Service
The individual received service
1 = Received service directly
FSS, Jobs+, JRAP, HOPWA, 202,
Coordination
coordination assistance.
through the grant.
ROSS, MFSC
Service Code
2 = Received service through
grant-facilitated referral.
3 = Both 1 and 2.
Service coordination includes establishing linkages with appropriate agencies and service providers in the general community in
order to tailor the needed services to the program participant; linking program participants to providers of services that the
participant needs; and educating participants on issues, including, but not limited to, supportive service availability, application
procedures and client rights.
Parenting Skills
The individual received
1 = Received service directly
FSS, Jobs+, JRAP, HOPWA
Service Code
parenting training.
through the grant.
2 = Received service through
grant-facilitated referral.
3 = Both 1 and 2.
Parenting skills includes training in child development, family budgeting, health and nutrition, and other skills to promote their
long-term economic independence and the well-being of their children.
3 to 5 Years
The individual received
1 = Received service directly
FSS, Jobs+, JRAP, HOPWA, ROSS,
Childhood
assistance obtaining early
through the grant.
Education Service
childhood education for
2 = Received service through
Code
children between the ages of 3
grant-facilitated referral.
and 5 (or the age prior to the
3 = Both 1 and 2.
commencement of compulsory 4 = Household has children
education at primary school).
aged 3-5 years and did not
receive child care services.
Record for head of household
5 = No children in the
only; not recorded for children. household aged 3-5 years.
The early childhood program is child care combined with a developmentally appropriate educational component. This includes
Head Start and Pre-K. Do NOT record as a service to the child); record as a service to the head of household.

5,9,10,11

High School/GED
Preparation Service
Code

5,9,10,11

PostSecondary/College
Education Service
Code

5,6,7

Shelter Placement
Service Code

The individual participated in
an organized program of study
or a GED preparation class to
attain secondary school
diploma or equivalent. This
may take the form of classes or
one-on-one tutoring.
The individual is attending a
post-secondary school or
program, including college
(either full or part-time) and
assistance is provided to enable
the individual to enroll and/or
remain in the organized
program of study to attain a
post-secondary school diploma
or a certificate.
The homeless individual was
placed in an emergency shelter.

1 = Received service directly
through the grant.
2 = Received service through
grant-facilitated referral.
3 = Both 1 and 2.

FSS, Jobs+, JRAP, ROSS

1 = Received service directly
through the grant.
2 = Received service through
grant-facilitated referral.
3 = Both 1 and 2.

FSS, Jobs+, JRAP, HOPWA, ROSS,

1 = Received service directly
through the grant.
2 = Received service through
grant-facilitated referral.
3 = Both 1 and 2.

HOPWA

16
HUD XXXX - Approved MM/DD/YYYY

OMB Approval Number: 2501-XXXX
Expiration Date: MM/DD/YYYY

Indicator
1
Number

Data Element
Name

Data Element Description

Response Options

Applicable HUD Programs

A shelter is any facility whose primary purpose is to provide temporary housing. A shelter provides support, supervision, and a
safe place to live in a group home, cluster of apartments, or a network of homes that integrate housing and services for lowincome individuals and families.
5,6,7

5,6,7

5,6,7
5

5

Temporary Housing
Placement Service
Code

The housed individual was
1 = Received service directly
HOPWA
provided assistance for a
through the grant.
temporary or short-term
2 = Received service through
transfer to another property, a
grant-facilitated referral.
different unit within the
3 = Both 1 and 2.
property, or to an alternative
care facility.
Information and assistance was provided to the individual and/or family members regarding temporary housing options.
Includes assistance with an individual's transition back to their apartment from short-term care facility or hospital.
Permanent Housing
The individual was provided
1 = Received service directly
HOPWA
Placement Service
assistance for a permanent or
through the grant.
Code
long-term transfer to another
2 = Received service through
property, a different unit within grant-facilitated referral.
the property, or to an
3 = Both 1 and 2.
alternative care facility.
Information on long-term
housing options was provided.
Permanent Housing
Date the individual was placed
Date YYYY-MM-DD format.
HOPWA
Placement Date
in permanent housing.
Independent Living
The disabled or frail elderly
1 = Received service directly
FSS, Jobs+, JRAP, HOPWA, 202,
Service Code
individual received assistance
through the grant.
MFSC
in obtaining services to enable
2 = Received service through
him or her to remain in their
grant-facilitated referral.
own home.
3 = Both 1 and 2.
Services include apartment cleaning, laundry, shopping, and cooking, and referrals to services or supports to assist individual
with keeping, managing and maintaining all aspects of their home other than homemaking. Activities can include assisting
individual with simple money management budgeting, bill paying, reading mail, organization of personal records, or utility
company issues.
Transportation
The individual received
1 = Received service directly
FSS, Jobs+, JRAP, HOPWA, 202,
Assistance Service
transportation services to
through the grant.
ROSS, MFSC
Code
participate in medical or other
2 = Received service through
personal appointments,
grant-facilitated referral.
religious, social, or recreational 3 = Both 1 and 2.
activities.
This may include bus passes/tokens, rides in a service provider-owned van, arranging car pools, connecting to city/county special
transportation opportunities, assistance with personal auto repair, etc.

5

HIV/AIDS Service
Code

The individual received
HIV/AIDS health and counseling
services. Services include

1 = Received service directly
HOPWA, MFSC
through the grant.
2 = Received service through
grant-facilitated referral.
3 = Both 1 and 2.
Human immunodeficiency virus infection/acquired immunodeficiency syndrome (HIV/AIDS) health and counseling services
include access to treatment, financial assistance to pay for medication and medical tests, and assistance in securing housing.

5

Adult Personal
Assistance Service
Code

A chronically ill or disabled
individual needing help with
daily living, received assistance
with activities of daily living
(ADL), such as bathing or
dressing.

1 = Received service directly
through the grant.
2 = Received service through
grant-facilitated referral.
3 = Both 1 and 2.

HOPWA, 202, ROSS,MFSC

17
HUD XXXX - Approved MM/DD/YYYY

OMB Approval Number: 2501-XXXX
Expiration Date: MM/DD/YYYY

Indicator
1
Number

5,13,14,1
5

5,13,14,1
5

5,13,14,1
5

Data Element
Name

Data Element Description

Response Options

Applicable HUD Programs

Includes adult day care center services and services provided to frail elderly and disabled individuals who are unable to live
independently and perform ADLs and/or Instrumental Activities of Daily Living (IADL) without assistance. An adult day care
center, also commonly known as adult day services, is a non-residential facility that supports the health, nutritional, social
support, and daily living needs of adults in professionally staffed, group settings.
Assistance with ADL includes services associated with gaining independence in:
(1) Eating— assistance with cooking, preparing, or serving food, but must be able to feed self;
(2) Bathing— assistance in getting in and out of the shower or tub, but must be able to wash self;
(3) Grooming— assistance in washing hair, but must be able to take care of personal appearance;
(4) Dressing— able to dress self, but may need occasional assistance;
(5) Transferring—actions such as going from a seated to standing position and getting in and out of bed; and
(6) Other such activities as HUD deems essential for maintaining independent living.
Assistance with IADL are services that are more complex than those needed for ADL and include: handling personal finances,
meal preparation, shopping, traveling, doing housework, using the telephone, taking or managing medications, or other such
activities as HUD deems essential for maintaining independent living.
Medical Care
The individual is referred for
1 = Received service through
FSS, Jobs+, JRAP, HOPWA, 202,
Service Code
and receives medical or health
grant-facilitated referral.
ROSS, MFSC
care services to optimize and
2 = Did not receive service.
maintain physical health.
The medical or health care services are provided by a physician, medical professional, credentialed nutritionist. Medical services
also include dental services, home health services, receiving durable medical equipment and other adaptive equipment,
prescription medication and medication management, dietary support, and lifeline programs.
Mental Health
The individual is referred for
1 = Received service through
FSS, Jobs+, JRAP, HOPWA, 202,
Service Code
and receives mental health
grant-facilitated referral.
ROSS, MFSC
services.
2 = Did not receive service.
These services include being treated by credentialed psychiatrists, psychologists, therapists, and mental health counselors.
Mental health services may be delivered in a one-on-one setting or in a group setting through therapeutic support groups.
Prescription medication and medication management for mental health concerns are also considered mental health services.
Substance Abuse
Service Code

The individual received
substance abuse services
during participation in grant
activities.

1 = Received service directly
FSS, Jobs+, JRAP, HOPWA, 202,
through the grant.
ROSS, MFSC
2 = Received service through
grant-facilitated referral.
3 = Both 1 and 2.
These services include treatment for use of addictive substances such as tobacco, alcohol, drugs (prescription and street).
Examples of treatment providers are the American Lung Association or other smoking cessation programs, physicians, mental
health workers, alcohol and drug treatment facilities, and Alcoholics Anonymous (AA).

Public reporting burden for this collection of information is estimated to average 20 minutes per respondent, including the time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. This agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless that
collection displays a valid OMB control number. This information is collected in connection with HUD's respective discretionary grant program.
The information is considered sensitive and is protected by the Privacy Act which requires the records to be maintained with appropriate
administrative, technical and physical safeguards to ensure their security and confidentiality.

18
HUD XXXX - Approved MM/DD/YYYY

Office of Strategic Planning and Management

Grants Management and Oversight

APPENDIX B
COLLECTION OF FEDERAL EQUAL OPPORTUNITY INFORMATION ON
ETHINCITY AND RACE
HUD-funded grant recipients are obligated under various laws not to discriminate in
housing or services directly or indirectly on the basis of race, color, religion, sex,
national origin, age, familial status, or disability. Please refer to 24 CFR 121.2 for the
Department’s authority to collect this information. HUD rules further require that
recipients of Federal financial assistance comply with civil rights-related program
requirements (CRRPRs) that affect nearly every aspect of each program. HUD's nondiscrimination requirements are compiled from several different Federal laws
designed to protect each individual's right to fair housing and equal opportunity.
The collection of ethnicity and race information contained within these reporting
instructions are in accordance with OMB Statistical Directive 15 (as adopted October
30, 1997 at http://www.whitehouse.gov/omb/fedreg/ombdir15.html). The
collection of ethnicity and racial information is authorized by the U.S. Housing Act of
1937 as amended, the Housing and Urban Rural Recovery Act of 1983 and Housing
and Community Development Technical Amendments of 1984. The ethnicity and
racial categories in this classification are social-political constructs and should not be
interpreted as being scientific or anthropological in nature. They are not to be used as
determinants of eligibility for participation in any Federal program. The standards
have been developed to provide a common language for uniformity and
comparability in the collection and use of data on race and ethnicity by Federal
agencies.
Grantees must offer the opportunity to the head and co-head of each household to
“self-certify” during the application interview or lease signing. In-place tenants must
complete the format as part of their next interim or annual re-certification. This
process will allow the owner/agent to collect the needed information on all members
of the household. Completed documents should be stapled together for each
household and placed in the household’s file. Parents or guardians are to complete
the self-certification for children under the age of 18.
OMB has determined that a two-question format should be used in all cases
involving self-identification of ethnicity and race. Therefore, ethnicity information
(i.e., Hispanic or Latino) must be collected separately from race information, and
individuals who indicate that they are Hispanic or Latino should also have the
opportunity to select one or more racial categories. Information on an individual’s
ethnicity must also be collected before information on race. When completing race
information, individuals must be offered the option of selecting one or more racial
Page 8

Office of Strategic Planning and Management

Grants Management and Oversight

designations. Forms for the instruction accompanying the race information should
instruct the individual to read each racial designation carefully and then “Mark one
or more . . .” or “Select one or more . . .” races to indicate what the individual
considers him/herself to be.

Page 9