HMIS New User Authorization - A new process for HMIS new user authorization. Client Consent To Data Collection And ROI, How to add an Electronic Signature ROI (PDF), How to add an Electronic Signature ROI (Video). All people have a home. NH HMIS and CE Release of Information - Printable, NH HMIS and CE Release of Information - Virtual Signature, Link clients to mainstream benefits and services, Enable comprehensive system-level performance measurement. Data sharing is the ability to transfer data from one agency to another electronically through HMIS. Agency Agreements Agency Participation Agreement (Sample)This form is an agreement between an agency and NCCEH. Confidentiality of client information is of utmost importance in data collection. The following consent forms and policy documents support specific confidentiality and security standards to protect and inform both the client and provider. Click here to see examples of completed ROIs. What's new HMIS documentary Digital Learning - New HMIS Portal Latest Technical note released on: Wed, Dec 04, 2019 for Version 8.6.7 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. FileShare. Partners In Care, 200 N Vineyard Blvd Suite A-210, Honolulu. See our Training page for more details on how to sign up for HMIS trainings. food pantry. <> 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. Client Consent to Data Collection & ROI (2020), Online Fillable Client Consent to Data Collection and ROI (2020), Department of Veterans Affairs Release of Information, Consent Refused Data Entry Guide (updated 6Sept2019). Resources and assistance to support HUD's community partners. The following consent forms and policy documents support specific confidentiality and security standards to protect and inform both the client and provider. Capacity Building. Client consent will end seven years after the signaturedate by default; however, clients may also changetheir consent to share at any time. It can mean HMIS system visibility that is very focused and specific or very general and broad. 800-594-9854 Ext. Visit the FY 2022 HMIS Data Standards Changes page. If I need to be referred to another agency for services, my information will be forwarded to only 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. Client Revocation of HMIS ConsentIf a client decides to revoke consent, they must sign this form. Data sharing is a comprehensive term used differently in each community where it is implemented. An example of a standardized form is HMIS Form 105 which reports monthly attendance figures for maternal and child health and FP visits, diagnoses for the outpatient department, . End User Best Practices Cheat SheetTips and reminders for HMIS users. Download the Client Consent and Supplemental Form. Data sharing is intended to meet identified needs with principles for implementation locally defined and need-based. The client cannot be denied services based on refusal to share data. You have the right to see your information in the HMIS, ask for changes, or ask for a printed copy upon request. With this form, you can give permission to have information about you collected and shared with Partner Agencies that help King County provide housing and services. 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. www . 6. Homeless Count. 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. $(this).parent('.panel').find('.fa-plus').show(); Due to the nature of UHMIS, when client consentends, this agency will share no new information,but this agency will not remove anything already shared within the system. HMIS Client Grievance FormRev. Participants were informed of their freedom to participate in the study . Agencies should refer first with their own data privacy agreements, then any data sharing arrangements theymay have. Personal Identifying Information (Name, Social Security Number, Date of Birth, Gender, Veteran Status, photo) Personal identifying information about your dependents (if applicable) (Note: Anyone 18 years of age or older must sign a separate consent form.) For more detailed information about the responsibilities an agency has regarding data privacy, please review theData Privacysection of theMinnesota HMIS Policies. WI HMIS includes your demographic information and other essential personal information needed to best determine your service needs. 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; 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 An amendment to the privacy notice regarding use or disclosure will be effective with respect to information processed before the amendment, unless otherwise stated. In instances where past privacy notices did not include a statement about amendments and retroactive impact, client data obtained under those privacy notices would not be permitted to be used for any purposes other than the original uses and disclosures outlined in the privacy notice. Closed Today See open hours. 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 . Find answers to frequently asked questions. sg+QN y]ZU(_,iOw0*'% |xw/"402wu1*y@R,) ?cmJ*J@ d@4FET~2ZREKdW^8>+V$lL)'+F7e;xtbYiyRn^a$Vh|oF The Statewide HMIS Data Committee and HMIS Lead recently approved the use of a new HMIS consent to share form. Households How-To GuideThis guide explains how to manage households in HMIS. Please have the following readily available as you complete this form: Governance. Find answers to frequently asked questions. PART II - YOUR CONSENT Basic Information: This information will be shared through HMIS and with members of the Collaborative. HMIS. All questions must have an answer in order to save - please choose N/A where needed. Schedule a BusinessObjects ReportInstructions for running a BusinessObjects report, in a Knowledge Base article that you can easily bookmark! Department of Veterans Affairs Release of Information ROI Frequently Asked Questions (2022) Consent Refused Data Entry Guide (updated 6Sept2019) 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. Additionally, make sure theData Privacy Noticeis available to clients at intake, even if an intake is being conducted over the phone. Resource Management System. You may contact the food pantry manager, Carla Schroyer at 410-285-4674 ext. This form allows the Institute for Community Alliances (ICA) to configure data collection appropriately for agencies in the database. `RQ$7;k+g?Ew?J?=T'{z%QqRdO}EI;a[mq]l[ 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. 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. San Diego uses the software Clarity (distributed by . Explore collections of guided learning opportunities on a variety of topics. Account status change request. WHAT IS HMIS of Central Florida? 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-level data: Data about an individual HMIS client. CES HUD Guidance For more information on CES, please visit the Coordinated Entry Community Sample Toolkit. *, 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.*. Don't Miss: Corpus Christi Food Bank Donation. If you have any questions, please submit a request and a Training and Development Specialist or KYHMIS Specialist will respond. The HMIS code migration is scheduled for Tuesday January 3rd, 17th & 31st. KMNH has developed an extensive collection of reports and dashboards that may already meet your needs. 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. Copyright 2020 Institute for Community Alliances. HMIS is a data collection system specifically designed to support planning, management, and decision making in health facilities and organizations. The documents have not been reviewed by HUD or its contractors for applicability, legality, or compliance with federal statutory and regulatory guidelines. $('.panel-collapse').on('hide.bs.collapse', function () { The HMIS (Homeless Management Information System) is a local web-based information technology system that San Diego's Continuum of Care (CoC) uses to capture and report on client, project, and system level information regarding homeless services utilization, performance and outcomes. See Washington State HMIS forms here. Find point of contact information for HUD's grantees. 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. Approval of data requests and applicable fees will be determined by the BTG BOD. Learn through self-paced online trainings, recorded webinars, and more. View brief descriptions of HMIS Project Types. $(this).parent('.panel').find('.fa-minus').show(); Request to waive penalty. Annual Assessment for Children under 18, 2021 CNY HMIS Update. HMIS Consent Forms Confidentiality of client information is of utmost importance in data collection. ICA's . For system administration questions contact nevada-admin@bitfocus.com. Dependent children under 18 in household, if any (Please print first and last names): . 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 . 112 or . 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. Each form is downloadable and modifiable to meet custom requirements. Client Consent and Data Privacy Notice documents are on the Administrative Documents page. A Homeless Management Information System (HMIS) is a locally administered, electronic data collection system that stores longitudinal person-level information about persons who access the homeless service system in a Continuum of Care. Resources. Client . stream The client is not guaranteed to receive assistance by consenting to share data. Welcome to HMIS! 'Client Revocation of Consent' form with this agency. HMIS Training: Completing the Electronic Consent Form 319 views Jan 9, 2019 2 Dislike Share Save Ending Homelessness 81 subscribers This five minute video provides training on how to complete the. Signing this consent form does not guarantee you services. $(this).parent('.panel').find('.fa-minus').hide(); Please send all requests for changes to support@bitfocus.com. Please contact mnhmis@icalliances.org if you need assistance filling out this form. 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. FileShare. HMIS. HMIS Data Collection Template (PDF) - recent standards revision, a form any agency may use for collecting all of the required HMIS elements at enrollment and exit. 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. Decisions regarding permitted types of consent (inferred, written, verbal, etc.) There are well-defined data collection procedures and limitations. The Service Prioritization Decision Assistance Tool (SPDAT) was developed by OrgCode Consulting as an assessment tool for frontline workers to prioritize which homeless clients should receive assistance first and to determine when clients have sufficiently stabilized so that assistance is no longer needed. Coordinated Entry System. BTG Client Informed Consent Form (Jun 2018) BTG Authorized Agency List (Apr 2021) I can receive a copy of this Consent and the Client Information Sheet I may refuse to sign this Consent. Homeless Programs Reporting ScheduleCheck out this resource for information on upcoming report deadlines. Explore collections of guided learning opportunities on a variety of topics. Most often, a consent form is used for medical purposes to hold the hospital or surgeon harmless of any wrongdoing due to the risks involved with . 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. Please note that the training request form will need to be submitted along with the new user agreement form. View MN HMIS' Provider List of over 200 agencies. General HMIS InstructionsA guide with information about basic HMIS features and step-by-step instructions for common data entry activities. 2023 US Department of Housing and Urban Development, 2004 HUD Data and Technical Standards Notice. You have the right to receive a copy of this consent form. 2003-2021 Bitfocus, Inc. All rights reserved. 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. Voluntary verbal informed consent was obtained from all respondents prior to interviews. Increased visibility of HMIS information is designed to ensure a safe and confidential method for sharing data. Learn through self-paced online trainings, recorded webinars, and more. All Rights Reserved. SAP BusinessObjects User SettingsThis video demonstrates how all users should configure their BusinessObjects account settings. 1 MB Download. The Projects for Assistance in Transition from Homelessness (PATH) Program participation in HMIS provides a platform for coordinating care and improving access to mainstream programs and housing resources and supports the generation of the PATH Annual Report. 2 The Baltimore City Mayor's Office of Homeless Services serves as the HMIS Lead Agency for the Baltimore City Continuum of Care. The form can be signed two ways: 1. Consent' form with this agency. HMIS empowers agencies to track key indicators on homelessness so they can deliver . page of this form.Report developers and HMIS staff may also see your d ata. Legislative Affairs MyOrg. Tourist Development Forms. Legislative Affairs MyOrg. 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. WHAT IS HMIS? Funding. We serve as the community coalition to address homelessness and housing vulnerability. The data systems are known as a Homeless Management Information Systems (HMIS). Ask a basic policy or reporting system question. This means the agency representative signature must still be present. Institute for Community Alliances The following forms are essential to compliance with client confidentiality and data security requirements, HUD Data Standards, PATH, and CES referral prerequisites. 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. Homeless Management Information System (HMIS) - Intake Form. HMIS Help Desk. Client/server system: Architecture in which the client and server computers are connected via a LAN or Serving. Decisions regarding permitted types of consent (inferred, written, verbal, etc.) Please have the following readily available as you complete this form: The staff person at your agency who can provide accurate information and answer questions about the project; Knowledge of the funding source, including when the grant starts/started; For federally-funded projects, the grant identifier from your contract or grant; For shelters and housing projects, knowledge of the number of beds and units per this funding source. and they may reflect local laws and policies. All rights reserved. * 1. Effective Wednesday, July 5, 2017, all Homeless Providers contributing data into HMIS are required to use this new form. Client Consent and Coordinated Assessment: What can I enter into HMIS? Search for a specific grantee and view itsawards, contact information, and reports, and more. Please bear in mind that these documents were created by organizations based on their specific needs and objectives, Paper Application. Your feedback will help shape future HMIS training events. Register for upcoming training, webinars, conferences, and more. By signing this form, I give this Agency permission to share (verbally, or through the HMIS, mail, fax, or by hand) information collected about me and any dependents listed on the back of this form with HMIS Partner Agencies, for the LB HMIS Consent & LB ROI Page 1 of 4 Revision 20201110v5 . 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. Please provide the date of the training you most recently attended: Enter the date of your training (approximate) Date. For Agencies/Projects Not Currently Set Up in HMIS: For Agencies/Projects Currently Set Up in HMIS: Data and Performance Management Meeting Materials, Article: HMIS Requirements for New Agencies. A head of household's consent will apply for every other household member. 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). HMIS Privacy & Data Sharing Overview - Client Consent Form attached at the bottom, Password: Reach out to your System Administrator. In general, HMIS standards do not stipulate what form of consent must be obtained to share data within HMIS. HMIS data specifically designed to support planning, management, and decision making based on on Grading of facilities, various indicators at Block, District at State as well as National Level. This copy is a sample. Capacity Building. LA-HOP. Thank you! Continuum of Care. A current list of Partner Agencies is at Search for a specific grantee and view itsawards, contact information, and reports, and more. 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. policies and corresponding procedures that are appropriate locally and that are compliant with federal, state, and local law. 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. 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). may be made locally by the CoC, working in conjunction with the HMIS Lead, and should also consider possible state or other local requirements. System Administration provided by Bitfocus, Inc. }) Request in-depth assistance with implementing a HUD-funded program. Explore featured publications and browse regulations, policy guidance, toolkits, and other resources. 2.24 miles ( serves your local area) 524 Maryland Avenue, Essex, MD 21221. Browse the library of grantee reports and plans, organized by program. Giving That Gives Back 2. Resource Management System. For technical support contact nevada@bitfocus.com. Homeless Management Information System (HMIS). $(this).parent('.panel').find('.fa-plus').hide(); HMIS Client Consent Form: Informed Consent Agreement (Sample) Print ShareThis Date Published: June 2011 Description This is an example of an informed consent agreement. Effective March 1, 2014, the Institute for Community Alliances (ICA) became the HMIS lead organization for the State of Wisconsin. Since its inception in 2004, BTG has utilized the HMIS to collect client-level data, as well as data on the provision of housing and services to at-risk and homeless individuals and families. 2023 US Department of Housing and Urban Development, Client Consent Form: Informed Consent (Sample), HMIS Client Consent Form: Informed Consent Agreement (Sample). If I refuse, I will not lose any benefits or services. Authorized Power of Attorney or Proxy notarized letter from Client along with signed HMIS consent form. 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.