Part III: Barriers to Housing Stability Assessment
Complete one assessment per household and record all information on this form.
Some information may be collected after program entry as you get to know the household and learn about their barriers over time. You may enter this information into HMIS at a later date, but remember that it should describe the household’s situation at entry (remember to backdate).
Avoid using the “Not Assessed” category. Funders expect complete data collection for all clients served. Only mark “Not Assessed” if you are unable to get certain information from clients.
14.Do any household members have tenant screening barriers to getting housing? Yes No (skip to question 17) Not assessed (skip to question 17)
15.How many evictions or unlawful detainers have household members experienced? Zero 1 2-3 4-9 10+ Not assessed
16.Please complete the grid below:
Have any household members experienced these tenant screening barriers?
Not Assessed (use rarely)
Poor reference from current/prior landlords
Lack of rental history
Unpaid rent or utility bills
Lack of or poor credit history
One or more misdemeanors
Critical felony (sex crime, arson, drugs)
17.Do any household members have income barriers to getting or keeping housing? Yes No Not assessed
18.Does the household need temporary assistance to get or keep housing? Yes No Not assessed
19.Is the household currently housed? Yes No
If yes: What percent of income does the household spend on housing?
35% or less 36% to 50% 51% to 65% 66% to 80% More than 80% Not assessed
If no: How much money is the household able to spend per month on housing?
Zero $1-$100 $101-$151 $151-$200 $201-$250 $251-$300 $301-$350
$351-400 $401-$450 $450-$500 $501-$550 $551-$600 $601-$700 $701-$800
$801+ Not assessed
20.Please complete the grid below:
Have any household members experienced these income barriers?
Lacks steady, full time employment
Lacks high school diploma or GED
Job barrier: limited English proficiency
Job barrier: lack of reliable transportation
Job barrier: lack of reliable/affordable child care
Drug or Alcohol Treatment Facility: Includes inpatient treatment and detox.
Extent of Homelessness by Minnesota’s Definition
The State of Minnesota defines as homeless “any individual, unaccompanied youth or family that is without a permanent place to live that is fit for human habitation.” Doubling-up is considered homeless if that arrangement has persisted less than 1 year.
The State of Minnesota defines an individual, unaccompanied youth or family as “Long-Term Homeless” if they are without a home for a year or more OR have had at least four (4) episodes of homelessness in the past three (3) years. Any period of institutionalization or incarceration (including transitional housing, prison/jail, treatment, hospitals, foster care, or refugee camps) shall be excluded when determining the length of time the household has been homeless.
Foster Home: In question 2, this term applies to youth only.
Group Home: Includes mall facility for people with disabilities (cognitive or physical); may also be used for corrections clients. Includes adult foster care. Placement done through social services or corrections departments.
Half-way House: Includes placement for corrections clients after jail or prison OR for clients after chemical dependency treatment.
Mental Health Treatment Facility or Hospital: Includes regional treatment centers (state hospitals), Intensive Residential Treatment Services (IRTS), crisis residences, and psychiatric inpatient units at local hospitals.
Permanent address: A permanent address is an apartment, house, or room where the client last lived for 90 days or more. Shelters and time-limited housing are not permanent addresses.
Residence for People with Physical Disabilities: Includes nursing homes, long-term care facilities, and rehab hospitals.
U.S. Military Veteran: A veteran is someone who has served on active duty in the Armed Forces of the United States for 180 OR MORE days. This does not include inactive military reserves or the National Guard unless the person was called up to active duty