Agency/User HMIS Access Forms
HMIS User Access Request
The HMIS User Access Request (UAR) Form is used by an agency’s Executive Director or other authorized representative to request, update, or remove access to the Homeless Management Information System (HMIS).
This form collects the user’s contact information and essential details related to their HMIS permissions, including the specific HMIS project(s) the user should be able to access. The information submitted is used to verify authorized personnel at each agency, initiate required HMIS training, and create or update the user’s profile within HMIS.
When this form is required
The UAR Form must be completed in the following situations:
To initiate training and access for new HMIS users
To modify an existing user’s HMIS access due to changes in job responsibilities, department, or assigned projects
To remove HMIS access when a user no longer requires access or their employment with the agency has ended
Important Notes
This is a digital form and will be completed in Airtable
For security purposes, ICA verifies all authorized representatives before processing a request
New user requests must be reviewed and approved by a HMIS Manager to confirm HMIS license availability within the CoC
If you have questions or need assistance completing the form, please contact the HMIS Helpdesk
Agency Policy Forms
Privacy and Security Notice (Revised July 2022)
This notice describes the HMIS privacy policy of your agency. The information collected by your agency includes: basic identifying demographic data, such as name, address, phone number and birth date; the nature of the clients situations and the services and referral they receive from your agency. This information is known as the clients Protected Personal Information or PPI. All agencies which utilize the HMIS share their data with other participating agencies, with the exception of Protected Class Agencies. Protected agencies service specific protected client populations, such as HIV/AIDS, alcohol and/or substance abuse, and mental health, and do not share program information. All clients served by your agency is covered by this policy.
Procedure:
This document will need to be edited on page three and page four. Make sure that you edit the “Header” and add your agency name. When completed return a copy of the HMIS Data Privacy Policy to the HMIS Project office via email and then place a copy into your HMIS Policies and Procedures binder or file. All Agencies must provide a copy of the Privacy and Security Notice with the client should they request one.
Client Informed Consent to Share and Release of Information (Revised October 2020)
By signing the Client Informed Consent to Share and Release of Information form, the client understands that any information the client shares with an agency participating in HMIS is kept confidential and that only those authorized to input data into HMIS can view the client’s personally identifying information; depending on the CoC, however, health information will not be shared. By signing this form, the client also understands the client has the right to refuse to answer a certain question in HMIS. If the client decides at a later date to no longer share client information in HMIS, future information can be locked down.
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. A head of household’s consent will apply for every other household member. An agency must maintain the original, signed Client Informed Consent to Share and Release of Information form in client’s hard copy file or in the HMIS. The agency will continue to maintain the original, signed Client Informed Consent to Share and Release of Information form for each client entered into HMIS for a minimum of seven years from client’s program exit date.
For the majority of CoCs on the implementation (Balance of State, Joplin, St. Louis City, St. Louis County, and St. Joseph), client health information is not shared to other agencies. They use this ROI:
For the Springfield CoC, client health information is shared to other agencies in the Springfield CoC. They use this ROI:
If you have any further questions about ROIs, please see our more detailed guide on their use.
HMIS Consumer Notice (Revised August 2021)
The HMIS Project Consumer Notice explains to the client the Partner Agency participates in the HMIS Project. This notice must be placed in a visible area where clients will have the opportunity to view it.