06-1011 - City of Des Moines

* Roll Call Number 

.. on nn........ f) I£l.~ II) ll....... on. 

Date ______MflY.2.i-'_iQQQ__._______ 

APPROVAL OF CONTIN OF CAR PROGRA APPLICATION 

Agenda It~Umber 

WHEREAS, in response to a Super NOF A published in the Federal Register on March 8, 

2006, to supplement fuding for local homeless programs, the City's Housing Services 

Deparment and the Polk County Housing Continuum prepared an application for $2,571,481 in 

Continuum of Care Program fuds, which is on fie in the City Clerk's Offce and by this 

reference made a par thereof; and 

WHEREAS, the application was developed from the City's Continuum of 

Care strategy, 

whereby Continuum of Care funds would provide needed services to homeless persons in Des 

Moines and address high priority service gaps within the parameters of Continuum of Careeligible 

activities; and 

NOW, THEREFORE, BE IT RESOLVED by the City Council of the City of Des Moines, 

Iowa, that the above-referenced Continuum of Care application is hereby approved. 

BE IT FURTHER RESOLVED that the Mayor is hereby authorized and directed to 

execute the above-referenced Continuum of Care Program application and certifications and the 

City Manager or his designee is hereby directed to submit the above application to HU. 

APPROVED AS TO FORM: 

/7 /' '" -I 

~1:/l~ i~tl-~~14t1/ 

An DiDonato 

Assistant City Attorney 

(Council Communication No. 06- i ~'l ) 

MOVEDBY~ TO ADOPT 

COUNCIL ACTION YEAS NAYS PASS ABSENT 

CERTIFICATE 

COWNIE i. 

BROOKS i. I, DIANE RAUH, City Clerk of said City here by 

COLEMAN l- certify that at a meeting of the City Council of 

said City of Des Moines, held on the above date, 

HENSLEY l- among other proceedings the above was adopted. 

KIERNAN 

i, 

MAHAFFEY ¿" IN WITNESS WHEREOF, I have hereunto set my 

hand and affixed my seal the day and year first 

VLASSIS I- above written. 

, .' - (',:;~ 

APPROVED 

:, R"", 

i.,~i./' II /? II' 

L~~ 

~.'/ .' d 

~ 

l.~ri"t W l \'.Jé./,l_' 'l 

;; It.';, i ~.~ ~~ ,tlKA' (;~fI 17~' "l.. /. ;P',i 'l ~.v.)) vn'" l/ 

MaY.0r 

TOTAL I 

MOTION CARRED I I 

--~ ~;¿/~ i 

City Clerk

an Council 

Communication 

~ CITY OP DES moinES 

Date I May 22, 2006 

Agenda Item No. 28 

Roll Call No. 06- to f/ 

Communication No. 06-282 

Offce of the City Manager 

Submitted by: Chris M. Johansen, Housing 

Services Director 

I 

AGENDA HEADING: 

Approval of Continuum of Care Program Application 

SYNOPSIS: 

The City of Des Moines is proposing to submit an application to the U.S. Deparment of Housing and 

Urban Development (RUD) for Continuum of Care Program funding which will provide needed services 

to homeless persons in Des Moines and Polk County. The program is designed to develop supportive 

housing and related services that wil allow homeless persons to live as independently as possible. 

FISCAL IMPACT: 

Amount: $2,571,481 (application amount) 

Funding Source: HUD/Continuum of Care Program 

ADDITIONAL INFORMATION: 

On behalf of the City, the Housing Services Department is proposing to be the applicant for a Continuum 

of Care grant that includes the HU geographic areas of the City of Des Moines and Polk County in the 

amount of $2,571,481. The application is made up of ten Supportive Housing Program (SHP) projects 

and one Shelter Plus Care (S+C) project. As the applicant, the City's Housing Services Department will 

be responsible for the overall management and administration of the grant, including drawdowns, fund 

distribution and reporting to HU. The City wil retain approximately $46,203 of the grant funds for 

administrative costs if the application is approved. Eleven agencies (project sponsors) wil utilize these 

funds to assist homeless residents. 

This year's application includes the following programs in priority order: 

. YMCA of Greater Des Moines - Permanent Housing Program ($192,998): this is a two-year 

application for bonus funding which HUD makes available annually to target a particular sector 

of the homeless population. With $736,309 of funding from other sources, the Downtown 

YMCA will make 30 units of permanent housing available to chronically homeless men with 

disabilities (physical, mental and/or substance'àbuse). This new program wil address two local 

priorities - permanent housing and chronic homelessness. 

. Iowa Institute for Communty Alliances - Iowa Homeless Management Information System 

($220,500): this is a new two-year expansion of the federally required Homeless Management

Council Communcation No. 06-282 

Page 2 of 4 

Information System (HMIS). The grant will fud staff, hardware/softare resources, and 

operatig expenses to expand the coordination network with emphasis on street outreach, 

supportive servces, and permanent supportive housing. The HMS is used throughout the metre 

area and also statewide. This expansion will operate a pilot service in Polk County to expand 

electronic paricipation by a wider aray of service providers (including street outreach) and 

improve data quality of all paricipants. 

. ' House of Mercy - Transitional Housing Program ($289,733): this is a one-year renewal of an 

existing transitional housing program for np to 148 individual women and/or women with 

children. The project provides housing and a wide aray of supportive servces including case 

management, counseling, medical and dental health care, transportation and job search assistance. 

The project leverages $556,005 in additional fuding and 81 % of the clients who exited the 

program last year moved to permanent housing. 

. House of Mercy at Capital Park ($227,468): this is a one-year renewal of a permanent housing 

program that serves women with disabilities. Up to 26 individual women and/or women with 

Mercy purchased and 

children can be served by the project, located at 1240 E. 12th St. House of 

rehabilitated the facility in 2005 and it opened in September to expand their continuum of 

services to include permanent housing. Paricipants in Mercy's transitional housing program can 

move to this facility, if their progress to self-sufficiency will take longer than the two years 

allowed for a transitional housing program. Based on the availability of space, other agencies can 

also refer women to the facility. House of Mercy will leverage $56,867 of other fuds to operate 

the program. 

. YMCA - Transitional Housing Program ($102,217): this is a one-year renewal of a program that 

provides 120 units of transitional housing and support services to disabled and/or chronically 

homeless men. In 2005, staff provided case management and assisted 163 clients to address 

substance abuse, mental health, or medical problems, find employment and move onto permanent 

housing. The YMCA leverages $775,679 from other sources to operate this program. In 2005, 

343 persons exited the program and 107 ofthem moved to permanent housing 

. Iowa Homeless Youth Centers - Lighthouse Host Home ($287,356): this is a one-year renewal 

that provides transitional housing and support services for up to 20 youth includig youth with 

children. IHC transitioned 75% oftheIr clients to permanent housing last year. 

. Iowa Homeless Youth Centers - Buchanan Transitional Living Center ($99,391): this is a oneyear 

renewal that provides transitional housing and support services for up to 8 youth. Clients are 

required to work and/or attend schooL. The project served 28 youth last year and 71 % moved to 

permanent housing. 

. Priar Health Care - Enhancement ($256,109): ths is a one-year renewal of a supportive 

service program that provides outreach, case management, healthcare, substance abuse and 

mental health services. The program assists adults and children to transition from the street to 

decent affordable housing through outreach, referral, and support services. Primar Health Care 

also conducts site visits to all Des Moines area shelters to provide health screenigs and treat 

medical problems. PHC leverages $189,716 of additional fuding and 719 adults exited the 

program last year.

Council Communication No. 06-282 


. Primar Health Care - Street Outreach ($85,000): this is a one-year renewal of a supportive 

services project to assist 25 chronically homeless persons obtain needed medical and mental 

health services and move from the streets to transitional and/or permanent housing. PHC 

leverages $64,408 of additional fuding and 86 persons exited the program last year of which 

76% obtained additional financial resources. 

. West Des Moines Human Services - Transitional Housing Program ($87,325): this is a one-year 

renewal of a program that provides transitional housing and support services in four single-family 

homes and can serve up to 18 adults and children annually. The agency also provides case 

management, employment assistance, transportation, and other basic needs. Transitional housing, 

especially for large families, is an identified need in the Consolidated Plan and the Continuum of 

Care. The project leverages an additional $60,953 of other funds and of the 2 households that 

exited the program last year one moved to permanent housing. 

. Anawim _ Shelter Plus Care ($723,384): this is a one-year renewal of a program that provides 

permanent housing in 102 units with 205 beds for chronically homeless individuals. It is similar 

to the Sec. 8 housing program and subsidizes up to 100% of the rent. Federal regulations require 

that case management be provided by other agencies locally, the cost of which is used as match 

for the program. In 2005, the case management match totaled $916,133. Human service 

agencies are very wiling to provide case management for their clients who obtain decent 

affordable housing. Landlords are also interested in the program because the lease is between 

Anawim, the landlord, and the client and Anawim follows up on landlord/client problems. 

The application has been developed from the City's Continuum of Care strategy and wil address high 

priority service gaps within the parameters of Continuum of Care eligible activities. This is the ninth 

year that the City has been an applicant for this program. The projects are selected based on the 

priorities in the Continuum of Care. The Polk County Housing Continuum provides considerable 

assistance in the development of the application and funding priorities. The Polk County Housing 

Continuum adopted the Committee's recommendations at their meeting on May 3, 2006 and 

recommended that the City Council approve the application. 

PREVIOUS COUNCIL ACTION(S): 

Date: May 23, 2005 

Roll Call Number: 05-1277 

Action: Continuum of Care Program application made to HU for Supportive Housing Program (SHP) 

and Shelter Plus (S+C) supplemental funding for local homeless programs to address service gaps. 

(Council Communication No. 05-269). Moved by Hensley to adopt. Motion Cared 7-0. 

BOARD/COMMISSION ACTION(S): 

Date: May 17, 2006 

Roll Call Number: NA

Council Communcation No. 06;.282 


Action: The Neighborhood Revitalization Board (N) received application inormation. 

ANTICIPATED ACTIONS AN FUTURE COMMTMENTS: NONE

Part I: CoC Organizational Structure 

HUD-defined CoC Name:* 

Des Moines/Polk County CoC 

*HUD-defmed CoC names and numers are available at: ww.hud.gov/offces/admgrants/fudsavai1.cfm. If 

not have a HU-defined CoC name and number, enter the name of 

A . C CL dO 

. 0 ea rganization Chart 

CoC Lead Organization: City of Des Moines 

CoC Contact Person: Robert Schulte 

; 

Contact Person's Organization Name: 

Street Address: 100 East Euclid, Suite 101 

. 

CoC Number* 

1A-502 

you do 

your CoC and HU will assign you a number. 

City of Des Moines Dept. of Housing Services 

City: Des Moines 1 State:IA -I Zip: 50313 

Phone Number: 515.237.1384 1 Fax Number: 515.242.2844 . 

Email Address: RAchulte&)dmgov.org 

CoC-A 

B: CoC Geography Chart 

Using the Geographic Area Guide found on HU's website at 

htt://ww.hud.gov/offices/admgrants/fudsavai1.cfm. List the name and the six-digit geographic 

code number for every city and/or county paricipating withn your CoCo Because the geography 

covered by your CoC will affect your pro rata need amount, it is important to be accurate. Leaving out 

a jursdiction wil reduce your pro rata need amount. For fuher clarfication, please read the 

this NOFA regarding geographically overlapping CoC systems. 

gudance in Section m.C.3.a of 

Geographic Area Name 

Des Moines 

West Des Moines 

Polk County 

6-digit 

Code 

191362 

195508 

199153 

1 

Geographic Area Name 

6-digit 

Code 

CoC-B

coe Structure and Decision-Making Processes 

C: CoC Groups and Meetings Chart 

The purose of the CoC Groups and Meetings Char is to help HU understad the curent strcture 

and decision-makg processes of your CoCo List the name and role (fuction served) of each group 

in the CoC planing process. Under "CoC Pnmar Decision-Makg Group," identify only one group 

that acts as the pnmar leadership or decision-makg group for the CoCo Indicate frequency of 

meetings and the number of organations paricipatig in each group. Under "Other CoC 

Commttees, Sub-Commttees, Workgroups, etc." you should include any established group that is par 

of your CoC's organational strcture (add rows to the char as needed). Please lit your description 

of each organation's role to 2 

lies or less. 

CoC-Related Planning Groups. 

2 

Meeting 

Frequency 

(check only 

one column 

i= 

.c i. 

u 

.. Cl 

c= ~ 

Cl 

~ t 

~ t¡ . 

Enter the 

number or 

organitions 

entities that are 

members or 

each CoC 

t: . ~ planng group 

1: ã = lited on th 

~ ; ã char 

CI is ~ 

20 

CoC-C

D: CoC Planning Process Organizations Chart 

List the names of all organzations involved in the CoC under the appropriate category. If more than 

one geographic area is claied on the 2006 Geography Char (Char B), you must indicate which 

geographic area(s) each organzation represents in your CoC plang process. In the last colums, 

identify no more than two subpopulation(s) whose interests the organzation is specifically focused on 

representing in the coe plang process. For "Homeless Persons," identify at least 2 homeless or 

formerly homeless individuals. 

~ 

J3 

. l; 

~u 

~ 

~ 

Specifc Names of Al CoC Organitions 

STATE GoVERNNT AGENCIE 

IA Workforce Development 

IA Fince Authori - Council on Homelessness 

LoAL GoVERN AGENCI 

City of Des Moines 

Polk County Board of Supesors 

Neighborhoo Revitaliztion Board 

City of West Des Moines Hum Serces 

Ci of Altoona 

PUBLIC HOUSING AGENCIE 

City of Des Moines, Det. Housing Serces 

SCOOL SYSTEMS I UNIRSIT 

Des Moines Public Schools 

Des Moines Area Communi Colle e 

LAw ENFORCEMENT I CORRClONS 

Des Moines Police Depent 

LOCAL WORKORCE IN Acr (W) 

BOARS 

Cetrl Iowa Em loyment & Traing Consortum 

OTHER 

3 

Gegraphic Area 

Represented 

191362 

199153 

191362 

195508 

199153 

Subpopulations 

Represented, ü any* 

(no more than 2)

NON-PROFI ORGANTIONS 

AIs Project of Central Iowa 199153 HN/AIS 

American Red Cross /2-1- 1 199153 

Anawi S+C 191362 SA SM! 

Aunt Joe's House of Hospitality 191362 

Beacon of Life 191362 DV SM! 

Berie Lorenz Recovery 191362 SA DV 

Centrl Place Family Resource Center 199153 SM! SA 

Chldren & Families of Iowa 191362 DV Y 

Churches United Shelter 191362 SA VET 

Communty Housing Development Corp. 191362 

Des Moines Habitat for Humty 191362 

Four Oaks 199508 DV 

Hawtorn Hil- New Directions Shelter 191362 y 

HOME Inc. 191362 SM! 

Home Connection 191362 

Homes of Oakdge 191362 

House of Mercy 191362 SA DV 

Iowa Homeless Youth Cete 191362 y DV 

IA Intitute for Communty Alances 199153 

Iowa Coalition for Housing for the Homeless 199153 

Legal Aid of Iowa 199153 

Pr Health Cae, Inc. - Outreach 191362 SM! SA 

Proteus, Inc. 191362 

~ Rebuilding Together 191362 

t Re-Entr 191362 

I" 

u. 

Red Rock Area Communty Action 199153 SM! VE 

I" Spetr Resources 

~ Visitig Nur Serces 

; YMCA of Greater Des Moines 

ø. Young Women's Resource Cente 

Youth Emergency Shelte & Serces 

YWCA 

191362 

199153 

191362 

191362 

191362 

191362 

DV 

SA 

Y 

Y 

SA 

y 

SM! 

DV 

FAI-BASED ORGANTIONS 

Catholic Chties 191362 DV Y 

CJM Hasen Hous 191362 SA 

Connection Café -St. John's Lutheran Church 

Cross Mistres 

Des Moines Area Religious Council 

Door of Faithope Minstres 

Excel Community Outreach 

191362 

191362 

191362 

191362 

191362 

SMI 

DV 

y 

SMI 

SMI 

SA 

Y 

SA 

SA 

Interaith Hospitality Network 

Pathways Enterises Minstr 

Rizpah CDC 

Ruth Harbor 

St. Vincent DePaul Society 

FUNERS 1 ADVOCACY GROUPS 

Polk County Housing Trut Fund 

United Way of Centrl Iowa 

Agenda One (formerly Hum Servces Planng 

Allance 

195508 

191362 

191362 

191362 

191362 

SA 

DV 

SMI 

y 

SA 

VETS 

y 

SA 

VETS 

BUSINESSES (BANKS, 

AsSOCIATIONS ETC. 

DEVELOPERS, BUSINESS 

Harbor of Hope 191362 

4

Cooper Smith & Co. 

Neighborhood Finance Corporation 

Greater Des Moines Parershi 

HOSPITALS I MEDICAL REpREENTATIS 

BROADLA WNS MEDICAL CENTR 

HOMELESS PERSONS 

Mario Hayslett 

Nanc Wolf-Keith 

OTHER 

Vetem Admisttion of 

Centrl Iowa 199153 VE 

*Subpopulations Key: Seriously Mentally III (SMI, Substace Abuse (SA), Vetera (VET), 

HN/AIS (H, Domestic Violence (DV), and Youth 00. 

E: CoC Governing Process Chart 

HU is movig toward providig greater defition and settg stadards on the goverg proess of 

Continuum.s of Care. Check the box for each Question below, and explai briefly if necessar. 

Yes No 

1. Does the CoC have a separte plang and decision-makg body/entity that is 

broady representative of the public and private homeless servce sectors, includig (8 D 

homeless client/consumer interests? If no, pleae explai. 

2. Is the priar decision-makg entity composed of at leat 65 percet 

representation by the private sector (includig conser interests)? Ifno, pleae (8 D 

explai. 

3. Is the priar decision-makg entity memberhip selected in an open and 

democratic process by the CoC membership? Ifno, pleae explai. (8 D 

4. Is there a Chai and Co-Chai representig both the private and public sector at 

the same time, with staggered 2-year term and the Chai position rotatig between 

the private and public sectors? If no, please explai. 

The Housing Continuum anually elects offcers: chaerson, vice-chaierson, and 

secreta. Officers are selected from a 20 member board consistig of 10 established 

representatives from the public sector (6 seats), private sector (3 seats), and homeless 0 (8 

or formerly homeless (1 seat) and 10 appointed representatives from the provider 

communty (outreach, shelters, tritional, peranent rental, and homeownership). 

The by-laws will be amended to incorporate a rotatig chai with representation from 

both the private and public sectors with staggered 2-year terms so that the process is in 

place for the anual election of offcers in Janua 2007. 

5. Has the CoC developed a Code of Conduct for the CoC decision-makg entity 

and its Chair and Co-chair? If no, please explai. 

The Housing Continuum by-laws curently include decision-makg procedures for 0 (8 

voting, parliamentar procedure, and election of officers. The Board will develop a 

Code of Conduct Policy for the decision-makg entity and its chairs by Janua 2007. 

5

F: CoC Project Review and Selection Chart 

The CoC solicitation of projects and project selection should be conducted in a fair and imparal 

maner. Please mark all appropriate boxes to indicate all of the methods and processes the CoC used 

in 2006 to assess project(s) pedormance, effectiveness, and quality, paricularly with respect to the 

Project Priorities Char (CoC-Q). Ths applies to new and renewal projects. Check all that apply: 

1. 0 en Solicitation 

a. Newspapers 

e. Outreah to Faith-Based 

Grou s 

b. Letters to CoC Membership 

f. Anouncements at CoC 

Meeti s 

c. Responsive to Public Inquies 

d. Emai COC Membersm /Lister 

g. Anouncements at Other 

Meetin s 

2. Ob' ective Rati Measures and Penormance Assessment 

. a. CoC Ratig & Review Commtt 

b. 

Exist 

Review CoC Monitori Findin s 

c. Review HU Monitorig Findigs 

d. Revew Independent Audit 

e. 

f. 

h. 

c. 

d. 

Review HU APR 

Review Unexecuted Grats 

G: CoC Written Complaints Chart 

Assess Spendig (fast or slow) 

Assess Cost Effectiveness 

Assess Provider Organation 

Ex erence 

m. Assess Provider Organtion 

C aci 

Evaluate Pro' ect Presentation 

Review CoC Membersmp 

Involvement 

Review Match 

Review Levera . 

e. Al CoC Present Can Vote 

f. Consensus 

. Absta if confct of interest 

Were there any written complaints received by the CoC regarding any CoC matter DYes 

in the last 12 months? 

i: No 

If Yes, briefly describe the complaints and how they were resolved. 

7 

CoF 

CoC-G

Part II: CoC Housing and Service Needs 

H: CoC Services Inventory Chart 

(1) (2) (3) (4) 

Prevention Outreach Su ~portive Servces 

Provider Organiations 

b/ 

0 .5 

0 ~ 0 ~ õfI 

0 0 ~ 

0 

~ 0 

~ 0 0 

5 5 g 

~ ~ 0 fI 

0 

b/ 

~ ~ i ~ u 

... 

fI 

0 

Ð 5 

.( .- 

.- en en 

en ~ ... E :8 ~ 

.( 

e 

~ 

§ 

'+2 5 

fI en 

0( ~ .( .5 

8 = ~ 

~ i 

~ 

ü ~ 

:: en õ .( - 

0 

0 ~ :g 0 

.8 '3 

l 1 

§ 

~ ~ u 

'+2 

en 

"¡ l) - ... ~ tI 

§ 

~ 

"Ó 

g - 

.- 

0 0 

$ .g ~ 

~ ~ ~ å' ~ ~ ~ 

~ ~ ~ 5 8 tI ~ (~ ':3 ~ tM æ us 

Agi Resource oflowa X X 

AIS Project of Centr Iowa X X X X 

Anwi Housin X 

Beacon of Life X X 

Berne Lorenz Recover X X X 

Broadwn Homeless Mentl Heath X 

Centr Iowa Employmnt and Trag 

Consortum 

Chdrn and Fames oflowa- Famy 

Violence Center 

X 

X 

Chdren and Fames oflowa X 

Churches United X X X X 

Citiens for Commty Imrovement X 

City of Des Moines Commty Servces 

X X 

Diviion 

Communty Support Advoctes X 

Cross Mitres X X 

Creative Visions X X X 

DM Police Deparnt (DART-Domestic 

Abuse Resoonse Team) 

X X 

Des Moines Regiter Leg Ceter X 

Des Moines Public School System X X 

Des Moines Area Communty College X 

Four Oak X X 

Free Access to the Red Cross 211 Homeless 

Helpline 

X 

Golden Circle X 

Golden Circle Behavioral Health X 

Goodwil Industres X 

8 

CoC-H

(1) (2) (3) (4) 

Prevention Outreach Su iportive Services 

bO 

0 .5 

~ ~ - 

0 

() 

tä 

0rl 0 () 

0 

~ S 

G G 

l ~ 

Provider Organiations 

.. 

.~ rl 

rl 

rl 

~ 

() 0 

0 

() .. 

Ü 

.. tä .~ () ~ () CI 

~ 5 

:5 l g ~ 

i: 

t: 

0 

rl .~ rl 

rl .~ 

.( ~ ~ e rl ~ 0 

~ 

~ 

'.l 

~ ~ 0 

bO 

CI 

.~ rl 

:: ~ Ü - rl - cE tä :: § 

~ 

~ 0 ~ 

&i ~ 

~ .š 'tl ü ~ 

0 bO 

t: 

~ 

0 0 - '.l 

rl 

~ Õ - .~ .~ fI 

~ 

() 

t: 

,0 0 

bO rl 

~ g 

~ ~ 

~ ~ ~ ~ ~ ~ æ l 

0 

"d - g. 

~ 

.~ 

CI 

~ 5 ü .3 fI u ':3 ~ .. tÍ Ü 

Home Connection X X 

Home Inc. X 

Homeless Helplie X 

Homeless shelter and servce boklets in 

public places and on the web 

X 

Homes of Oakdge X X X 

Hope Mitres X X X X X 

House of Mercy X X X X X X X 

Hum Serce Pla Alce X X 

Intitute for Socia and Economic 

Development 

Iowa Homeless Youth Cete X X X 

Iowa Lega Aid X 

MECCA X X 

Metropolita Trait Authority X 

New Directions X X 

Opportties Th Trait 

Polk County FlOSS X 

Polk County Famy Development Self- 

Suffciency 

X 

Polk County Genera Assistace X X 

Polk County Heath Servces X 

Polk County Mental Heath X 

Polk County Vetera's Afair X X 

Powell Chemical Depdency X 

Pri Health Cae X X X X 

Pri Health Cae/P ATH X X X X X X X X 

Proteus X X 

Red Rock Commty Action Agency X X 

Reggie's Place X 

ResCare X 

9 

X 

X

(1) (2) (3) (4) 

Prevention Outreach Supportive Services 

bI 

0 ... ç: 

~ ~ .. 0 

~ 

u 0rn 

CI 

0 

0 u 

~ § 

5 5 l ~ 

Provider Organiations ... rn 

rn 

~ 

0 

u 0 

u 0 t 

u 

~ ... u CI 

... rn ~ 5 ~ :ë l g 

rn ... ß e ~ 

~ rn rn ~ 0 

~ .S 0 cB fä ~ 

~ 

~ 

5 

S ~ 

~ 

.~ s 

~ 

=' bI 

! 

.- 

rn Õ 0 

:: 

0 0 ~ :: jJ u 

:g 

i 1 ~ 

-. U 0 

p. 

.~ rn ... .. .. CI 

§ 

0 

10 :ö 

~ 

CI "t 

1- 

rn 

0 0 

Salvation Ary 

~ 

:¡ 

0 

rn 

8 

~ 

.s .i CI 

¿Z 5 tI ~ :. U ':i ~ ~ ~ 

X X 

~ 

u 

.g 

ùí úS d 

fä 

~ 

Salvation Ary-Saly Truck X 

United Communty Serces X 

V A Ceter X 

Varety Club 

West De Moines Hum Serce X X X X 

YMCA X X 

Youth Emegency Serces and Shelte X X 

Y outhuid Progr X 

YWCA X X 

CoC Housing Inventory and Unmet Needs 

I: CoC Housing Inventory Charts 

. Ths section includes thee housing inventory cha-for emergency shelter, tranitional housing, and 

permanent housing. Note that the inormation in these cha should reflect a point-in-time count. For 

the Permanent Housing Inventory Char the bed listed under "new inventory should indicate bed 

that became available for occupancy for the fit time between Februar 1, 2005 and Januar 31,2006. 

For complete instrctions in filling out ths section, see the Intrctions section at the begig of the 

application. 

10 

X


Emer2encyShelter: Fundamental Components in CoC System - Housin2 Inventory Chart 

Target Pop Year-Round Total Other Beds 

HMIS Number of Geo 

Year- Overflow 

Provider Name Facility Name Par. Year-Round Code 

Fam. Fam. Indiv. 

A B 

Round 

Seas- 

& 

Code Beds in HMS D Units Beds Beds 

Beds 

onal 

Voucher 

Current Inventory Ind. Fam. 

Hawtorne Hil Mintres New Directions 1 35 191362 FC 8 35 35 

Chldren & Famlies ofIA Famy Violence F 191362, FC DV 11 40 22 62 2 

Churches United Churches United 1 116 191362 SMF 116 116 

lHope Minstries Bethel Mission 1 112 191362 SMF 112 112 

OM Interfaith Hosp. DMI N 199508 FC 1 14 14 

Network 

Catholic Charties Saint Joseph's Shelter 1 24 191362 PC 5 24 24 

1 2 2 191362 YF 1 2 2 4 

IA Homeless Youth Center Emergency Shelte 

I~ OSM YWCA 

Young Emergency 

Services and Shelter 

~ ~ 

1 60 191362 YM 60 60 

Safe Place 

290 61 SUBTOT. CURN'I 26 115 312 427 2 

INVENTORY: 

SUBTOTALS: 

New Inventory in Place in 2005 Ind. Fam. 

(Feb. 1. 2005 - Jan. 31. 2006) 

None 

SUBTOTAL NEW 

INVNTORY: 

SUBTOTALS:

Anticipated Occupancy 

Date 

-- Inventorv Under DeveloDment 

None 

SUBTOTAL INVENTORY UNDER DEVELOPMENT: 

TOTALS: 26 115 312 427 I I 2 

nmetNeed UNMETNEEDTOTALS: 30 108 42 150 

1. Total Year-Round Individual ES Beds: 312 14. Tota Year-Ro'Ùd Famly Beds: 115 

2. Year-Round Individual ES Beds in HMS: 290 5 . Year-Round Famly ES Beds in HMS: 61 

3. HMS Coverage Individual ES Beds: 93% 6. HMS Coverge Family ES Beds: 53% 

by 100. Round to a whole number. 

by 100. Round to a whole number. Divide line 5 by line 4 and multiply 

Divide lie 2 by line 1 and multiply 

CoC-I 


Transitional Housing: Fundamental Components in CoC System - Housing Inventory Chart 

Geo Target Pop Year-Round 

.. 

I\ 

Code A B IF~lYIFamIYllndivid. 

Number of 

HMIS Par. 

(J Units Beds Beds 

Code Beds I Year-Round in HMIS 

Facilty Name 

Provider Name 

Ind. Fam. 

191362 FC 1 5 5 

191362 SM 22 22 

Current Invento 

St. Ambrose Miss Lil's Lodge N 

22 

110 

Harbor of Hope 1 

Hope 

Harbor of 

191362 SM 110 110 

22 191362 FC 11 22 22 

Hope Mistres Door of Faith 1 

Hope Minstres Hope Famy Center 1 

17 191362 FC 4 17 17 

121 191362 M 42 121 27 148 

27 

Tra. Housing 5 

IWDM Humn Servces 

Tran. Housing 5 

House of Mercy 

59 191362 FC 21 59 59 

191362 SF 34 34 

Tran. Housing 1 

34 

IHome Connection 

Beacon of Life 1 

191362 SF 17 17 

191362 YM 8 8 

Life 

Beacon of 

8 

¡Berne Lorenz Recovery Berne Lorenz Rec. N 

IllC Buchan Tran 5

IHC Lighthouse 5 18 191362 FC 6 18 18 

Crial Justice Minstres Hanen House . 1 12 191362 SM 12 12 

Anawi Housing Proper Mangement N 191362 SM 2 6 6 

YMCA Tranitiona Hsng 1 169 191362 SM 169 169 

YWCA Tranitiona Hsng 1 40 40 191362 FlC 10 40 40 80 

Good Sarta Urban Minstres N 191362 FC 16 47 47 

Four Oak . Four Oak N 191362 FC 2 8 8 

SUBTOTALS: 422 277 SUBTOT. CURRNT 115 343 439 782 

INVENTORY: 

New Inventory in Place in 2005 Ind. Fai. 

(Feb. 1.2005 - Jan. 31. 2006) 

SUBTOTAL NEW 

INNTORY: 

SUBTOTALS: 

Anticipated Occupancy Date 

Inventory Under Development 

.. 

(, 

Four Oaks Famly Livig Center 191362 tFc 11 11 

Crial Justice Mintres Hanen House 6/1 0/2006 191362 SM 2 2 

WDM Hum Services Traitional Housing 191362 FC 9 9 

. 

Hope Mintres Hope Famy Ct July 2006 

191362 PC 10 10 

YMCA Traitiona Hsng Apnl2006 3 3 

SUBTOTAL INVENTORY UNDER DEVELOPMENT: 30 5 35 

TOTALS: 115 373 444 817 

66 165 79 244 

Unmet Need UNMT NEED TOTALS: 

1. Total Year-Round Individual TH Beds: 444 ~. Total Year-Round Famly Beds: 373 

2. Year-Round Individual TH Beds in HMS: 422 5. Year-Round Famly TH Beds in HMS: 277 

3. HMS Coverage Individual TH Beds: 95% 6. HMS Coverge Famly TH Beds: 74%

ivide line 5 by lie 4 and mutiply by 100. Round to a whole 

iumber. 

Divide lie 2 by line 1 and multiply by 100. Round to a whole number. 

CoC-I 

Chart 

Year-Round Total 

Year- 

Individual Round 

Famly Famly 

/CH Beds 

Units Beds 

Beds 

Geo 

Code 


Year-Round 

HMIS 

Provider Name I Facility Name I Par. Beds in 

HMIS 0 A B 

Code 

Current Invento Ind. Fam. 

Anawim Housing Shelter Plus Care 5 66 262 191362 FC 61 262 66/33 328 

House of Mercy Capital Park 5 1 15. 191362 FC 5 15 1/0 16 

SUBTOTALS: 67 277 SUBTOT. CURRNT 66 277 67/33 344 

INVNTORY: 

New Inventory in Place in 2005 I Ind. I Fam. _ 

I 

SUBTOTALS: 

eb. 1. 2005 - Jan. 31. 200 

i 

.. 

.i 

SUBTOTAL NEW 

INVENTORY: 

I I 

Anticipated Occupancy 

Inventory Under Development 

Date 

Anawi Housing Shelter Plus Care May 2007 191362 FC 5 24 5/5 29 

House of Mercy Capital Park March 2006 191362 FC 3 12 2 14 

Children & Fames ofIA Family Violen.ce Center July 2006 191362 FC 15 30 30 

SUBTOTAL INVENTORY UNDER DEVELOPMENT: 23 66 7/5 73 

TOTALS: 89 343 74/38 417 

12 45 29 74 

i I 

I I I 

Unmet Need UNMET NEED TOTALS:

74 4. Total Year-Round Family Beds: 343 

1. Total Year-Round Individual PH Beds: 

67 5. Year-Round Famly PH Beds in HMIS: 277 

2. Year-Round Individual PH Beds in HMS: 

3. HMS Coverage Individual PH Beds: 

91% 6. HMS Coverage Famly PH Beds: 81% 

(Divide line 5 by line 4 and multiply by 100. Round to a whole 

(Divide line 2 by line 1 and multiply by 100. Round to a 

number.) 

whole number.) 

*Perment Supportve Housing is: S+C, Section 8 SRO and SHP~Perment Housing component. It also mcludes any perment housing projects, such as 

public housing unts, that have been dedicated exclusively to servg homeless persons. 

CoC-I 

~ 

U1

J: CoC Housing Inventory Data Sources and Methods Chart 

Complete the following chars based on data collection methods and reporting for the Housing 

. Inventory Char, including Unmet Need determination. The surey must be for a 24-hour point-intime 

count durng the last week of January 2006. 

18 

D 

No Adjustments Made 

form 

check al that a I 

*For fuer instrctions, see Questions and Anwers Supplement on the COC porton of 

htt://www .hud. gov/ offces/adm grants/fudsavail.cfm 

16 

lain how and wh . 

CoC-J

CoC Homeless Population and Subpopulations 

K: CoC Point-in- Time Homeless Population and Subpopulations Chart 

Complete the followig char based on the most recent point-in-tie count conducted. Par i and Par 

2 must be completed using stastcaly reliable, unduplicated counts or estiates of homeles perons in 

sheltered and unheltered locations at a one-dy point in tie. Include homeless Hurcae Ka 

evacuees in Par i and 2, and complete Par 3 if applicale. Par 3 may be completed using point-in- 

time information or may be estimated if no point-in-tie count has been done since September i, 

2005. Completion of a point-in-time count of sheltered and unsheltered homeless persons durg the 

last week in Januar 2006 is not requied. 

Indicate date of last point-in-time count: 01125/06 (mmlddlyy) 

Part 1: Homeless Population 

-- Households : 

Number of Famlies with Childrn (Famly 

1. Number of Persons in Famlies with 

Childr: 

2. Number of Single Individua and 

Perons in Households without Children: 

Eme 

Unsheltered Total 

25 150 197 372 

76 489 600 1165 

212 432 930 1574 

(Add Lines Numbered i & 2) Tota Persons: 288 921 1530 2739 

Part 2: Homeless Subpopulations Sheltered Unsheltered Total 

a. Chonically Homeless (For 

sheltered, list persons in emergency 254 191 445 

shelter onI 

b. Severely Mentally ni 268 * 

c. Chrnic Substace Abuse 382 * 

d. Vetera 117 * 

e. Persons with HI/AIS 26 * 

f. Victis of Domestic Violence 297 * 

g. Unaccmpaned Youth (Under 18) 41 * 

If applicable, complete the followig section to the extent that the inormation is available. Be sure 

to indicate the source of the inormation by checkig the appropriate box: 

Data Source: t8 Point-in-time count OR D Estimate 

Part 3: Hurricane Katrina Evacuees Sheltered Unsheltered Total 

Total number of Katria evacuees 

Of this total, enter the number of evacuees 

homeless rior to Katra 

*Optional for Unsheltered 

44 

1 

17 

44 

1 

CoC-K

L: CoC Homeless Population and Subpopulations Data Sources & Methods Chart 

Complete the followig chars based on the most recent point-in-time count conducted. 

L-1: Sheltered Homeless Po ulation and Sub 0 ulations 

(1) Check the primarv method used to enumerate sheltered homeless persons in the CoC 

check one : 

l' Point-in- Time (pIT) no intervew - Providers did not interew sheltered clients durg the 

oint-in-time count 

D PIT with intervews - Providers intervewed each sheltered individual or household durg the 

oint-in-tIe count 

D PIT plus sample of intervews - Providers conducted a point-in-tie count and intervewed a 

radom sam Ie of sheltered ersons or households for exam Ie, eve 5th or 10t erson 

D PIT plus extrapolation - Inormation gathere from a sample of interews with sheltere 

erons or households is extr olated to the total sheltered ulation 

D Admiistrative Data - Providers used adstrtive data (case files, staf experse) to 

com lete client 0 ulation and sub ulation data for sheltered homeless ersons 

D HMS - CoC used HM to complete the point-in-time sheltered count and subpopulation 

inormation 

D Other - leae eci : 

(2) Indicate steps taken to ensure data qualty of the sheltered homeless enumeration (check 

all that a i : 

l' Instrctions - Provided wrtten intrctions to providers for completig the sheltered point-intime 

count 

l' Trainin - Traed roviders on com leti the sheltered int-in-tie count 

l' Remid and Follow-up - Remided providers about the count and followed up with provider 

to ense the maxum ssible re onse rate and accurac 

l' HMS count - Used HM to veri data collected from providers for the sheltered point-in-tie 

D Other - please specify: 

3 How often will sheltered counts of sheltered homeless 

D Biennal eve two ear 

D Anual 

t8 Sem-anua 

Other - lease s eci 

4 Month and Year when next count of sheltered homeless ersons will occur: Jul 2006 

(5) Indicate the percentage of providers completing the populations and sub 

populations 

surve : 

100% 

100% roviders CoC-L-l 

18

L-2: Unsheltered Homeless Po ulation and Sub 0 ulations* 

i Check the rima method used to enumerate unsheltered homeless ersons in the CoC: 

D Public laces count - CoC conducted a oint-in-tIe count without client intervews 

D Public places count with intervews - CoC conducted a point-in-tie count and 

intervewed eve unheltered homeless erson encountered dur the ublic laces count 

D Sample of interviews - CoC conducted a point-in-time count and intervewed a random 

sam Ie ofunheltered ersons 

Extrapolation - CoC conducted a point-in-time count and the information gathered frm a 

t8 sample of intervews was extrapolated to total population of unheltered homeless people 

counted 

Public places count using probabilty sampling - High and low probabilties assigned to 

homeless people expected to be found 

in each area. The CoC selected a statistically vald saple of each type of area to enumerate 

on the ni t of the count and ex lated reults to esate the entie homeless u1ation. 

D designated geographic areas based on the number of 

D Servce-based count - Intervewed people using non-shelter servces, such as soup kitchens 

and dro -in center, and counted those that self-identified as unheltered homeless erons 

D HMS - Used HM to com lete the enumeration ofunheltere homeless eo Ie 

D Other - lease eci : 

2 Indicate the level of covera e of the oint-in-time count of unsheltered homeless eo Ie: 

D Com lete covera e - The CoC counted eve block of the 'ursdction 

t8 Known locations - The CoC counted areas where unheltered homeless people are known 

to con e ate or live 

D Combination ~ CoC counted central areas using complete coverage and alo visited known 

locations 

D Used servce-based or rob abilty sam li (cover e is not licable 

(3) Indicate community parters involved in point-in-tie unsheltered count (check all that 

a I 

t8 Outreach teams 

Dt8DD Law Enforcement 

Other - pleae ecify: 

Servce Providers 

Communi volunteers 

(4) Indicate steps taken to ensure the data quality of the unsheltered homeless count (check all 

that a I : 

D Trainin - Conducted a trai for oint-in-tie enumertors 

D HMS - Used HMS to check for du licate inormation 

t8 Other - specify: Intervew people with experence of more than 10 year in outreach 

activities who have extensive knowledge of the metr area. 

How often wil counts of unsheltered homeless eo Ie take lace in the future? 

o Biennal eve two ears 

o Anua 

t8 Semi-anual 

o uaerl 

o Other - lease s ecif : 

Month and Year when next count of unsheltered homeless ersons wil occur: Jul 2006 

*Please refer to 'A Guide to Countig Unsheltered Homeless People' for more inormtion on unheltered COC-L-2 

enumeration technques. 

18

CoC Homeless Management Information System (HMIS) 

M: CoC HMS Charts 

CoCs should complete this section in conjunction with the lead agency responsible for the HMS. All 

inormation is to be as of the date of application submission. 

M-2: List HU-defied CoC Name(s) and Number(s) for ~ CoC included in HMS 

I mpiemen i tation: 

Co-M-l 

HU-Defied CoC Name* CoC# BU-Defied CoC Name* CoC# 

Des Moinesolk County IA-S02 Iowa Balance of State lA-SOl 

Sioux Cityilakota County 1A-500 

*Find HU-defied COC naes & num at: htt://ww.hud.gov/offcesladm/~ntsfundsvai1.cfm CoM-2 

M-3: HMS 1m lementation Status 

II Data Entr Anticipate Data Entr 

Sta Date for your CoC Sta Date for your CoC 

rn or in 

05/2001 

M-4: Client Records** 

Calenda Total Client Records Enteed in 

Year HM / Analytcal Databas (D lieated 

2004 10824 

2005 11 751 

Progrm Typ 

and fudi 

Number of agencies. 

Total 

3 

numbe parcipatig in HM 

of agencies 

9 1 

receivie: ff 

McKIe 6-Vento fuds 

19 1 10 1 

32 18 

leae review intrctions 

19 

If no curt or anticipate data entr date, indieate 

ren: 

D New COC in 2006 

DStil in plang/softare selection proces 

DStil in intial imlementation procss 

CoM-3 

Total Unduplieated Client Recrds Ente in 

HM / Anl . cal Database 

7573 

8648 

CoM-4 

Number of agencies 

parcipatig in HM not 

receivig ff McKiey- 

Vento fuds 

o 

1 

1 

o 

2 

Date achieved or anticipate achievig 

75% be cover e mm 

Achieved 08/2001 

Achieved 08/2001 

Achieved 0112006

-'.'1 

Challenges and Barriers: Briefly describe any signficant challenges/barers the CoC has experienced in: 

1. BMS Implementation: Our HMS implementation for the Des Moines/olk County Continuum 

continues to operate generally smoothy. Our most significant implementation barer was the loss of 

partcipation by our primary domestic violence servce provider - Family Violence Center as a result 

of the reauthorization of the Violence Againt Women Act and the advocacy leading up to the final 

reauthorization. Ths loss reduced our family bed data collection parcipation rate among emergency 

and tranitional housing providers to 73% th year from what would have been a partcipation rate of 

89% this year. Not only did the contiuum lose signficant data, but it has impacted one of our 

expansion goals related to development of data shang protocols among Des Moines area agenCies to 

create a data shag network that support effective serce deliver to homeless and nea homeless 

clients/consumers in the continuum. 

2. BMS Data and Technical Standards Final Notice Requirements: The prima challenge for our 

implementation in regards to the stadads ha been the implementation of PKI (public Key 

Inastrctue) with our network. Ths requiement is an extemely expenive element and one tht 

was not planed for with our fudig matr. We have be workig coopetively with the HM 

Technical Assistace staff to network with other simlarly sizd implementations across the countr 

to investigate solutions. One of our staf members ha also been par of the PKI workgoup for the 

National Hum Serces Data Consortum Cuntly, it appears our most viable solution may 

come though our HMS softare vendor. They are in the procss of developing an aspet of the 

softare tht includes the fuctional requiementsofPKI and could be intalled though our existig 

network softare. 

, **For fuer intrctions on cha M-4 and M-5, see Intrctions section at the begig of application. Co-M-5 

M-6: Training, Data Quality and Implementation of HMS Data & Technical Standards 

20

21 

? 

YES NO 

D (g 

(g D 

D (g 

(8 D 

(g D 

D (g 

CoC-M-6

Part III: CoC Strategic Planning 

N: CoC to-Year Plan, Objectives, and Action Steps Chart 

Please provide local action steps and measurable achievements for attg each of the 5 national 

HU objectives listed, as par of the goal to end chrnic homelessness and help to move famlies and 

individuas to permanent housing. In the colum labeled "Lead Person," please list one individual tht 

is responsible for ensurg that the objective is met. You may list additional CoC objectives as needed. 

Please note that your Contiuum will be reporting on your achievements with respect to eah of these 

objectives in the 2007 application. 

Objectives to End 

Chronic Local Action Steps 

Homelessness and 

Move Famies and (How are you going to do it? List action 

Individuals to steps to be completed withn the next 

Permanent HousinS! 12 months.) 

EXAPLE: 1. Create new 1. Exand New Hope Housing projeçt 

PH beds for chronialy with 5 new TRA S+C be for chronically 

homeles persons homeless persons 

1. Create new PH bed 1. Expand Shelter Plus Car 

for chrnicay progr with 5 new SRA bed 

homeless 'persns. for chronicaly homeless perns 

2. Imlement suportve and 

housing serces to specificaly 

2. Increase percentage support homeless parcipants in 

of homeless perons the Shelter Plus Care progr. 

stayig in PH over 63. Conduct meetigs with housing 

month to 71 %. and case management to review 

and fuer develop plang to 

support parcipants. 

4. Implement strtegy developed 

though Polk County Housing 

Contiuum (Traitional Housing 

3. Increase percentage Component) to assist homeless 

of homeless persons indo in TH to access PH by settg 

movig from TH to PH aside a specific # of 

unts. 

to 61%. 5 Conduct reguar meetigs 

between Traitional Housing and 

Permanent Housing to review and 

modify process as necessar. 

6. Provide opportties for the 

4. Increase percentage h i ar. ti . th PHC 

of homeless persons ome ess p cipa gIn. e 

. 1 db case management servces to 

b~oming emp oye y obta a job and/or engage in 

11 ~. workforce iob trainng activities. 

.. fl 

.! 6 ~ 

i m ~ 

~ t e 

=;aM 

~ ~~.e ~.. 

5 

bed 

5 bed 

71% 

61% 

11% 

22 

.. 

.! 6 

~. e ~ 

lU - 

~ ~ ~ 

fl lU ~ 

Jt'l 

~~.e 

20 

bed 

10 be 

73% 

63% 

15% 

.. 

lU = 

:i lU fl 

· m ~ 

~ t ~ 

~ = C,.. ;aQ 

:=.; .e 

50 

bed 

15 bed 

75% 

65% 

20% 

Lead Person 

(Wo is responsble for 

accomplishing CoC 

Objectives?) 

Caol Smit: Chir, CoC 

Housing Commitee 

Bil Swann, Anawi 

Housing Shelter + Cai 

Admsttor 

Bil Swann, Anwi 

Housing Shelter + Ca 

Admstator 

Cat Vanote- YWc. 

Bobrett Brewton 

Pnmar Health Cm 

(pHC)

7. Continue to implement HMS in 

the CoCo We expect to expand data 

5. Ensure that the CoC sharg by between servce 5 

has a fuctional HMS providers durg the next 12 additional 

system. month. Alo, we expect to program 

integrate street outreah providers 

into the HMS. 

Other CoC Objectives in 2006 

1. Increase workig 1. Contiue to ence servce 

knowledge of delivery to homeless thugh 

Contiuum member increaed parcipaton in Pee 

in the provision of Review Prce. 

housing serces to 

50%. 

2. Expand member 2. Host dischage plang panel 

undertadig of issues discusion at each anua meetig 

related to begig Janua 2007 to keep 

homelessIless and what contiuum members abret of 

factors contrbute to its nee, trends or chages. Succes 

peretution. mea by member agency 

parcipation. 

3. Increase and 

enhce 

communcationlcollab 

oration among 

Contiuum member. 

4. Enhance methods 

Used to enumerate 

unheltered homeless 

persons in the CoCo 

3. Organe a consumer focus 

grup by September 200 to seek 

client pertives and solutions. 

Success meaur by % of 

. homeless populaton in 

attendace. 

3. Surey trg need of 

Contiuum membership. 

3. Conduct workhops to meet the 

nee of Contiuum members. 

50% 

70% 

1% 

the July 200 

unheltered when doing the point- Jan. 2006 

4. Add a "street count" of 

in-tie surey. 

5 

additional 

progr 

60% 

85% 

2% 

a dditi~ on al Jule hi' Eberbach: t: C Iowa. 

program . 

(21 tota Alliances 

program) 

75% 

95% 

3% 

sttute ior ommunty 

Kory Schnoor, 

211/ American Red 

Cross 

Bobrett Brewo 

Pnmar Heath Cai 

(pHC) 

4 20 40 Sue Patern-Nielsen 

workhops workhops workhops Wes Des Moines 

Hum Serces. 

23 

Conduct 

steet 

count 

twce 

anuav 

Conduct Jule Eberbach: Iowa 

street Intitute for Commun1 

count Alance & Ananda 

twce Subraanan Agenda 

anuay One 

Co-N

0: CoC Discharge Planning Policy Chart 

HU McKinney-Vento homeless assistace fuds are not to be used for projects that taget persons 

being discharged from publicly fuded institutions or systems of care. Check "Yes" or "No" in each 

box, as appropriate. *If "Yes" is indicated for "Formal Protocol Finalized" or ''Formal Protocol 

Implemented," include a brief sumar of the formal protocol for each applicable system category. 

Your response in this section should tae up less than 2 pages. 

Publicly Funded 

Intitution(s) or Intial Protocol in Formal Protocol Formal Protocol 

System(s) of Care in Discussion Development Finaled* Implemented* 

COC Gegrhic Area 

Foster Care DYes DNo DYes DNo DYes DNo (8 Yes DNo 

Heath Care Dyes DNo DYes DNo DYes DNo (8 Yes DNo 

Menta Health DYes DNo (8 Yes DNo DYes DNo DYes DNo 

Corrections (8Yes DNo DYes DNo DYes DNo Dyes DNo 

Foster Care: 

The state of Iowa has taen a strong postue in addressing the issue of "agig out". In parcular the 

State fuds the Iowa Afercar Provider Network that promotes appropriate discharge plang 

activities. The Network of providers advocate, mentor, and asist though the delivery of after cae 

serces, includig acess to college scholarhips provided by the state. The member of the Polk 

County Housing Contiuum hold fi to the followig priciples for youth dischaged from Foster 

Care. 

. Individual Discharge Plannig. Intial discharge plang begi at the time of 

registrtion with the youth and foster care givers to ensure for an exit sttegy that results in 

appropriate housing and afer care serces for "agig out" youth. 

. Collaborating and Parterig. ConSistent with Iowa law regardig local area tranition 

commttees, communty collaboration is the next crtical step in order to obta safe and 

affordable livig conditions for youth leavig the foster care system. If temporar shelter or 

tranitional housing placement is unavoidable, the assigned workers provide carefu 

documentation so that the youth ar supported durg the trition though case 

management, fuer housing couneling, or additiona supportve serces. 

. Trackig and Monitoring. Respnsible agencies maita contat with youth discharged 

until the goals and objectives of 

the plan are completed. For youth refuing servces, Case 

Managers document the decision; and whenever possible, outreach servces may continue to 

be provided for the youth. 

Iowa law mandates that the cae peranency plan for children in foster care include a wrtten 

tranition plan of servces for youth 16 year and older and the establishment of local trition 

commttees to address the tranition need of youth at the time they leave foster care. These 

committees act to address gaps existing in servces or supports available that would assist the youth 

in the tranition from foster care to adulthood. Ths protocol makes every effort to ensure that the 

transition will not result in the youth becomig homeless. 

24

Health Care: 

All area hospitals in Polk County are accredted by JCAHO (Joint Commssion on the Accreditation 

of Health Care Organzations. Primar Health Care, Inc. and the standads set fort by the 

Commssion require all organtions to have a set plan of care which moves along a continuum 

from entr and assessment, to plang, treatment and coordiation to referral, trfer of care and 

discharge. Simlar to the statewide discharge plan, the members of the Polk County Housing 

Contiuum have adopted the followig priciples related to discharge from health organations. 

. Individual Discharge Planning. Discharge plang begi at the point of entr with 

involvement from the consumer or the designated others. Owership of the plan is increased 

when the consumer, as well as, the signficant others) is involved. 

. Collaboratig and Partnerig. Effective discharge plang processes are the diect result 

of reliable parerhips and collaborations. Members of the Contiuum li with varous 

other health care organations to create the best possible discharge plan and to avoid some 

of the curent uran trends, such as patient dumping or release to the streets. 

. Trackig and Monitorig. Utilition of an al-ecompassing management inormtion 

sysem undersores an effective discharge plang proces, by improvig communcaon, 

faciltatig access to resoures, and trkig completion of the discharge plan. 

The Iowa Council on Homelessnes fied a formal discharge policy and submitted it to the 

Governor in 2005. The proposed policy recmmendations address discharge plang for a varety 

of populations at risk of becmig homeless, includig those who are to be releaed from publicfuded 

medcal and substace abuse treatment facilties and recmmends that each state deparent 

be intrcted to implement a discharge protocol based on gudig pricipals tht would make every 

effort to ine that the discharge does not result in the person becmig homeless. 

Discussions are now tag place with the Governors Executive Council regardig implementig a 

policy based on these pricipals and staff 

has been intrcted to prepare a letter diecting all state 

deparents to implement a Formal Protocol. We anticipate completion before July, 2007. To kee 

local contiuum members abreat of 

the trends and the progress, we will conduct tring sessions 

concerg discharge plang at each of our anual meetings, begig Janua, 2007. 

Mental Health: 

Some area mental health organations are also accredted by the Joint Commssion, as well as 

governed by state statutes for all asects of mental health care in Iowa town and counties. In those 

cases, the intitutions must adhere to a discharge plang process simlar to the one listed above. 

Those not involved with JCAHO are requied to follow Iowa statute: 

1. Mental Health Chapters 229.3 and 229.16 

2. Mental Retadation Chapters 222.15 

3. Psychiatrc Chapters 225.27 

Mental Health Chapters 226.19 

Members of the Polk County Housing Continuum are conducting fuer study into Mental Health 

discharge planng in Polk County. From that study, it is anticipated that the Commttee members 

25

wil then begin to develop protocols and provide membership traing as to what to expect and what 

is expected from mental health institutions as patients are discharged into the communty. As per 

the national trends, continuum members plan to develop a toolkt by November 2006 and offer 

traig episodes for area social workers and other key staff responsible for discharge plang at 

mental health intitutions. 

The Iowa Council on Homelessness fialized a formal discharge policy and submitted it to the 

Governor in 2005. The proposed policy recommendations address discharge plang for a varety 

of populations at risk of becomig homeless, includig those who ar to be released from public- 

fuded Mental Health facilties and recommends that each state deparent be intrcted to 

implement a discharge protocol based on guding pricipals that would make every effort to inure 

that the discharge does not result in the person becoming homeless. 

Discussions are now tag place with the Governor's Executive Council regardig implementig a 

policy based on these pricipals and stahas been intrcted to prepare a letter diecting all state 

deparents to implement a Formal Protocol. The Council expects completion by July 2007. To 

kee local contiuum member abreat of the trends and the progress, we will conduct trg 

sessions concerng discharge plang at each of our anua meetigs, begig Janua 2007. 

Corrections: 

Intial discussions 

. 

are occurg 

. 

between member of the Polk County Housing Consortum and the 

varous divisions of Corrtions. Members ar proactive and make routie visits to nea-by prisons 

and the Polk County jaiL. The purse of the visits is to assess the need of inates who will be 

discharged, and provide them with the necessar inormation and referrs. 

The Iowa Council on Homelessness fialed a formal discharge policy and submitted it to the 

Governor in 2005. The proposed policy recmmendations address dischage plang for a varety 

of populations at risk of becmig homeless, including those who are to be released from public- 

fuded prisons and recommends that eah state deparent be intrcted to implement a dischage 

protocol based on gudig pricipals that would make every effort to inure that the discharge does 

not result in the peron becmig homeless. 

Discussions are now tag place with the Goverors Executive Council regardig implementig a 

policy based on these pricipals and stahas been intrcted to prepare a letter diecting all state 

deparents to implement a Formal Protocol. The Council expects completion by July 2007. To 

keep local continuum members abreast of the trends and the progress, we wil conduct traig 

sessions concerng dischage plang at each of our anua meetings, begig Janua 2007. 

26 

CoC-O

P: CoC Coordination Chart 

A CoC should reguarly assess the local homeless system and identify shortcomings and unet needs. 

One of the keys to improving a CoC is to use long-term strtegic planing to establish specific goals 

and then implement short-tennmedum-ter action steps. Because of the complexity of the existing 

homeless system and the need to coordiate multiple fudig sources, there are often multiple longterm 

strategic planng groups. It is imperative for CoCs to coordiate, as appropriate, with each of 

these existig strategic plang groups to meet the local CoC shortcomigs and unet needs. 

Anwer each question in the check 

box provided, using an X to indicate Yes or No for each. 

Consolidated Plan Coordination 

a. Do Con Plan planers, authors and other Con Plan staeholders paricipate in CoC 

eneral lan meetin s? 

b. Do CoC member parcipate in Con Plan plang meetigs, focus groups, or 

ublic foru? 

c. Were CoC strtegic plan goals addressing homelessness and chronic homelessness 

used in the develo ment of 

the Con Plan? 

Jurisdictional to-year Plan Coordination 

a. Are there separte formaljursdictiona10-yeaPlan(s) being developed and/or 

being 

implemented with your COC geography? (If 

No, you may skip to the next section of 

ths cha. 

b. Do 10-yea Plan conveners, authors and other steholder parcipate in CoC genera 

lan meetin s? 

c. Have 10-yea Plan paricipants taen steps to align their 

plang process with the local 

CoC Ian? 

d Were CoC strte . c Ian oats used in the develo ment of the 10- ear Plan s ? 

e. Provide the number of jursdictions with your CoC geography tht have formally 

im lemented a 10- ear Ian s . 

Polic Academ * Coordination 

a. Do CoC members paricipate in State Policy Academy meetigs, focus groups, public 

forus, or listservs? 

b. Were CoC strtegic plan goals adopted by the CoC as a result of 

communcation/coordiation with the State Polic Academ Tea? 

c. Has the CoC or any of its projects received state fudig as a result of its coordition 

with the State Polic Academ? 

Public Housin A enc Coordination 

a. Do CoC member meet with CoC area PHA to improve coordiation with and access to 

maitream housin resours? 

Coordination with State Education A encies 

a. Did the CoC provide the state education agency with a list of emergency and tranitional 

housing facilties located with the CoC boundares that serve famlies with school-age 

children or school-age unacompaned youth under the age of 18? 

* A State Policy Academy is a state-level process designed to help state and loc policymers imrove access to 

matream services for people who are homeless. For more inormtion about gettg involved in a State Policy 

Academy, see htt://ww.hrsa.gov/homeless. 

CoC-P 

27 

YES NO 

(g D 

(g D 

(g D 

(g D 

(g D 

(g D 

3 

YE NO 

(g D 

(g D 

D rg 

(g D

CoC 2006 Funding Priorities 

Q: CoC Project Priorities Chart 

For fuher intrctions for filling out ths section, see the Instrctions section. 

HU-dermed CoC Name:*Des MoineslPolk CoC 

CoC #: IA-502 

(1) (2) (3) (4) (5) (6) (7) Program and 

SF-424 

Applicant Name 

è 

Component Type** 

Requested 

Project Sponsor 

Name 

(pleae Remove 

Exales) 

Project 

Name 

'C Project 

... Q 

a. Amount 

ø. *** 

aa. ~ 

E- 

SUP SHP S+C SRO 

"; 

~ 

~ 

= 

~ 

Z ~ ~ Z 

YMCA of Greater YMCA Perent 

1 192,998 2 PH 



Des Moines Housin Promu 

owa Intute for 

Commty 

Alce 

Iowa's Contiuum 

Outcme and 

Univer Need 

Toolkt ß-CUN 

2 220,500 2 HMS 

aouse of Mercy House of Mercy TR 

City of Des Moins Traitiona 3 289,733 1 




HOUSin2 Promu 

House of Mercy House of Mercy at 

4 227,468 1 PH 

¡yCA of Greate 

Des Moins 

owa Homeless 

Youth Pro2I 

owa Homeless 

Capital Par 

YMCA Traitional 

Housin Promu ' 

Lighthouse Host 

Home 

5 

6 

102,217 

287,356 

1 

1 

TR 

TR 

Bucha 

City of Des Moines Youth Progr Traitiona Livig 7 99,391 1 TR 


Ceter 

Pri Health Cae Enhcement 

Proiect 

8 256,109 1 SSO 

City of Des Moines Pri Heath Cae Outreach Projec 9 85,000 1 SSO 

West Des Moines West Des Moines 

City of Des Moines Traitiona 10 87,325 1 TR 

Housin Promu 

(11) Subtotal: Requested Amount for CoC $ 1,848,097 

Competitive Projects:*** 

S+C Component Tye** 

City of Des Moines Anawi Housing Shelter Plus Care 13 723,384 1 SRA 

(12) Shelter Plus Care Renewals:**** 

(10) Subtotal: Requested Amount for $723,384 

S+C Renewal Projects: 

(11) Total CoC Requested Amount: $2,571,481 

CoC-Q 

*HU-defined CoC names & numbers are available at: htt://ww.hud.gov/offces/adm/grants/fundsavaiLcfm 

**Place the component ty (pH, TR etc.) under the appropriate progr for each project in colum 7. 

28 

1 

1

R: CoC Pro Rata Need (PRN Reallocation Chart 

(Only for Eligible Hold Harmless CoCs) 

CoCs that receive the I-year Hold Harmless PRN amount may reduce or eliminate one or more of 

the 

SHP grants eligible for renewal in the 2006 CoC competition. CoCs may reallocate the fuds made 

available though ths process to create new permanent housing project(s). These new project(s) may 

be for SHP, S+C, and Section 8 SRO projects and their respective eligible activities. 

Advisory Warninl!: According to the CoC competitive process, a CoC that scores below the intial 

fudig lie will not have the new projects on ths char fuded. As such, the reallocated fuds 

that 

had been used for renewals would no longer be available to the CoCo 

1. Wil your CoC be using the PRN reallocation process? DYes 'i: No 

H Yes, explai the open decision makg process the CoC used to reuce and/or eliate projects 

(use no more than one-half 

page). 

2. Enter the total I-year amount of all SHP projects that are eligible Example: $ 

for renewal in 2006, which amount you have veried with your field $530;000 

offce: 

3. Startg with the total entered above for question 2, subtract the Example: $ 

amount your coe proposes to use for new permanent housing $390,000 

projects, and enter the remaiing amount: 

(In this exmple, the amount proposed for new PH projects is $140,000) 

4. Enter the Reduced or Elimiated Grant(s) in the 2006 Competition 

(1) (2) (3) (4) (5) (6) 

Expirg Grants Program Component Annual Renewal Reduced Retained Amount 

Code Amount Amount from Enstinl! Grant 

Ex: MAOIB3,00002 SHP TH $100,00 $60,000 $40,000 

Ex: MAOIB4oo003 SHP SSO $80,00 $80,000 $0 

(7) TOTAL: 

5. Newly Proposed Permanent Housinl! Projects in the 2006 Competition 

(8) (9) (10) (11) 

2006 Project Priority Number Program Code Component Transferred Amounts 

Example: #5 SHP PH $90,000 

Example: #12 S+C TR $50,000 

29 

(12) TOTAL: 

CoC-R

S: CoC Project Leveraging Summary Chart 

HU homeless program fudig is limted and can provide only a portion of the resources needed to 

successfully address the needs of homeless familes and individuals. HU encourages applicants to 

use supplemental resources, includig State and local appropriated fuds, to address homeless need. 

Enter the name of your Continuum and list the total amount of leveraged resources available. To get 

ths number, fid the total at the bottom of the Project Leveragig Char for all Exhbit 2 project 

applications, add up all of these the totals, and enter ths single number in the char below. Complete 

only one ch~ for the entire CoC (do not add any rows). Provide inormation only for contrbutions 

for which you have a written commitment in hand at the time of applicatin. 

Warning: HO will prosecute fale clai and statements. Conviction may result in cri and/or 

civil penalties (18 D.S.C. 1001, 1010, 1012; 31 D.S.C. 3729,3802) 

Name of Contiuum 

Des Moinesolk County CoC 

T: CoC Current Funding and Renewal Projections Chart 

Total Value of Written 

Commtment 

$1,709,461 

Coc-s 

Congress has asked HU to provide estimates of expected renewal amounts over the next five year. 

Please complete the char below to help HO arve at the most accurate estiate possible. For 

fuer intrctions in fillig out ths cha see the Intrctions section. 

30

T: CoC Current Funding and Renewal Projections 

Supportve Housing Program (SUP) Projects: 

Requested 

Renewal Projections 

(Current Year) 

2006 2007 2008 2009 2010 2011 

Al SHP Funds 

Type of Housing 

Transitional Housing (TH) 

$866,022.00 $866,022.00 $866,022.00 $866,022.00 $866,022.00 $866,022.00 

(Y;HOM;WDM;llC) 

Safe Havens- TH 

Permanent Housing (PH) 

$420,466 $227,468 $323,967 $323,967 $323,967 $323,967 

(HOM;Y beginng 2007) 

Safe Havens-PH 

SSO (PHC) $341,109 $341,109 $341,109 $341,109 $341,109 346,000 

HMIS $220,500 110,250 110,250 110,250 110,250 

Totals $1,848,097.00 $1,434,599. $1,665,089.83 $1,6641,348 $1,641,348 $1,646,239 

r- Shelter Plus Care (S+O ProJects: 

w.. 

All S+C Funds 

Requested 

Renewal Projections 

Number of (Current Year) 

Bedrooms 2006 2007 2008 2009 2010 2011 

Units $ Units $ Units $ Units $ Units $ Units $ 

0 

1 37 $239,316 36 $232,848 36 $232,848 36 $232,848 36 $232,848 36 $232,848 

2 39 $307,476 44 $346,896 44 $346,896 44 $346,896 44 $346,896 44 $346,896 

3 15 $151,380 12 $121,104 12 $121,104 12 $121,104 12 $121,104 12 $121,104 

4 3 $33,804 2 $22,536 2 $22,536 2 $22,536 2 $22,536 2 $22,536 

5 

Totals 94 $731,976 94 $723,384 94 $723,384 94 $723,384 94 $723,384 94 $723,384 

form HU-40090-1 

(4/2006)

Part IV: CoC Performance 

U: CoC Achievements Chart 

Enter the goals and action steps that you that you listed on your 2005 CoC application and briefly 

describe measurable achievements in the past 12 month. The inormation provided in the fist two 

colums should be the same as provided in the 2005 CoC application. Add rows as needed. 

Goals 

í 

Chronic Homelessness Goals 

Action Steps 

1. Sustai and increase 

the number of 

permanent housing 

a. Contiue the expanion of 

S+c from 23 to 33 unts for the 

chronically homeless. 

unts to serve 

chronically homeless 

individuals. 

I 

Measurable Achievements 

a. Anawi Housing bv Dec. 2006: 

Anawi S+C is serg 24 

chronicaly homeless individuas and 

anticipates meetig the 33 unts by 

the end of the year. 

b. Add 12 new tritional bed . for unccompaned chrnically b. Children & Famlies ofIowa 

homeless perons. 

(CFI) by Dec. 200: 

. CFI privately fuded 12 new bed 

in the CoC. The focus of these 

bed shied to women and 

children thus alterg the purose 

to addres another of our gaps of 

providig housing to homeless 

famlies. 

. In ths year's application, we 

hope to fulfill the ongoing need 

for additional bed for chronically 

homeless individuals with the 

YMCA's new project application 

(raed fit in the CoC's project 

priority listing). 

2. Susta and increae 

a. Conduct steet outreach and 

supportive serces! 

, a. Priar Health Care by Dec. 2006 

mamcwme a rrum of25 

interventions to 

In the most recent reporting period, 

chronically homeless persons 

chronically homeless 

the number of chronically homeless 

from the streets to the next 

individuals to assist persons mamcwated from the streets 

housing level, includig 

them toward self- 

to the next housing level: 

pennanent housing. 

suffciency. 

. 38 of 47 (80%) persons were 

32 

appropriately housed and 

increased their housing status at 

exit. 

. 19 of30 (63%) persons remaig 

active in the program entered 


. 9 of9 (100%) persons enrolled 

for 6 months or more are stil in 

form HU-40090-1 


. Provide therapeutic case 

management and help navigate 

parcipants though the varous 

systems, includig substance 

abuse, assessment, and refe.ial. 

appropriate housing after 6 

month. 

b. Priar Health Care by Dec. 2006 

In the most recent reporting period, 

number of chronically homeless 

persons assisted with obtaig 

benefits of the maitream programs 

for which they are eligible: 

. 23 of30 (77%) perons increased 

their income (10, obtained 

entitlements, 7 applied for SSI or 

other entitlements, and 6 became 

employed). 

. 47 of 47 (100%) persons referred 

to receive on-going mental and 

physical heath sign up for 

entitlements, and/or chemical 

dependency counelig; eah 

client averaged referrs in thee 

3. Contiue to improve different areas. 

a. Prvide agencies servg the 

abilty to accurely Iowa Intitute for Communty 

chrnicay homeless licens to 

count the number of Alances by December 2006 

Servce Point (H). 

chronicaly homeless . 2 (minimum) licenes issued to 

b. Provide agencies servg the 

individuas in servce chronicaly homeless two the 3 priar progr serg 

area. chronicaly homeless individuals 

Serce Point trgs (H). 

(December 05) 

Other Homelessness Goals 

c. Tra servce provider to . 10 trgs held July 05 - May 

trk chronically homeless and 

monitor their housing 

progression with quaerly 

follow-up reports. 

06. One trg is held each 

month for provider agency staf. 

Curculum includes properly 

defig chronically homeless 

individuals, quaty data 

collection and accurate and 

appropriate exit housing status 

inormation. 

1. Susta and increae 

housing unts for 

homeless individuals 

Increase the number of 

Shelter + Care. 

unts of Anawi Housing bv Dec. 2006 

Anawi S+C is at capacity serg 

and famlies. 

102 unts. They will be receivig a 

slight grt increase in the 10th year 

renewal to serve 94 unts. Units will 

supportive serices! 

interventions to 

homeless individuals 

a. Provide tageted case 

management and life skills (e.g. 

parenting, budget counelig, 

child care, job traig, 

be added in Mayas fuding permts. 

a. Providers in CoC by Dec. 2006 

The CoC has worked to increase 

outreach and concentrated case 

management, to help homeless 

2. Sustai and increase 

33 

form HU-40090-1 


:: and famlies to assist 

them toward self- 

suffciency. 

transportation, chemical 

dependency & mental health persons maitain housing. Twenty- 

referrals, food, etc.) to help link seven CoC providers offer case 

homeless individuals to the 

cOmmunty. 

management support services and life 

skills. Some measurable 

achievements include: 

34 

Parenting: 

. Priar Health report that 100% 

of homeless teens Parcipating in 

pregnant and parenting classes 

had full term deliveries, of which 

100% Paricipated in HIV/AIS 

testig, 95% enrolled in case 

management servces and 86% 

became housed. 

. House of Mercy report tht 42 

perons improved their parenting 

atttudeseliefs and 39 perons 

succsfuly completed the 

parentig curculum upon exit. 

Chemcal dependency treatment & 

referrl: 

. Pr Health Care report that 

176 persons parcipated in the 

substace abuse support groups, 

62 substace abuse assessments 

were coni1eted and 1,05$ group 

encounter were made. 

. House of Mercy report that 1 i 5 

perns dealig with addiction 

received counelig and increased 

their knowledge! understanding 

of bra addiction, with 63 of 67 

(94%) being drg and alcohol free 

at exit. 

Menta Health Referrals: 

Prar Health Care report that 

. 100% of the active program 

Parcipants received on-going 

mental health, domestic violence 

and/or chemcal dependency 

counseling or traig, iflwhen 

needed. 

. 44 Parcipants in the housing 

progr received mental health 

assessments and/or entered into 

an appropriate treatment plan. 

. 123 persons identified as havin,g 

form HU-40090-1 


, 

abusive parners paricipated in 

trauma counseling sessions. 

Health Care: 

. Primar Health Care reports that 

100% of the children or youth 

seen at Youth Emergency Shelter 

and Servce received medical 

assessment withi thee days (72 

hr.) of arval (included physical 

exam if the child had no exam 

with past six month and PPDtubercul 

testig for all clients 

over six years of age). 

Budget Couneling: 

House of Mercy report that 

. 69 perons received assistace 

- with fiancial concer and 

passed' a fice management 

competency. 

Education & Employment: 

House of Mercy reprt that 

. 15 perons passed GED tests or 

attaied a GED and 27 perons 

eared college credts. 

. 72 persons completed a job 

readess skills assessment, of 

which 68 passed the competency. 

b. 2-1-1 & Service Point by Dec. 

b. Utilie Service Point (H) 2006: 

data to document serces to . Data sharg network design 

100 individuals and 500 

completed March 2006. 

famlies and to follow . Agency staf trained to collect 

stabilization of the individual or 

household. 

data and data quaity testing 

completed April 2006. 

. Comparative historic data was ru 

from our HMS system for 

puroses of comparative analysis. 

. We expect to have data results on 

50% of the consumers by 

December of 2006 and a 

3. Strengthen the 

Continuum of Care 

a. Increase communcation 

between agencies conducting 

completed year end report by the 

end of April 2007 . 

a. Amy Hensley. City ofDSM by 

Dec. 2006: Agencies completed the 

Peer Reviews with 70% 

paricipation rate. 

Peer Review last year. The 

Communcations/ Networking 

35 

form HU-40090-1 


. Collect volunteer hours and 

donated goods data from 50% of 

local homeless provider 

agencies. 

c. Continue the process of 

consolidating AIand the 

Polk Co. Housing and Homeless 

Collaboration to maxime 

resources and to implement a 

coordited strctue and 

message. 

V: CoC Chronic Homeless (Cll Progress Chart 

committee is coordiating the 

upcomig peer review process and is 

including it with the performance 

measure report packet due from 

members in July, 2006. 

b. Sue Paterson-Nielsen by Dec. 2006 

Although only a small number of 

providers have consistently reported 

this data, the figues show that 

providers in the CoC received 

donated goods valued at more than 

$700,000 and volunteer hour valued 

at more than $350,000. 

c. Board bv Sept. 2005 . 

In July, 2005 twenty-nie people 

representig 25 agencies of the 

Afordable Housing and Homeless 

Parersmp (AI) and the Polk 

County Housing and Homeless 

Collaboration met and approved new 

bylaws. On Aug. 3, 2005 eleven 

members representing 4 public 

agencies, 6 private agencies, and 1 

formerly homeless person held the 

fist offcial Board meeting of the 

Polk County Housing Continuum. 

ths char should be based on Janua 2006 point-in-tie counts. For fuher intrctions in fillig out 

tls char, please see the Instrctions section. 

(3) (4) Identiy the cost of the !i CH bed 

(2) New PH beds from each fundi source 

Year 

(1) 


CH Persons 

Number of PH 

beds for the 

CH 

for the CH 

between 

Feb. 1, 2005 - 

Jan. 31, 2006 

Public 

Private 

2004 Exam le: 90 45 

2005 Exam le: 82 50 

2006 Example: 75 60 

2004 808 21 

2005 445 44 

2006 445 33 

form HU-40090-1 

36 (4/2006)

(5) Briefly describe the reason(s) for any changes in the total number of 

betwee 2005 and 2006 use less than one-half a e . 

Colum (2): As noted earlier, the reason for the changes in the number of 

the chronically homeless 

PH bed for the CH are due 

to CFI privately fuding its 12 new bed and shiftg focus of these bed to women and children, 

thereby addressing another one of our CoC's needs. In this year's application, we hope to fulfill the 

ongoing need for additional bed for chronically homeless individuals with the YMCA's new project 

a lication (raned fit in the CoC's roject priori listing). 

Coc- V 

W: CoC Housing Performance Chart 

The followig char will assess your CoC's progress in reducing homelessness by helping clients 

move to and stabilie in permanent housing, access maitram servces and gain employment. Both 

,housing and supportve servces projects in your CoC will be examed. Provide inormation from the 

most recently submitted APR for the appropri~ RENEWAL project(s) on your CoC Project Priorities 

Cha. Note: If you are not submittg any reewals in ths year's competition for the applicable areas 

resented below, check the ro riate box in the char. 

1. Parcipants in Permanent Housing 

. HO will be assessing the perentage of al parcipants who remai in S+C or SHP permanent 

housing (PH) for more than six month. SHP projects include both SlI-PH and SHP-Safe Haven 

PH renewals. Complete the followig char utiliing data based on the precedg operatig year 

fromAPR Question l2(a) and l2(b) for 

PH projects included on your CoC Prority Char: 

D No applicable PH renewals are on the COC Project Pnorities Ch APR 

t8 All PH reewal projects with APRs submitted are included in calculatig the resnses below Data 

a. Numbe of arci ants who exited PH ro'ect s APR uestion 12 a 

b. Numbe of arci ts who did notleave the ro'ec s APR estion 12 

c. Numbe who exited afer sta' 7 month or Ion er in PH-APR uestion 12 a 

d. Numbe who did not leave aft stayig 7 month or longer in PH-APR question 12(b) 

e. Percentage of all parcipants in PH projects stayig 7 month or longer 

(c. + d. divided by a. + b. multiplied by 100 = e.) 

2. Parci ants in Transitional Housin 

HO will be assessing the percentage of all THclients who moved to a permanent housing 

sitution. TH projects include SHP- TH and SHP-Safe HavenI not identified as permanent 

housing. Complete the followig char utilig data based on the precedg operating year from 

APR uestion 14 for TH renewal ro'ects included on our CoC Priorities Char. 

D No applicable m renewals are on the CoC Project Pnorities Ch APR 

t8 All m renewal projects with APRs submitted are included in calculatig the resnses below Data 

a. Number of arci ants who exite TH ro'ec s Includi unown destition 452 

b. Number of arici ants who moved to PH 194 

c. Percent of parcipants in m projects who moved to PH (b. divided by a. multiplied by 100 = c.) 43% 

Coc-w 

37 

49 

114 

46 

76 

75% 

form HU-40090-1 


X: Mainstream Programs and Employment Project Performance Chart 

HU will be assessing the percentage of clients in all your renewal projects who gaied access to 

maitream servces, especially those who gained employment. This includes all S+C renewals and 

all SHP renewals, excluding HMS projects. Complete the followig char based on responses to 

APR Question 11 for each of the renewal projects included on your CoC Priority Char. For fuer 

instrctions for fillng out ths section, see the Intrctions section at the begig of the application. 

D 

(g 

No applicable renewal projects for the Maintream Progr and Employment Ch included in the 

CoC Prorities Ch. 

All non-HMS renewal projects on the CoC Prorities Ch tht submitted an APR are included in 

calculatig the responses below. 

(1) (2) (3) (4) 

Number of Adults Income Source Number of Exitig Percent with 

Who Left (Use Adults with Each Income at Exit 

same number in Source of Income (CoI3+Col 1 x 100) 

each cell) 

ExDle: 105 a. SSI 40 38.1% 

Exple: 105 b. ssm 35 33.3% 

543 a. ssi 24 4.4% 

543 b. SSDi 10 1.8% 

543 c. Social Secmity 8 1.5% 

543 d.Geera1 Public Assistce 25 4.60/. 

543 e. TAN 44 8.1% 

543 f. SCH 0 00/. 

543 2. Vete Benefits 5 1% 

543 h. Employment Income 108 19.9% 

543 i. Unemlovrent Benefits 3 .6% 

543 j. Vete Health Cae 0 0% 

543 k. Medicaid 37 6.8% 

543 1. Foo Stamps 78 14.40/. 

543 m. Other (child support foster 12' 2.2% 

care stiped, sot labor for cash) 

543 n. No Fincial Resources 252 46.4% 

Coc-x 

38 

form HU-40090-1 


Y: Enrollment and Participation in Mainstream Programs Chart 

It is fudamental that your CoC systematically helps homeless persons identify, apply for and followup 

to receive benefits under SSI, SSDI, TAN, Medicad, Food Stamps, SCHI, WI, and Veterans 

Health Care as well as any other State or Local program that may be applicable. Whch policies are 

curently in place in your CoC to help clients secure these maitream benefits for which they are 

eligible? 

Check those activities implemented by a majority of your CoC's homeless assistance providers 

check all that i: 

homeless assistace providers have case managers systematically assist clients in 

com letin lications for maitream benefit ro am. 

t8 A majority of 

18 The CoC systematically analyzes its projects' APRs to assess and improve acess to 

maitream ro ams. 

18 The maitream CoC conta ro a ams. specific plang commttee to improve CoC-wide parcipation in 

homeless assistce provider use a single application form for four or more of 

18 A majority of 

the abve maitrea ro ams. 

18 The CoC systematicaly provides outreach and intake sta specifc, ongoing trg on how to 

identi eli 'bil and ro chan es for maitrea ro 

whose only resnsibilty is to identify, enrolL, and follow-up 

with homeless ersons on arci ation in maitrea ro 

homeless assistce provider supply trrttion assistace to clients to atend 

18 The COC has specialed sta 

maitrea benefit intments. 

homeless assistce providers have sta systematicay follow-up to ensure that 

18 A majority of 

IV A majority of 

LC maitream benefits ar received. 

with the State Interagency Council(s) on Homelessness to reduce or 

remove barers to accessin maitream serces. 

Co Y 

t8 The CoC coordiates 

z . u t dG t A d d p. t th 2005 C C C fir Ch rt 

nexecu e ran s war e nor 0 e 0 ompe ion a 

Provide a list of all HU McKiey-Vento Act awards made prior to the 2005 competition that are 

not yet under contract (i.e., signed grt agreement or executed ACC). 

Project Number Applicant Name Project Name Grant Amount 

Example: MI3B901oo2 MIchian Homes, Inc. TI for Homeless $514,000 

39 

Total: NA 

form HUD-40090- i 


AA C CP . . f . E St Ch 

. 0 articiPa ion in nerey ar art 

. 

HO promotes energy-efficient housing. All McKinney-Vento fuded projects are encouraged to 

promote energy effciency, and are specifically encouraged to purchase and use Energy Star labeled 

products. For information on the Energy Sta intiative go to: htt://ww.energysta.gov. 

Have you notified CoC members of the Energy Star intiative? (gYes DNo 

Percentage of CoC projects on CoC Priority Char using Energy Star appliances: 35% % 

AB: Section 3 Emplovment Policy Chart 

1. Is any project in your CoC requestig HU fuds for housing rehailtation 

or new constrction? 

2. If you answered yes to Question 1: 

Is the project requestig $200,00 or more? 

3. If 

CoC-AA 

YE NO 

D t8 

D D 

you answered yes to Question 2: 

Wht activities will the project underake to enure tht employment and other ecnomic 

Urban 

opportties are diected to low- and ver low-income persons, per the Housing and 

Development Act of 1968 (kown as "Section 3'')? 

Check all that apply: 

D The project will have a preference policy for hinng low- and ver low-income persons 

residig in the servce area or neighborhood where the project is located and for hig Youth 

build parcipantsgraduates. 

D The project will advertise at social serce agencies, employment and trag center, 

communty centers, or other organations that have frequent contact with low- and very lowincome 

individuals, as well as local newspaper, shopping centers, radio, etc. 

D The project will notify any area Y outhbuild program of job opportties. 

D If 

the project will be awardig competitive contrts of 

more than $100,000, it will 

establish a preference policy for "Section 3 business concern"* that provide ecnomic 

opportties and will include the "Section 3 clause"** in all solicitations and contrcts. 

* A "Section 3 business concern" is one in which: 51% or more of the owner are section 3 residents of the 

area of serce; or at leas 30% of its perment ful-tie employees are curently section 3 residents of the 

area of servce, or with thee yea of 

their date of hie with the business concer were setion 3 residents; 

or evidence of a commtment to subcontrct greater th 25% of the dollar award of all subcontrcts to 

businesses tht meet the qualifications in the above categories is provided. 

**The "Section 3 clause" can be found at 24 CFR Part 135. 

CoC-AB 

40 

form HUD-40090-1 


America's Affordable Commu,.llies 

Initiative 

U.S. Department of Housing 

and Urban Development 

I 

OMS approval no. 2510-0013 

(exp. 03/31/2007) 

Public reportng burden for this collecton of information is estimated to average 3 hours. This includes the time for collecting, 

reviewing, and reportng the data. The information will be used for encourage applicants to pursue and promote effort to remove 

regulatory barrers to affordable housing. Response to this request for information is required in order to receive the benefits to be 

derived. This agenc may not collect this information, and you are not required to complete this form unless it displays a currently 

valid OMS control number. 

Questionnaire for HUD's Initiative on Removal ~f Regulatory Barriers 

Part A. Local Jurisdictions. Counties Exercising Land Use and Buildig Reglatory Authority and 

Other Applicants Applyig for Projects Located in such Juridictions or Counties 

rCollectively, Juridiction) 

1. Does your jursdction's comprehenive plan (or in the case of a trbe or TDHE, a local' 

Indian Housing Plan) include a ''housing element? A loc comprehensive plan 

mea the adopted offcial statement of a legislative boy of a local goverent that 

sets fort (in words, maps, Îllustrtions, and/or tales) goal, policies, and gudelies 

intended to diect the present and futu physical soial and ecnomic development 

tht occur with its plang jurction and tht includes a unfied physical plan 

for the public development of land and water. If your jurction does not have a 

local comprehenive plan with a" ''housg element," pièae enter no. If no, skip to 

question # 4. 

2. If your jurction ha a comprehensive plan with a housing element, does the plan 

provide esates of curent and anticipate housing nee, tag into acunt the 

anticipated growt of the region, for existg and futue reidents, includig low, 

moderate and middle income fames, for at leas the next five year? 

3. Does your zonig ordiance and map, development and subdvision reguations or 

, other land use contrls conform to the jursdiction's comprehenive plan regardig 

housing nee by providig: a) sufcient land use and denity categones 

(multiamly housing, duplexes, smal 

lot homes and, other simlar elements); and, b) 

sucient land zoned or mapped "as of nght" in these caegones, that can pert the 

buildig of affordable hoUsing addressing the nee identied in the plan? (For 

puroses of ths notice, "as-of-nght," as applied to zonig, mea uses and 

development stadads that are detered in advance'and specifically authonzed by 

the zonig ordiance. The ordiance is largely self-enforcing because little or no 

discretion occur in its adstrtion.). If the jursdiction has chosen not to have 

either zonig, or other development controls that have varg stadards based upon 

distrcts or zones, the applicant may also enter yes. 

4. Does your jursdiction's zo$g ordice set minimum buildig size requiements 

that excee the local housing or health code or is otherwse not based upon explicit 

health stadads? 

41 

1 

DNa 

2 

(g Yes 

DNo (g Yes 

DNa (g Yes 

Dyes t8 No 

Form HUD-27300 (4/04)

5. If your jursdiction hai / velopment impact fees, are the fees spt,v~ned and calculated 18 No DVes 

under local or state statutory criteria? Ifno, skip to question #7. Alternatively, if 

jursdiction does not have impact fees, you may enter yes. 

6. If yes to question #5, does the statute provide criteria that sets standards for the DNo DVes 

allowable tye of capital investments that have a diect relationship between the fee 

and the development (nexus), and a method for fee calculation? 

7. If your jursdiction has impact or other signficant fees, does the jursdiction provide DNo DVes 

waivers of these fees for afordable housing? 

8. Has your jursdiction adopted specific buildig code languge regardig housing DNo ~Ves 

rehabiltaon that encourages such rehabiltation thugh grdated reguatory 

requiments applicable as different levels of work are pedormed in existig 

buildigs? Such coe languge increaes reguatory requiements (the additional 

improvements requied as a mater of 

reguatory policy) in proporton to the extent of 

rehabiltaon that an owner/developer chooses to, do on a volunta basis. For fuer 

inormaton see HU publication: "Smart Codes in You Community: A Guide to 

Building Rehailtation Codes" 

(ww.huduser.orglpublicationsdestechlsmarcodes.htm) 

9. Do your jurction use a rect version (Le. published with the las 5 year or, if DNo t8 Ves 

no rect verion ha been published the las verion publied) of one of the 

nationay recgn model buidig coes (i.e. the Inteona Coe Council 

(ICe), the Buidig Offcial and Coe Admstors Internonal (BOCA), the 

Souther Buidig Code Congress Intertiona (SBCI), the Interona Conferece 

of Buidi Offcial (lCBO), the Nationa Fire Protetion Asiaton (N A)) 

without signcat techncal amendment or modication. In the case of a trbe or 

TDHE, ha a recent verion of one of 

the model buildig coes as desribed abve 

been adopted or, alteratively, has the trbe or TDHE adopted a buildig code that is 

substatialy equivalent to one or more of 

the regn model buidig codes? 

. Altervely, if a signficant techncal amendment ha been made to the above model 

codes, ca the jursdiction supply supportg data that the amendments do not 

. negatively imact afordabilty. 

10. Does your jursdiction's zonig ordiance or land use reguations pert 

manufactued (H-Còde) housing "as of right" in al residential distrcts and zoni 

classifcations in which simlar site-built housing is pertted subject to design 

density, buildig size, foundation requiements, and other simlar requiements 

the method of 

applicable to other housing tht will be deemed realty, irespective of 

production? 

your 

t8 No DVes 

42 Fonn HUD-27300 (4/04:

11. Withi the past five) .s, has a jursdiction offcial (i.e., chief ""Lccutive, mayor, (gNo D Ves 

county chaian city manager, adminstrator, or a trbally recogned offcial, etc.), 

the local legislative body, or plang commssion, directly, or in parership with 

major private or public stakeholders, convened or fuded comprehensive studies, 

commissions, or heags, or has the jursdiction established a formal ongoing 

process, to review the rules, reguations, development stadards, and processes of the 

jursdiction to assess their impact on the supply of afordale housing? 

12. With the past five yeas, ha the jursdiction initiated major reguatory reforms (g No D Ves 

either as a result of the above study or as a result of inormation identified in the 

barer component of the jursdiction's ''H Consolidated Plan?" If yes, attch a 

brief list of these major regulatory refonn. 

13. With the past five yeas has your jursdction modfied intrctue stadads 

and/or authoried the use of new inastrctue technologies (e.g. water, sewer, 

stet width) to signcantly reuce the cost of housing? 

, 14. Does your jursdiction give "as-of-right' density bonuses sucient to offset the cost 

of buildig below maet unts as an incentive for any maret rate residential 

development that includes a porton of affordale housing? (As applied to denity 

bonuses, "as of right" mean a denity bonus grted for a fied perctage or 

number of additiona maket rae dwellg unts in exchange for the provision of a 

fied numbe or percentage of afordale dwellg unts and without the use of 

discretion in deterg the number of additiona market rate unts.) , 

rg No DVes 

rg No DVes 

15. Has your jursdcton eslihed a single, consolidaed pet applicaon procs for DNo 18 Ves 

housing development th includes buidig, zonig, engieerig, envionmenta, and 

related pets? Altertively, does your jursdction conduct concurt, not 

s~uential, reviews for all requi permits and approvals? 

16. Does your jurdiction provide for expedted or "fas trk" permttg and approvals 

, for all afordale housing' projects in your communty 

rg No DVes 

17. Has your jursdction established time lits for governent review and approval or DNo Dves 

disapproval of development permts in which failure to act, afer the application is 

deeed complete, by the governent with the designated time period, results in 

automatic approval? 

18. Does your jursdiction alow "accsory aparents" either as: a) a special excetion 

or conditional use in all single-famy residential zones or, b) "as of right" in a 

majority of residential distrcts otherwse zoned for single-famly housing? 

19. Does your jursdiction have an explicit policy that adjusts or waives existing parg 

rg No DVes 

reQuiements for al affordale housing developments? 

rg No DYes 

20. Does your jursdiction requie afordable housing projects to undergo public review 

or special heags when the project is otherwse in fu compliance with the zonig 

ordice and other development reguations? 

Dves t8 No 

Total Points: 

43 Form HUD-27300 (4104) 

I 

i

Part B. State Agencies an, Jepartments or Other Applicants r01 .. í'ojects Located in Unincorporated 

Areas or Areas Otherwise Not Covered in Part A 

1 2 

1 Does your state, either in its planng and zonig enabling legislation or in any other DNo DYes 

legislation, requie localities regulatig development have a comprehensive plan 

with a ''housing element?" If no, skip to question # 4 

2. Does you state require that a local jursdiction's comprehensive plan estimate 

curent and anticipated housing need, tag into accunt the anticipated growt of 

the region, for existing and futue residents, includig low, moderate, and middle 

inCome famlies, for at least the next five year? 

3. Does your state's zonig enalig legislation requie tht a local 

jursdiction's 

zonig ordiance have a) suffcient land use and denity categories (multifamly 

housing, duplexes, sma1lot homes and other simlar elements); and, b) sucient 

land zoned or mapped in these categories, that can permt the buildig of afordle 

housing that addresses the nee identified in the comprehenive plan? 

4. Does your stae have an agency or offce that includes a spific mission to 

detere whether local governents have policies or proedures that are rasing 

cost or otherwe discourgig afordle housing? 

5. Do your stae have a lega or adsttive requiement tht loc governents 

undere periodc self -evaluaon of reguations and proses to assess their imact 

upn housing afordilty address these barers to afrdabilty? 

6. Does your stte have a technca assistace or educaon progr for loc 

jursdctions that includes asisg them in identifyg reguatory barer and in 

recmmendig sttegies to loca governents for their removal? 

7. Does your state have specific enabling legilation for loc impact fees? If no skip to 

question #9. 

, 

8. If yes to the queson #7, does the state statute provide critera that sets stadads for 

the allowable tye of capita investments that have a diect relationship between the 

fee and the development (nex) and a method for fee calculation? 

9. Does your stte provide signcant fiancial assistace to local governents for 

housing, communty development and/or tranrttion that includes fudig 

prioritition or lig fudig on the basis ofloca regulatory barer removal 

activities? 

44 

DNo DYes 

DNo DYes 

DNo DYes 

DNo DYes 

DNo Dyes 

DNo DYes 

DNo DYes 

DNo DYes 

Form HUD-27300 (4/04)

10. Does your state have a.._ ..idatory state-wide buildig code that a) does not permt 

local techncal amendments and b) uses a recent version (i.e. published wit~ the last 

five years or, if no recent version has been published, the last version published) of 

one of the nationally recgnzed model buildig codes (i.e. the International Code 

Council (ICC), the Buildig Offcials and Code Admstrtors International (BOCA), 

the Southern Building Code Congress International (SBCI), the International 

Conference of Buildig Offcials (ICBO), the National Fire Protection Association 

(N A)) without signficant techncal amendment or modification? 

Alternatively, if the state has made signficant techncal amendment to the model 

code, can the state supply supporting data that the amendments do not negatively 

impact affordabilty? 

11. Has your jursdiction adopted specific buildig code languge regarg housing 

rehailtation tht encourges such rehailtation though gradted reguatory 

requiements applicable as different levels of work are performed in existg 

buidigs? Such coe languge increaes reguatory requiements (the additiona 

improvements requied as a matter of reguatory policy) in proporton to the extent of 

rehailtaon that an owner/developer chooses to do on a volunta basis. For fuer 

inormaton see HU publicaon: "Smart Coes in Your Community: A Guide to 

Building Rehabilitation Coes" 

(ww.huduser.orglpublicationsdestecb/smarcoes.htm) 

12. With the past five yea ha Y0ll state made any changes to its own proeses or 

requiements to streae or consolidae the state's own approval proceses 

involvig pets for water or wasewater, envinmenta review, or other Stateadministerèd 

perts or progr involvig housing development. If yes, briefly list 

these chages. 

13. With the past five yeas, ha your stae (i.e., Goveror, legislatue, plang 

deparent) diectly or in parership with major private or public steholder, 

convened or fuded comprehenive studies, commsions, or panels to review state or 

loca nies, regulations, development stadads, and procees to asess thei impact 

on the supply of afordable housing? 

DNo DYes 

DNo Dyes 

DNo DYes 

DNo Dyes 

14. With the past five yeas, has the state intiated major regulatory reform either as a DNo DYes 

rest of the above study or as a result of inormation identified in the barer 

component of the states' "Consolidated Plan submitted to HU?" If yes, briefly list 

these major reguatory reform. 

15. Has the stte underten any other actions regardig local jursdiction's reguation of DNo DYes 

housing development includig perttg, land use, buildig or subdvision 

regulations, or other related adstrtive proedures? If yes, briefly list these 

actions. 

Total Points: 

45 

Form HUD-27300 (4/04)

Acknowledgment of 

Application Receipt 



Type or clearly print the Applicant's name and full address in the space below. 

ROBERT SCHULTE 

DEPARTMENT OF HOUSING SERVICES 

100 E. EUCLID, SUIT 101 

DES MOINES, IOWA 50313 

(fold Ii) 

Typ or clealy pnnt the followig information: 

Name of the Federal 

Progr to which the 

applicant is applying: 

D 

D 

CONUUM OF CA SHP AND SHETER + CA 

To Be Completed by HU 

HU received your application by the deadline and will consider it for funding. In accordace 

with Section 103 of the Deparent of Housing and Urban Development Reform Act òf 1989, 

no iIiormation wil be released by HU regardig the relative stading of any applicant until 

fuding announcements ar made. However, you may be contacted by HU aftr initial 

. screening to permt you to correct certin application deficiencies. 

HU did not receive your application by the deadline; therefore, your application wil not 

receive fuer consideration. Your application is: 

D Enclosed 

D Being sent under separate cover 

Processor's Name 

Date of Receipt 

46 

form HUD-2993 (2199)

You are our Client! 

Grant Applicant Survey 


And Urban Development 

Ofce of Departental Grants 

Management and Oversight 

OMB No. 2535-116 (exp. 12/31/2008) 

The inormtion collection requiements contained in th documnt have been approved by the Offce of Management and Budget 

(OMB) under the Paperwork Reduction Act of 1995 (44U.S.C. 3501-3520). Th agency may not collect th inormtion, and you are 

not requird to complete th fonn uness it diplays a curently vald OMB contol numer. Public report burden for th 

collection is estite to average 30 miutes per response, includig the tie for reviewig intrctions, searchig exiti data 

soures, gatherig and maintag the data neeed and completi and reviewi the collection of inormtion. All inormtion 

collection contained ùi thi Surey is optiona. 

The Deparnt of Housing and Urban Development is tr to provide a more user frendy, cutomer drven fudig procss. 

, Pleae let us have your comments and recommendations for imrovements to the Notice of Fudi Availabilty Application and 

form and/or-the Electronic Grt Application Outreach procss. You ca complete and submit th surey and attch it to your 

elecnic application or you ma diectly to: Deparent of Housin and Urban Development, 451 ., Street, SW - Room 3156; 

Washigton, DC 20410. . 

Inuctions. Liste below are severa qutions regadi outrch conducte by the Federa Govemnt to pree organtions 

-for th~ Gr.gov regitrtion proc, the retreva of fudi opportties, and sumiion of eleconic applications. The grdi 

scae belôw provides options from extemly helpfu to not applicale. In the box provided grde th governnt on its outrch 

effort 'from O-None tb G-Not aplicable to my nee. Secton seven provide spac for you to mae SUGGESTIONS FOR 

IMROVE, please iden the secon you ar commg on. Field level help is avable by click on th Fl key. 

0= None A = Extmely helpfu B = Somewht helpfu 

F = Not helpfu G = Not applicable to my ne 

C = Helpfu D = Not ver helpfu 

Section 1 - Electronic Grant Application Outreach Provide det abut the ty of inonntion you 

reeived frm HU about Grts.gov as indicate below. 

1. Th bruresyguids) (ins ti(s)): Grde: 

2. TiUe of th WOs) lcofers)'tings)fningon(s) 

Q-NONE 

3. Tile(s) of satellit brs): 

.. ' Super NOF A Gener Section Chge 

4. Díd~u reive infonnatin fr the ~enc Can Center? 

yes, Please prvie the date(s) and rate the quality 

, of asistanc recived. 

Dyes 18 No If 

5. Did you recive Infonnation from the Granlgov Conta Center? ? 

Dyes 18 No If yes, please prvi th date(s) and rate the qualit of 

assistnce reived. 

Q-None 

Date att: 

Dates): , 

3/14/200 

Date(s): 

Gr: 

O-None 

Dates): Grade: 

O-None 

6. Ho cold we Imroe ou comunication to yo and otrs lie yo (pse expain)? 

The webcast feed is ver diffcult to see and follow. The system tends to lock up. 

Section 2 - Electronic Grant Application Registration Process 

I.Did you fid the Grants.gov website inormation on registration clearer and easier to 

understad th last year? 

'2.Do you have access to ffM compatible softare? 

3,.Do you have Internet access with your offce or division? 

If ri. is the accss within: 

. a. Witin your organiztion? 

b. Available in your building? 

Grade: 

D-Not ver helpful 

Grde: 

O-None 

DYes 18 No 

18 Yes 0 No 

18 Yes 0 No 

8Yes Yes 8 No 

Grant Applicant Survery form HUD-2994-A (10/2005) 

47

C. Available at home? 

d. Available within 1 mile of where you work? 

e. Available within 5 miles of where you work? 

f. Available more than 5 miles of where you work? 

4. Do you have problems with Internet access due to any of the following? 

Cost? 

Reliabilit 

Ofce accss rihts? 

Poor qualit reception? 

Section 3 - Funding Opportunities 

Which Funding Opportnity are you commenting on 

1. Did you find the Submission Checist helpful? 

.2. Wer th Funing Opportni insctns dear and easier to follow thn la year? 

3. Wer th Prora spec funding opprtni instrns clarer an easier to foll thn last year? 

4. Did yo,u fid se of th fuding opprtit duplicatie? 

If ye, to any d th que abo, Idti th se(s) an ar fo stinng th reunt kitl. 

Section 4 - Finding Grant Opportunities 

~Yes ~ No 

Yes No 

Yes No 

Yes No 

~Yes l No 

Yes No 

Yes No 

Yes No 

'1. Was ,It eaer to find th Findng Oprtites on-ne throh Grnts.gov thn prvis 

meths? 

o Yes 18 No 

. 2. Ba on prvius years, ho easy wa it to find grats åi 

the Ch fr dr , 

a. Fedral Register About the sae 

b. Trade journals 

c. ÑJen websites 

- 3. How could fidin grant opprtnit be imprved (pease expain)? 

Section 5 - Applying for Grant Opportunities 

1. Was there more than one persn involved In coeting the applicatin submission? 

2. Did you find th elecnic application usefu fur dissemination purpses? 

3. Did the same indivdual wh downloade th grat appicatin submit th applictin? 

4. Did you knw where to lok for instrctns for copleting and submitng the 

application? 

None 

About the same 

Numbe 

11 

Dyes DNo 

18 Yes D No 

18 Yes D No 

Insert CFDA numral: 

14.235 

18 Yes 0 No 

DYes 18 No 

DYes 18 No 

o Yes 18 No 

5. At what point in th proce did you download and read the Applicatin Instrns? B-Afer lookig at the application 

6. What Secon of the Electnic Application Desktp Guide were most uséful? 

7. How could the Eleconic Aplicatin Desktp Guide be Improved (please explain)? 

Grant Applicant Survery form HUD-2994-A (10/2005) 

48

8. Did you find the Submission Tips helpful? 

9. Did you find the NOFA Application Submission Checklist helpful? 

10. Did you know how to use the attchment tonn in the application package? 

11. Did you have a problem saving your application? 

Section 6 - Applicant Information 

Organation Legal Name City of Des Moines 

Grade 

F-Not helpful 

Grade 

O-None 

t8 Yes 0 No 

o Do not knw 

t8 Yes 0 No 

o Do not knw 

Address 100 Eat Euclid. Suite 101 CityDes Moines State IOWA 

Zip Code50313 Telephone Number: (includ 

ar coe) 515.237.1384 

Contat Name: Rober Schulte Emai Address RAchult~dmgov.org 

Section 7 - Suaaestions 

For improving the Elecic Grant procs, please spe below. Please identi the secton you are 

commenting on. 

Grant Applicant Survery 

49 

form HUD.2994.A (10/2005)

APPLICATION FOR 

FEDERAL ASSISTANCE 2. DATE SUBMITTED 

May 25, 2006 

Applicant Identifier 

Version 7/03 

1. TYPE OF SUBMISSION: 

Application 

Pre-applicatin 

3. DATE RECEIVED BY STATE State Application Identifier 

IJ Constrction bl Constrcton 4. DATE RECEIVED BY FEDERA AGENCY Federal Identifier 

Is: Non-Constrctlon 

5. APPLICANT INFORMATION 

o Non-Constructlon 

legal Name: 

CITY OF DES MOINES 

Oraanlzatlonal Unit: 

Dr:artent: 

D PARTMENT OF HOUSING SERVICES 

Organiztinal DUNS: 

07-349-909 

Divsion: 

COMMUNITY INVESTMENT ADMINISTRATION 

Address: 

Street 

100 EAST EUCLID, SUITE 101 

Cit . 

D~ MOINES 

Cou'l 

POL 

State: 

IOWA I I' Coe 313 

Contr 

US 

Name and telephone number of person to be contacted on matters 

Involvng this application (give area code) 

Prefix: Firt Name: 

MR ROBERT 

Middle Name 

lat Name 

SCHULTE 

Su 

EmI: 

RASCHUlTE~DMGOV.ORG 

6. EMPLOYER IDENTIFICATION NUMBER (EIN): Phone Numbe (giv area co) 

~D-~~lQHJ~l!~ 

8. TYPE OF APPLICATION: 

515.237.138 515.242.284 

I Fax Numb (giv are coe) 

7. TYPE OF APPLICANT: (Se ba of foo for Apliction Typ) 

f Revon, ente appate-Ietters) In box(es) 

Se back of foo for descpti of letter.) 

o New Ð Contiuation () Revision MUNICIPAl 

0 0 

bt (sp) 

Otr (sp) 9. NAE OF FEDERA AGENCY: 

HOUSING AND URBAN DEVLOPMENT 

. 10. CATALOG OF FEDERA DOMESTC ASISTANCE NUMBER: 11. DESCRIPTIVE TITLE OF APPLICANS PROJECT: 

TIT (Name of Prra): 

IT~-~m~ CONSOliDATED APPLICATION FOR SHP AND S+C FUNDS WI 

ELEN (11) PROJECTS; 1# YMCA #2I-OUNT, #3 HOUSE OF 

MERCY, #4 HOUSE OF MERCY CAPITAl PAR. #5 YMCA 

12. AREA AFFECTED BY PROJECT (Cis. Cont, Sttes. etc.): 

TRSIITIONA, # 6 IHYC, #7 IHYC, #8 PRIMAY Hl TH CARE 

ENHAEMENT, #9 PRIMAY Hl TH CA OUTRECH, #10 WEST 

DES MOINES, #11 ANWIM SHELTER + CA HSG 

13. PROPOSED PROJECT 

Sta Date: 

1/1/07 I Ending 12/1/07 Date: 

14. CONGRESSIONA DISTRICTS OF: 

a. Apcant 

1A-D3 l,b. A-D3 Prjec 

15. ESTIMATED FUNDING: 

a. Federal ~ 

2,571,481 

.. 

16. IS APPLICATION SUBJECT TO REEW BY STATE EXCUTIVE 

bRDER 12372 PROCESS? 

a. Yes. D THIS AVAIlALE PREAPlICATIONlAPPlICATlON TO THE STATE EXCUTIV WAS ORER MADE 12372 

b. Aplicnt ~ .. 

c. State $ 

.. 

PROCESS FOR REVIEW ON 

d. Locl $ ... 

b.No. 

Ð PROGRA IS NOT COVERED BY E. O. 12372 

e. Oter 

f. Proram Incoe 

$ 

~ 

... 

... 

o OR PROGRA HAS NOT BEEN SELECTED BY STATE 

FOR REVIEW 

17. IS THE APPLICAN DELINQUENT ON ANY FEDERL DEBT? 

g. TOTAl ~ ... 

2,571,481 

Dyes If "Yes" attch an explaation. ei No 

18. TO THE BEST OF MY KNOWLEDGE AND BELIEF, AL DATA IN THIS APPLlCATIONlREAPLlCATION ARE TRUE AND CORRECT. THE 

PoCUMENT HAS BEEN DULY AUTHORID BY THE GOVERNING BODY OF THE APPLICANT AND THE APPLICAN WILL COMPLY WI THE 

IATTACHED ASSURACES IF THE ASSISTANCE IS AWARDED. 

"'. j\horzed Renresentative 

f:i!rIX I T.M. First Name FRANKLIN 

Middle Name 

last Name 

COWNIE 

b. TiUe 

MAYOR g / ./ d. Signa~ . ~r:eprep¡-" 1& 'l,/U." - IF 

Previous Editicl Usatje -- \: AuUionzed for locl Reoroducon 

- 

Sufix 

c. Telephone Number (give area co) 

515.283.4944 

ß. Date Signed 

. - - &&_& 

rl424 (Rev.9-2003) 

Prescnbed bv OMB Circular A-102 

50 

DATE:

2006 Supportive Housing Program Funding Request 

Name of Agency & Order of Funding Amounts Years of 

Rankine Fundini! 

1. YMCA $192,998 2 Yea Renewal 

2. HM $220,500 2 Year Renewal 

3. HOUSE OF MERCY $289,733 1 Year Renewal 

4. HOUSE OF MERCY $227,468 1 Yea Renewal 

5. YMCA $87,325 1 Year Renewal 

6. IHC $287,356 1 Yea Renewal 

7. IHC $99,391 1 Yea Renewal 

8. PRIY HEALTH CAR $256,109 1 Yea Renewal 

9. PRIY HEALTH CAR $85,00 1 Yea Renewal 

10. WEST DSM HU SERVICES $87,325 1 Yea Renewal 

11. ANA WI SHELTER + CAR 723,384 1 Yea Renewal 

Total SHP ReQuest $2,571,481 

51

Section IV: Applicant Certification 

These certified statements are required by law. 

Previous versions obsolete form HU-40090-4 

A. For the Supportive Housing (SHP), Shelter Plus Care (S+C), and Single Room Occupancy 

(SRO) programs: 

Fair Housing and Equal Opportnity. 

It will comply with Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000(d)) and regulations 

pursuant thereto (Title 24 CFR par I), which state that no person in the United States shall, on the 

ground of race, color or nationa origi be excluded from paricipation in be denied the benefits of, or 

be otherwse subjected to discriation under any progr or activity for which the applicant 

receives Federa ficial assistace, and will imedately tae any meaures necessar to effectuate 

ths agreeent. With reference to the real proper and strctue( s) thereon which are provided or 

improved with the aid of Federal fiancial assistace extended to the applicant, ths assuance shall 

obligate the applicant, or in, the case of any tranfer, tranferee, for the period durg which the real 

propert and strctue(s) are used for a purse for which the Federa fiancial assistace is extended 

or for another purose involvig the provision of simlar serces or benefits. 

It will comply with theFai Housing Act (42 U.S.C. 3601-19), as amended and with implementig 

reguations at 24 CFR par 100, which prohibit discriation in housing on the basis of rae, color, 

religion, sex, disailty, famlial statu or nationa origi. 

It will comply with Executive Order 11063 on Equa Opportty in Housing and with implementig 

regulations at 24 CF Par 107 which prohibit discrion because of rae, color, creed, sex or 

nationa origi in housing and related facilties provided with Federal fiancial assistace. 

It will comply with Executive Order 11246 and all reguations puruat therto (41 CF Chapter 60- 

1), which state that no persn shal be discriated agai on the basis of ra, color, religion, sex or 

national origi in all phases of employment durg the pedormance of F eder contrcts and shall tae 

affative action to ensure equal employment opportty. The applicant will incorporate, or cause 

to be incorporated into any contrct for constrction work as defied in Section 130.5 of HU 

reguations the equa opportty clause required by Section 130.15(b) of the HU regulations. 

It will comply with Section 3 of the Housing and Urban Development Act of 1968, as amended (12 

D.S.C. 1701(u)), and reguatons puruat thereto (24 CFR Par 135), which requie that to the greatest 

extent feasible opportties for trg and employment be given to lower-income residents of the 

project and contracts for work in connection with the project be awarded in substatial par to persons 

residing in the area ofthe project. 

It will comply with Section 504 of the Rehabiltation Act of 1973 (29 D.S.C. 794), as amended, and 

with implementing reguations at 24 CFR Par 8, which prohibit discriation based on disabilty in 

Federally-assisted and conducted programs and activities. 

It wil comply with the Age Discriation Act of 1975 (42 U.S.C. 6101-07), as amended, and 

implementing regulations at 24 CFR Par 146, which prohibit discrination because of age in projects 

and activities receiving Federal fiancial assistance. 

52 

Form HUD-40090-4 


It will comply with Executive Orders 11625, 12432, and 12138, which state that program paricipants 

shall take affrmative action to encourage paricipation by businesses owned and operated by members 

of miority groups and women. 

If persons of any paricular race, color, religion, sex, age, national origi, famlial statu, or disabilty 

who may qualify for assistace are unely to be reached, it will establish additional procedures to 

ensure that interested persons can obtain inormation concerng the assistance. 

It will comply with the reasonable modification and accommodation requiements and, as appropriate, 

the accessibilty requirements of the Fai Housing Act and section 504 of the Rehabiltation Act of 

1973, as amended. 

Additional for S+C: 

If applicant has estalished a preference for tageted populations of disabled persons puruat to 24 

, CFR 582.330(a), it will comply with ths section's nondiscriation requiements with the 

designated population. 

B. For SHP Only. 

20- Year Operation Rule. 

For applicats receivig asistace for acuisition, rehabiltaon or new constrction: The project will 

be opeted for no less th 20 year from the date of intial ocupancy or the date of intial serce 

provision for the purose specified in the application. 

I-Year Operation Rule. 

For applicants, receivig assistace for supportive servces, leasing, or operting costs but not 

receivig assistace for acuisition, rehailtation, or new constrction: The project wi be operated 

for the purose specified in the application for any year for which such assistace is provided. 

c. For S+C Only. Supportve Servces. 

It will make available supportve servces appropriate to the need of the population sered and equal 

in value to the aggregate amount of rental assistace fuded by HU for the full ter of the rental 

assistance. 

D. Explanation. 

Where the applicant is unable to cerify to any of the statements in ths cerfication, such applicant 

shall attch an explanation behid ths page. 

Applicant: 


~ 

53 

Date: 

MAY 2 2 iuau 

For PHA Applicants Only: 

(pHA Number) 

form HU-40090-4 


Appl i cantlReci pient 

Disclosure/Update Report 



')MB Approval No. 2510-011 (exp. 12/31/2006) 

Instructions. (See Public Reporting Statement and Privacy Act Statement and detailed instructions on page 2.) 

A IicantlReci ient Information Indicate whether this Is an Initial Report D or an Update Report D 

1. Applicantlecipient Name, Address, and Phone (include area coe): 2. Socal Secunty Number or 

Departent of Housing Services Employer 10 Number: 

100 E. Euclid, Suite 101, Des Moines, Iowa 50313 426-00-514 

( ) 

3. HUD Program Name 

Supportive Housing Program 

5. Stale the name and loction (strt addre, City and State) of the proect or actvity 

City of De Moines, 100 East Eucid, Suite 101, De Mone, Iow 50313 

Part I Threshold Determinations 

1. Ar yo applying for asistance fo a spefic proec or actvity Th 

tenns do not Include forula grants, such as public hosing opting 

subsidy or CDBG bloc grants. (For furt Inforation se 24 CFR Sec. 

4.3). 

(g Yes D No 

4. Amount of HUD Assistance 

Requestedeceive 

2,571,481 

2. Have yo reiv or do yo exp to receiv asistance within the 

Junsict of th Departt (HUD) , Invong the pr or actvi In 

this applicati, in exce of $200,00 dunng this fiscal yer (Oc. 1 - 

Sep. 30)1 For furt Inforati, se 24 CFR Se. 4.9 

Dyes (8 No. 

If you answered "No. to either question 1 or 2, Stopl You do not nee to complete the remainder of this form. 

However, you must sign the certcation at the end of the report. 

Part II Other Government Assistance Provided or Requested I Excted Sources and Use of Funds. 

Suc assstance includes, but is not limited to, any grant, loan, subsidy, guarantee, insurance, paymnt, crit or ta benefi 

DeparttlStateocl Ag Na an Adre Typ of Asistance Amt Ex Us of th Fun 

Reaterovided 

(Note: Use Additial pag If ne.) 

Part II Interested Parties. You must discose: 

1. All developrs, cotrct, or coltants Invo In th appicati fo th asstance or In the plnning, develot, or Implentati of th 

proec or actvity and 

2. any oth pers wh ha a financllnleret In the prect or actvity fo which the asistance is soght tht exce $5,00 or 10 pet of the 

asistanc (whchver is lo). 

Alphbetical list of all pe with a reble financial Intet 

In th ec or actvi For indiviuals lve th last name first 

(Note: Use Additional page If necry.) 

Certifcation 

Warning: If yo knowngly make a false statement on this for, you may be subject to cil or crminal pealt under Secton 1001 ofTiUe 18 of the 

Unite Stale Coe. In addition, any pers who knongly and malenally viate any reuire disclosure of inforation, Including intentional nondisclosure, 

is subjec to civil moey penalty not to exce $10,00 fo each violation. 

I certfy that this Inforation' e and cople 

Signatu : ,. Date: (mrdd) 

MAY 2 2 10U6 

54 Form HUD-2880 (3/99)

Appl i cantlReci pient 




OMS Approval No. 2510-0011 (exp. 12/31/2006) 


IicantlReci ient Information Indicate whether this is an Initial Report (g or an Update Report D 

1. Applicant/Recipient Name, Address, and Phone (include are coe): 2. Socal Security Number or 

Departent of Housing Services Employer ID Number: 

100 East Euclid, Suite 101, Des Moines, Iowa 50313 426-0-4514 

(515) 237-1384 



5. State the name and loction (strt addre, City and State) of the proect or actvity 

YMCA of Greater De Mone, 101 Locst Street, De Mones, Iow 50309 


1. Ar you appng for assistance fo a spec prec or actvity Th 

tenns do not include forula grats, such as public hosing oprating 

SUbsidy or CDBG bloc grants. (For furt inforati se 24 CFR Se 

4.3). 

'(8 Yes 0 No 


Requestedeceived 

$192 998 

2. Have yo rece or do yo exp to recive assistace within the 

juriicon of the Departnt (HUD) , invoving the prec or actvity in 

this apcation, in exce of $200,00 during this fiscal year (Oc 1 - 

Sep. 30)1 For furtr Inforation, see 24 CFR Se. 4.9 

DYes (8 No. 

If you answered -No" to either question 1 or 2, Stop! You do not nee to complete the remainder of this form. 

However, you must sign the certICtion at the end of the report. 

, Part II Other Government Assistance Provided or Requested I Expected Sources and Use of Funds. 

Such assistnc includes, but is not limited to, any grant, loan, subsidy, guarantee, insurance, payment, credit or ta benefi 

Dertentltateocl Ag Name an Adre Typ of Asistance Amnt Ex Use of th Fund 

Reaueterovided 

(Note: Use Additi page if ne.) 

Part II Interested Parties. You must discose: 

1. All deveop, cotrctor, or coultnts invo In the appication for th asta or In th plning, deveopmet, or implemetati of th 

proct or actvity and 

2. any otr pers wh has a financil intet In the prec or actvity fo which th assstance Is soght tht exces $50,00 or 10 perct of the 

aStance (whicever Is lo). . 

Alphbetical list of all pers with a rebl finacial Interet 

In th . ect or actvi For Iniviuals iv th last name first 

(Note: Use Additional pages if necery.) 

Certification 

Warning: If yo knowngly make a false sttement on this for, you may be subjec to civil or aiminal penalti under Secton 1001 ofTiUe 18 of the 

Unite State Coe. in addition, any pe who knowngly and materially viate any reuire disclosure of infotion, including intentionl non 

disclure, Is subject to civil moey penalty not exce $10,00 for each violation. 

I certfy tht this lnforati . tre a d co 

Signare; , L ~ 

i ll. 

Ma or, .M. Frankli Coie 

Date: (mmldd) 

MAY 2 2 20 

55 Form HUD-2880 (3/99)

Applicant/Recipient 




OMB Approval No. 2510-011 (exp. 12/31/2006) 

Instructions. (See Public Reporting Statement and Privacy Act Statement and detailed instrctions on page 2.) 

IicantlReci ient Information Indicate whether this is an Initial Report rg or an Update Report 0 

1. Applicantlecipient Name, Address, and Phone (include are coe): 2. Socal Security Number or 

Department of Housing Services Employer ID Number: 


(515) 237-1384 

3. HUD Proram Name 


5. State the name and loction (strt addre, City and State) of the proect or actvity 

Iow Cotinuum Outcome and Universl Nee Tookit (I-Cnt), 1111 9ft Street, Suite 245, De Moine, Iow 50314 


1. Ar yo applyng fo assistace for a specic prec or actty Th 

tes do not include foula grants, such as public houng oprating 

subsidy or COBG bloc grats. (For furt infotion se 24 CFR Se. 

4.3). 

(8 Yes D No 


Requestedeceive 

$220,500 

2. Have you reiv or do you exct to receve asistance within the 

juriict of the Departent (HUD) , invoving the prect or actvity in 

this applicati, in exce of $200,00 during this fiscal yer (Oc 1 - 

Sep. 30)? For furtr infotion, see 24 CFR Sec. 4.9 

Dyes t8 No. 

If you answered "No" to either question 1 or 2, Stopl You do not need to complete the remainder of this form. 


Part II Other Government Assistance Provided or Requested I Expected Sources and Use of Funds. 

Such assistance includes, but is not limit to, any grant, loan, subsidy, guarantee, insurace, payment, credit or ta benefi. 

DentlStateocl AQ Name an Adre Typ of Astanc Amnt Exed Use of th Fund 

Reauesterovied 

(Note: Us Adition page If necar.) 

Part II Interested Parties. You must disclse: 

1. Al develo, cotrct, or coultnts Invoed in th appication fo th astance or in the plnning, development, or implemetati of th 

prec or acvity and 

2. any oth pe wh ha a financial Intet in th prec or actvity fo which the astance is soht that exces $50,00 or 10 percnt of th 

asstace (whchever is lo). 

Alphabetical list of all pers wi a repobl financi interet 

in th . ec or actvi For Individuals ve th lat name first 

(Note: Use Aditinal page if necesary.) 

Certification 

Waring: If yo knowngly make a fals statement on this for, yo may be subjec to clvil or crinal penalties under Secton 1001 of TiUe 18 of the 

Unit States Coe. In addition, any pers who knngly and materially violate any reuired disclosres of inforation, Including intentional nondisclosure, 

is subject to civil oney penalty not to exce $10,00 for each violati. 

I certfy tht this Infonnati tre and copl . 

Signature: 

.~ 

I Date: (mmldd) 

Ma , .M. Franklin 

56 Form HUD-2880 (3/99)







IicantlReci ient Information Indicate whether this Is an Initial Report (g or an Update Report 0 

1. Applicantlecipient Name, Addres, and Phone (include area coe): 2. Socal Security Number or 

Department of Housing Services Employer 10 Number: 


(515) 237-1384 



5. State the name and lotion (strt addres, City and State) of the proed or actvity 

House of Merc, 1409 Clark Street Des Moines,low 50314 


1. Ar you applying for assistance fo a speci prod or actvity The 

tenns do not include forula grats, such as publiC hosing opting 

subsidy or CDBG bloc grants. (For furtr infortion se 24 CFR See 

4.3). 

l' Yes D No 


Requesteeceive 

$289,733 

2. Have yo reiv or do yo expd to receive assistance within the 

jurisdicton of the Dertnt (HUD) , Invong th proed or actvity in 

this appcation, in exce of $200,00 during this fil yer (Oc 1 - 

Sap. 30)? For furter inforti, se 24 CFR See. 4.9 

D Yes l' No. 

If you answered "No" to either question 1 or 2, Stop! You do not need to coplete the remainder of this form. 

However, you must sign the certcation at the end of the repor. 


Such assistance includes, but is not limite to, any grant, loan, subsidy, guarantee, Insurance, payment, crit or ta benefi 

DetlStatel Agcy Name and Addre Typ of Asistanc Amt Ex Uses of th Funds 

Reouetede 

(Note: Us Aditial pa if near.) 


1. All develo, cotrct, or cosultants invove In the appicati fo th asstance or In th planning, develont, or Implemtation of th 

proec or actvity and 

2. any oth pe wh has a financil Interet In th prec or actvi for which the asistance Is soht tht exces $50,00 or 10 perct of the 

assistance (whichever Is lo). 

Alphabetica Ust of all pers with a repoble financal Intet 

in the ec or actvi For indivduals, lve th lat name firs 

(Note: Use Additional page if necery.) 

Certifcation 

Warning: If you knowngly make a false statement on this for, you may be subjec to civil or aimlnal penalties under Secon 1001 of Title 18 of the 

Unite State Coe. In addition, any pers wh knngly and materilly violate any reuire disdosure of Infoation, including Intentionl nondisdosure, 

is subjec to civil money penalty not to exce $10,00 for each violation. 

i cert that this I foration tre and cople 

Signa re: ~ 

' l. 

. F anklin owie 

Date: (mmlddl) 

ZO 

57 Form HUD-2880 (3/99)





OMS Approval No. 2510-0011 (exp. 12/3112006) 


IicantlReci ient Information Indicate whether this is an Initial Report (g or an Update Report 0 

1. Applicantlecipient Name, Address, and Phone Onclude area coe): 2. Socal Secrity Number or 



(515) 237-1384 

3. HUO Proram Name 

Supportive' Housing Progràm 

5. State the name and loction (street addre, City and State) of the proec or actvity 

Hose of Merc, 1409 Clrk Strt Des Moines, Iow 50314 


1. Ar yo applyng for assstance fo a spec prec or actvity The 

tenns do not include foula grants, such as public housing opting 

subsidy or CDSG bloc grnts. (For furtr Infoation se 24 CFR See 

4.3). 

(8 Yes o No 



$227,468 

2. Have yo reive or do yo ex to recive asistance within th 

jurisdicton of th Departent (HUD) , Invoving the pr or actvity in 

this application, in exce of $20,00 during this fical yer (Oc 1 _ 

Sep. 30)? For furt Infoation, se 24 CFR See 4.9 

DYes i: No. 

If you answered "No" to eiter question 1 or 2, Stopl You do not nee to complete the remainder of this form. 



Such assistanc incudes, but is not limited to, any grant, loan, subsidy, guarantee, insurance, payment, credit or ta benefi. 

DerltlStatel Agcy Name and Adre Typ of Astance Amnt Ex Use of th Funds 

Recuesrovided 

(Note: Use Aditi pa if nery.) 

Part II Interested Parties. You must disclose: 

1. All deve, cotrct, or coultants Invove In th appication for th asistace or in th planning, deveopment, or implementation of the 

prect or acl and 

2. any oth pe wh ha a final Interet In th prec or actvity fo which th asistance is soght tht exce $50,00 or 10 pecent of th 

asistanc (whichver Is lor). 

Alphabetical lit of all pers with a reble financal Interet 

In the ec or actvi For Individuals ive the last name first 

(Note: Use Aditional page If necery.) 

Certification _ 

Waring: If you knowngly make a fals statent on this for, yo may be subjec to civil or aiinal penalties under Seon 1001 of Tille 18 of th 

Unite State Co. In additi, any pers wh knngly and materially viate any reuired disclure of inforation, Including Intentional nondisclure, 

is subjec to cil money penalty not to ex $10,00 for each vition. 

I ce that this Inforatin i tre and complete 

Signatur : Date: (mmlddl) 

MAY 2 2 ,2006 

58 Form HUD-2880 (3/99)





OMS Approval No. 2510-0011 (exp. 12/31(2006) 


A IicantlReci ient Information Indicate whether this is an Initial Report r8 or an Update Report 0 

1. Applicantlecipient Name, Address, and Phone (include are coe): 2. Socal Secrity Number or 

Department of Housing Services Employer 10 Number: 


(515) 237-1384 



5. State the name and lotion (street address, City and State) of the project or actvity 

YMCA of Greater De Moines, 101 Loct Street, De Mones, iow 50309 


1. Are you appng fo assstance fo a spec prec or actvity Th 

term do not Include foula grants, such as publc hong opting 

subsidy or CDBG bloc grants. (For furter Infoti se 24 CFR Sec 

4.3). 

i: Yes D No 


Requestedecived 

$102,217 

2. Have you reived or do yo exp to reve asistance within the 

jurisdict of th Dertent (HUD) , Invong th prec or actvity In 

this apicati, in exce of $20,00 during this fical yer (Oc 1 - 

Sep. 30)? For furt inforation, see 24 CFR Sec. 4.9 

D Yes i: No. 

If you answered "No" to either question 1 or 2, Stopl You do not nee to complete the remainder of this fonn. 

'However, you must sign the certfication at the end of the report. 


Such assistnce incude, but is not limit to, any grant, loan, subsidy, guarante, Insurance, payment, crit or ta benefi 

DeentlState AgnCf Nam and Adre Typ of Asta Amount Ex Use of th Fùnc 

Reatedro 

(Note: Use Aditil pa If nece.) 


1. All deve, cotrct, or coultnts Invo In th appicati for th asstanc or in th plnnin, developt, or implemtati of the 

prec or actvity and 

2. any other person wh has a financial Interet In th prec or actvity fo which th astance Is soht tht exce $50,00 or 10 perct of th 

assistance (whichver Is \or). 

Alphbetica rlSt of all pe with a repoble financal interest 

in the ec or actvl For Indivduals. lve the last name first 

(Note: Use Additionl pages If necery.) 

Certification 

Warning: If you knowngly make a false statement on this for, yo may be subject to civil or aimlnal penalties under Secton 1001 of nUe 18 of the 

Unite State Coe. In addition, any pers wh knngy and materilly viate any required disosures of infortion. including intentionl non 

. disclure, is subjec to civil moy penalty not to exce $10,00 for each viation. 

I cert that this i oration Is tre and coplete. 

Signature: Date: (mmddl) 

59 Form HUD-2880 (3199)







IicantlReci ient I nformation Indicate whether this is an Initial Report t8 or an Update Report 0 

1. Applicant/Recpient Name, Addres, and Phone (indude are coe): 2. Soal Security Number or 


100 East Euclid, Suite 101, Des Moines,lowa 50313 426.004514 

(515) 237-1384 

3. HUO Proram Name 


5. State the name and loction (street addres, City and State) of the proect or actvity 

Iow Homeless Youth Proram, 1216 Martn Luther King Parky De Mones, Iow 50314 


1. Ar yo applying for asstance for a specic prec or actvi Th 

tenns do not indude foula grants, such as public houing oprating 

subsidy or CDBG bloc grants. (For furter Infonati se 24 CFR Sec. 

4.3). 

t8 Yes D No 

4. Amount of HUO Asistance 


$287,356 

2. Have you rece or do you expct to reve asistanc within the 

juriict of th Deparnt (HUD) , invoving the prec or actty In 

this appcation, in exce of $20,00 during this fiscl yer (Oc 1 - 

Sep. 30)1 For furt Infoati, see 24 CFR Sec. 4.9 

DYes rg No. 

If you answered "No" to eiter question 1 or 2, Stop! You do not need to complete the remainder of this form. 


Pad II. other Government Assistance Provided or Requested I Expected Sources and Use of Funds. 

Such asSistanc includes, but is not limit to, any grant, loan, subsidy, guarantee, insurance, payment. credit or ta beefi 

DepartentlStatel Agcy Nam and Adre Typ of Asistance Amt Ex Use of th Funds 

Reouete 

(Note: Us 

Adition page if nery.) 

Partll Interested Parties. You must discose: 

1. All develop, cotrct, or coultants Invo in th appicati fo the asistanc or In th plnning, developnt, or implemntati of th 

project or actvity and 

2. any oth peon wh ha a financil Interet in the pro or actty fo which the asistance is soht that exces $50,00 or 10 percent of th 

asstance (whichver is lor). 

lit of all pers with a repoble finacil intet. 

Alphbetical 

in the ac or actvi For indiviuals ive th last name first 

(Note: Use 

Additionl page if necry.) 

Certification 

Warning: If you knowngly make a false statent on this fo, yo may be subjec to cil or aimlnal penalties under Secton 1001 of TiUe 18 of the 

United State Coe. In addition, any pers wh knngly and materilly violates any reuired disdosures of Infonation, Induding intentional nondisdosure, 

is subject to civil money penalty not to e ce $10,00 for each violation. 

I certfy that this in ation i tr and comple 

Signature: Date: (mmldd) 

, 

60 Fonn HUD-2880 (3/99)







IicantlReci ient Information Indicate whether this Is an Initial Report t8 or an Update Report 0 

1. Applicantlecipient Name, Address, and Phone (include area coe): 2. Socal Security Number or 

Departent of Housing Services Employer ID Number: 

100 East Euclid, Suite 101, Des Moines,lowa 50313 426-00-4514 

(515) 237-1384 



5. State the name and loction (strt addres, Ci and State) of the project or actvity 

Iow Homeles Youth Proram,1219 Buchanan De Mones, Iow 50314 


1. Ar yo applying fo assistance for a Spefic prect or actvity The 

tenn do not Include foula grants, such as public hoing oprating 

subsdy or COBG bloc grants. (For furter Inforation se 24 CFR Se 

4.3). 

18 Yes D No 

4. Amount of HUD Asistance 

Requesteecived 

$99,391 

2. Have yo reved or do yo ex to receiv assstance within the 

juriicton of th Deartnt (HUD) , invong th proect or actvity in 

th appication, In exce of $20,00 during this fical year (0c1 - 

Sep. 30)1 For furtr inforation, see 24 CFR Sec. 4.9 

Dyes r8 No. 

If you answered "No" to either question 1 or 2, Stop! You do not need to complete the remainder of this form. 

However, you must sign the ceICtion at the end of the report. 


Such assistance incudes, but is not limit to, any grant, loan, subsidy, guarantee, insranc, payment, credit, or ta benefi. 

DetlStateocl AQnCf Name and Adre Typ of Astace Amnt Ex Use of th Funds 

Reauetevied 

,(Note: Use Ad pa if necery.) 


1. All develo, cotrct, or coultants invove in th applicati for th asistance or In the plnning, deveopmet, or implentation of th 

prec or actvity and 

2. any oth pe wh ha a financial intet In th prec or actvity fo which the astance is soht tht exce $50,00 or 10 pent of the 

assistance (whichver is lo). 

Alphabetica Ust of all pe with a repoble financal intet 

in th . or actvi For Indivduals iv the last name first 

(Note: Use Additional page if necery.) 

Certifcation 

Warning: If yo knowngly make a false statement on this for, you may be subjct to cil or crmina peltes under Sec 1001 of TiUe 18 of th 

, Unite State Coe. In addition, any pers who knngly and mateally violte any reuire discosure of infortion, including intentional nodisclure,ls 

subject to civil money penalty not to exce $10,00 for each violation. 

I certfy tht this in oonation tre and co 

Signature: J Date: (mmldd) 

I 

MAY 22 Zltlt 

61 Fonn HUD.2880 (3/99)



U.s. Department of Housing 


OMS Approval No. 2510-011 (exp.12131/2006) 


IicantlReci lent Information Indicate whether this Is an Initial Report t8 or an Update Report D 

1. ApplicanVRecipient Name, Address, and Phone (indude area coe): 2. Soal Security Number or 



(515) 237-1384 



5. State the name and loction (stret address, City and State) of the proec or actvity: 

Primary Health Care, 979 Oakrdge Drve, De Mones, iow 50314 


1. Ar yo applying fo assistance fo a spec prec or actvity The 

term do not Indude foula grants, such as public hong oprating 

subsidy or coÈlG bloc grants. (For furt Infotion se 24 CFR See. 

4.3). 

(8 Yes 0 No 


RequestedIeceived 

$256,109 

2. Have yo reve or do yo expct to reive assistace within the 

Juriicton of th Departent (HUD) , Invoving th prec or actvity in 

this application, In ex of $20,00 during this fiscal yer (Oc 1 - 

Sep. 30)1 For fu Infoati, se 24 CFR See 4.9 

o Yes (8 No. 

If you answered "No. to either question 1 or 2, Stopl You do not need to complete the remainder of this form. 


Part II Other Government Assistance Provided or Requested I Excted Sources and Use of Funds. 

Such assistance Includes, but is not limited to, any grant, loan, subsidy, guarantee, Insuranc, paynt, crit or ta benefi. 

DerttlStatel Alcy Name and Adre Typ of Asisce Amnt Ex Use of th Funds 

Reauetero 

(Note: Use Aditon pa if nery.) 

Part II Interested Parties. You must discse: 

1. All deve, cotrct, or coltants Invo In th apicati for th asistance or In th plnning, deveopment, or Implemetati of th 

prct or actvi and 

2. any oth pe wh ha a finandal intet In th prec or actty for whic the asistance is soht tht exce $50,00 or 10 percnt of th 

asstance (whichver is lor). 

Alphabetical list of all pes with a repobl financl intet 

.in th . ect or actvi For Indivduals ¡ve th last name first 

(Note: Use Additional page if necry.) 

Certification 

Warning: If yo knowngy make a false stateent on this for, yo may be subject to civil or crminal penalties under Secton 1001 ofTiUe 18 of the 

Unit State Coe. In additi, any pe wh knngly and materilly violtes any reuire disure of inforation, Induding Intentional nodisdosure, 

Is subjec to cil mony penalty not to exce $10,00 for each violation. 

i cefy tht this inforation is and coplete. 

Signatu e: :' ii. . 

. Flnfñ 

~ Date: (mmldd) 

MAY 2 2 1U 

62 Fonn HUD.2880 (3/99)

ApplicantlReci pient 




OMB Approval No. 2510-11 (exp. 12/3112006) 


IicantlReci ient Information Indicate whether this is an Initial Report i: or an Update Report 0 

1. ApplicantIecpient Name, Address, and Phone (include area coe): 2. Socal Security Number or 

Department of Housing Services Employer 10 Number. 


(515) 237-1384 



5. State the name and loction (street addre, City and State) of the proect or actvity 

Primary Health Care, 979 Oakrdge Drive, De Mones, Iow 50314 


1. Ar yo applying fo assistance for a spec prec or actty Thes 

tenn do not include forula grants, such as public hosing oprating 

subs or CDBG blo grnts. (For furtr inforation se 24 CFR Sec. 

4.3). 

~Yes D No 


Requesteeceived 

$85,000 

2. Have you reive or do yo ex to receive assistance within the 

juriict of th Departent (HUD) , invong the pr or actvity in 

this aplicati, in exce of $20,00 during this fiscal ye (0c1 - 

Sep. 30)7 For furt inftion, see 24 CFR Se. 4.9 

DYes rg No. 

If yo answered "No" to either question 1 or 2, Stop! You do not need to complete the remainder of this form. 



Such assistance incudes, but is not limited to, any grant. loan, subsidy, guarantee, insurance, payment. credit or ta benefit 

DerttlStateocl NJ Name an Adre ,Typ of Astanc Ait Ex Use of th Funds 

Recuetevled 

(Note: Use Aditil page if ne.) 


1. All developrs, cotrct, or coltants Invove in th apicati fo the assistance or In th p1Ming, developnt, or implemtation of th 

projec or actvity and 

2. any other pe wh ha a financial Intet in th pr or actvity for which the astanc is soght tht ex $50,00 or 10 perct of th 

asistance (whichver is lo). 

Alphabetical list of all pe wi a repobl finandl intet 

in the ec or acvi Fo individuals, ive the last name first 

(Note: Use Additional page if necry.) 

Certification 

Warning: If yo knowngly make a fals statet on this fo, yo maybe subjec to cil or crminal penaltes under Secon 1001 of Title 18 of the 

United State Coe. In addition, any pe wh knongly and matelly vite any require disclosure of inforation, including intentil nondisclre, 

is subjec to civil moy penalty no to exce $10,00 for each violation. 

I certfy that this inforati Is tre and 

Signa re: i Date: (mmldd) 

MAY 2 2 iUUti 

63 Form HUD-2880 (3/99)







IicantlReci ient I nformation Indicate whether this is an Initial Report t8 or an Update Report 0 

1. ApplicantIecpient Name, Addres, and Phone (include area coe): 2. Socal Secrity Number or 



(515) 237-1384 



5. State the name and lotion (strt addre, City and State) of the proect or actvity: 

West Des Mones Transitil Hosing Proram, 318 SUI Strt, P.O. Box 65320, West De Mones, Iow 50265 


1. Are yo applng fo assistance to a specic prec or actvi Thes 

tes do not Include foula grants, such as public hosing oprating 

, subsidy or COBG blo grants. (For furt Infotion se 24 CFR See 

4.3). 

, ~ Yes D No 


Requestedleceived 

$87,325 

2. Have yo reiv or do yo ex to reive assistance within the 

Juriict of th Departent (HUD) , invoving th proec or actvity in 

this apication, In exce of $200,00 during this fi yer (Oct 1 - 

Sep. 30)7 For furt Inforti, se 24 CFR Se. 4.9 

DYes l' No. 

If you answered "No" to either question 1 or 2, Stopl You do not need to complete the remainder of this form. 


Part II ,Other Government Assistance Provided or Requested I Expected Sources and Use of Funds. 

Suc assistanc includes, but is not limitèd to, any grant, loan, subsidy, guarantee, insuranc, payment, crit or ta benefit 

Der1VStatel AQa¡ Name and Adre Typ of Asista Amnt Ex Us of th Fund 

Reauete 

(Note: Use Aditionl page if nery.) 


1. All develop, cotrct, or coultnts invo in the apication fo the astance or In the p1aooing, develoent, or implementation of th 

. proec or actvity and 

2. any ot pers wh ha a financial intet In th prect or actvity for which the asstance is soght that exces $50,00 or 10 percet of th 

assistace (whchever is lo). 

Alphbetica list of all pers with a repobl financi Inteest 

In th ec or actvi For.indivduals, lY th last nae first 

(Note: Use Addition page if necery.) 

Certification 

Warning: If you knowngy make a false statement on this fo, yo may be subject to cil or aimlnal penaltes under Secton 1001 of TiUe 18 of th 

Unite State Coe. In additi, any pe wh knngly and materially violate any reuire disclosure of infoation, including Intentionl nondisclure. 

is subjec to civil money penalty not to exce $10,00 fo each violation. 

I certfy tht this in rmation is e and cople 

Signa ~ 

i I 

. ranklin 

64 

Date: (mmdd 

MAY 2 2 2006 

Form HUD-2880 (3/99)

Applicant/Reci pient 






IicantlReci ient I nformation Indicate whether this Is an Initial Report 18 or an Update Report 0 

1. ApplicantIeciplent Name, Address, and Phone Ondude area coe): 2. Socal Security Number or 

Department of Housing Services Employer 10 Number. 


(515) 237-1384 



5. State the name and lotion (strt address, City and State) of the prect or actvity: 

, Anawim Housing 921 ell Avenue, Suite B, De Moines, Iowa 50309 


1. Are yo applyng for assstance fo a specific prec or actvity Th 

tenn do not indude forula grnts, such as public housing oprating 

subsidy or CDBG bloc grants. (For furter infortion se 24 CFR Sec. 

4.3). 

f8 Yes 0 No 


Requesteeclved 

$723,384 

2. Have yo reive or do yo exct to receive assistance within the 

juriict of the Deartent (HUD) , invoving th prec or actvity In 

this applicati, In exce of $200,00 during this fiscal yer (Oc 1 _ 

~ep. 30)7 For furt Infotion, see 24 CFR Sec. 4.9 

Dyes f8 No. 

If you answered "No" to either question 1 or 2, Stop! You do not need to complete the remainder of this form. 

However, you must sign the certifcation at the end of the repo. 


Such assistance indudes, but is not limited to, any grant, loan, subsidy, guarantee, insuranc, payment, credit, or ta benefi 

DeentlStateoc Agncy Name an Adre Typ of Asistance Amount Exct Use of th Funds 

Recuesteroed 

(Note: Use Adition pag if necry.) 


1. A1ldeve, cotrct, or coltants invove in th apication fo th asstance or in the plnning, developent, or implementati of th 

prect or actvity an 

2. any other pers wh ha a financial interest In th proec or actvity for which th astance is sot that exces $50,00 or 10 pent of th 

assistance (whichever is \or). 

Alphabetical list of all pe with a repble financlal interet 

In the recor actvi For Indivduals lve the last name first 

(Note: Use Aditionl page If necry.) 

Certification 

Waring: If you knowngly make a false statement on this for, yo may be subjec to civil or a1minal penalties under Secton 1001 of TiUe 18 of the 

United State Coe. In addition, any pers who knngly and materially violates any required disclosure of inforati, induding intetionl nodisclosure, 

is subjec to cil money penalty not to e $10,00 fo each violation. 

I certfy that this in~ nnation is e and coplete 

Signa e: Date: (mmfddl) MAY 22 ZU 

65 Form HUD-2880 (3/99)

SURVEY ON ENSURG 

EQUAL OPPORTUTY 

FOR ApPLICANS 

u.s. DEPARTMNT OF HOUSING 

AN URBAN DEVELOPMENT 

OMB No. 1890-014 

(E. 1131200 

.~..r.ir,-is6::~~;i~nj;~1%m¥~ilcmt:is:çn~~!r~~~mi;Qg:~apiï~iSi;$~I~r11~~~âi~:.~;":" 

i.i~ijä;~~l#:,qpp~ty:tg~ci~~~~~:l~a~rql4!2:~~~~jjia§~~t~t!; 

j;¥~~~l~~#~~~~.&:l~îi1iW~~~~~~~~~li~~~~~~Wi~fô~~¡:+~;;";,:~;;;'.,'.::','.., 

;~~~~~~~j~~;~t~;¡ll~~~~~~~~~~if¿i~~~~~~~~~~~~~~~~~~;..". 

.. . . . 

;,;.~~~Æq~iS~i~§~gqq~~~at~i~i:.~~§i2#i~;:¡:~ii~~i!t:.;,..,.,' 

;,:p~~:aji~¥;apRt~î~l~a;~~~§î1~~~~~4!s,:¥~T~ti~i:,::.",~~r.:..".':;;::'~.::;:dd.'.§,:3;~::d:.::i;..;:::2;;:,(:;;r.z.~:;)~~'!d:¿:"::d.~:;::~:,:d,':,,:.:';,§,.,::,;:: 

~=:"=:=-~~ 

'V..,,,.,~,,~_,~.~ "," , ,..- . :.,.. .'..- ., .... -'- "'; '-,". ,.-". -,.' "." .~.' :, ......- '." ,-_........' .". ," ," "," ",,,,",_., "." - - _..-.,...",....*"'., ... ". .... .~., ."",.""",'J ,,.~,o.,,,~.;-,,, .' ,~"". ._'."'" '. '.'" r..' . ,. ,,~_.~.."" ,,~., .__'" '-"r_ ..'..., 0".'..: "_ '.;__'. . __' '_".'" ~_ _ '. " ,;', ,_ _. . ,_' ,,".' _ ,_ __.,. .',.- " _' "_' 

:;~::::;~;~:~~,~-~::':~:','':~,::-:;'~:'..'' ,~. -.:'.. '-,,-"'_:.. '- -.-.. :.:, ::',:" ''"-:; ,,:",__',:, ~,:E--':.' -;.,,--,;_;'~',::-~',~:~,_~,!;:;-;~;" -_::~-~'-:_~,:,:-::':~:_:d;:;~ :-',.-:";::';\::,::~:'::';:";-~':'::.~:~'_;_: ,~; .:;':~- -'.- ',:. ':,_' "....,. ',,':~~;,~~_~0:,~:::;;,',~' :;-";;~~::;.;.;;,:;;~:,.~;.::;;;-::,:~:_ ~,~;',~,::_'~~,;:' - 

..-,.."'..""...,'", "",~':n"_."."'...:c"-~' ',,,_,,-__,,'.&.''''''''_'A'C¡.,,,_'_' "'-_'_'~'",n~'-"'.~','.."~",,''''';~~:''''''"'',~,=!.~' .. _ =-='-"'-'":'"~''''-_"'~'''---' ,"',"'''.=''__.......".....'',.._''''...,=......''... '......,.."',,_ -",""~"--...."'..,," __ ..._.~,," =""",__J.o'_ . ""~''' ~ .-.(__"'''''..''.. 

Applicat's (Organiation) Name: YMCA of Greater Des Moines 

Applicant's DUNS Number: 06-277-3668 

Grant Name: Permanent Housing Program CFA Number: 14-235 

1. Doe the applica have 501(cX3) sttu? 

X . Yes 0 No 

2. How may fu-ti equivalent employees doe 

the applicat have? (Check only one box). 

o 3 or Fewer 

o 4-5 

o 6-14 

o 15-50 

o 51-100 

. over 100 

3. Wht is the siz of the applicat's anual budget? 

(Check only one box.) 

o Less 

Th $150,00 

o $150,00 - $299,999 

o $300,000 - $499,999 

o $500,000 - $999,999 

0$1,00,000 - $4,999,999 

. $5,000,000 or more 

4. Is the applicat a faith-baedreligious 

orgation? 

X 

. Yes 0 No 

5. Is the applicant a non-religious commty-based 

organtion? 

X 

. Yes 0 No 

6. Is the applicant an intermediar tht will mage 

the grt on behalf of other organtions? 

o 

Yes 'NO 

7. Has the applicat ever recived a governnt 

grt or contrct (Federa State, or locl )? 

ii Yes ONo 

,8. Is the applicant a local affiate of a national 

organtion? 

X 

. Yes 0 No 

66 

SF 424-SUPP (4/200)


EQUAL OPPORTUTY 

FOR APPLICANTS 

u.s. DEPARTMENT OF HOUSING 


OMB No. 1890-014 

(E.1/31I2oo6) 

.',..:i.~~~;,:~ii~î~~;mm~i:~~~~;~~~!ií~m~,~.ä~!¥~~~~~~~;i~lì~iü~i9.rt~itl~. 

",!§~&~qaat~ïmg~í(Tiçq~~~~~!y;li~g~;la;:~)l:4~:;f2~:g§¿i~~y!:gj~~~g;tl~,p!.em~ti9~~;aii.ìçimts, 

;'j19!~~~~):~~;aÆ~~~&;pa~JRllt:~~!!t9~:i!~it9l;~n'Qtij!1~!m~R~h:aty~~~S~,tl~sJ.t()"ttii'()lJt,tls s\l~Y' 

~. "',',, .,"~-- -,' -, -"_.. ,., y "." '_:" '0. . ",' ~'_,'" -:.. ,c. -" ",' '" '. ,'-,";. ",,' ,,~,,',''''''' '.',_.,...." ,.~J .,.. ,- .....:'. . . .' ,... ';.- "~_'__' ,......" ..'. ',.,.:. ,.': '. _0_: d"'" ,___ ._'.. ..,. _.. _c,',,_ .,.. ._,_ .,_, '.' ,......" ,'_ "..'_ -' 

t;~a:ì~it:~~i~~:~:i~~~~ï~~m~äri~ií~;~~ti!i~l~afQ~~~~~r~~~g:" 

;d:#~~jì~;g~~!iW~~~~~ea~!f~Sø.~§S~~:m!~i!!J~#át¡ii~l'gilli::','..; 

'~~'~~~#!~~a!~~~Q~~g:~~~~~~~1~+;:r....;.'c'..::.:.;:T~;:dL'F':::~§.::;:'::~2;:;~~~~;Tt::;:.::E:P,::..~;;~:;:':r:;::::':':c.,;':..,.'..,. '" ."..,"' 

Applicant's (Organation) Name: Iowa Institute for Communitv Alances 

Applicant's DUNS Number: 14-934-1732 

Grant Name: Supportve HousIn2 Pro2lam CFA Number: 14.235 

4. Is the applicat a faith-based/religious 

orgation? 

. Yes DNo D Yes _No 

1. Does the applicat have 501(cX3) statu? 

2. How may fu-ti equivalent employee doe 

the applicant have? (Check only one box). 

D 3 or Fewer 

. 4-5 

D 6-14 

D 15-50 

D 51-100 

Dover 100 

3. Wht is the siz of the applicat's anua budget? 


o Less Th 

$150,00 

o $150,000 - $299,999 

o $300,000 - $499,999 

. $500,00 - $999,999 

0$1,000,00 - $4,999,999 

o $5,000,000 or more 

5. Is the applicant a non-religious communty-based 

organtion? 

. Yes ONo 

6. Is the applicat an interedi tht wi mage 


DYes _No' 

7. Has the âpplicat ever received a governnt 

grant or contrct (Federa State, or local )? 

. Yes ONo 

8. Is the applicat a loc affliate of a national 

organtion? 

67 

DYes 

_ No 

SF 424-SUPP (41200)


EQUAL OPPORTUNTY 

FOR APPLICANS 



OMB No. 1890-014 

(EXP. 1/31/200) 

';~ag~~~j~~~1l~~~~~4lf~~9~~~Wsp~~d.ëå~:~~:i~~~iíii.t~~... 

:.'~~!š§g:;f~li~~~l~r~~:;#!~~!i~~~~~~~.~ia9l~.W~;~~~t)lr 

f::~~~~!~ttig;;~~t!~~~~!~~,:,:;';".;."""'.:l:~;:i;:t~:'.ji~i.g:'gE:;¡~§gßg~~~~~:?:.::.~:::;~..:.E§~;;.~:::;i:£d'.".,..,' 

Applicant's (Organiation) Name: House of Merc 

Applicant's DUNS Number: 867043655 

Grant Name: Supportive HousIn2' Pro2'ram (SHP) CFA Number: 14.235 

1. Does the applicat have 501(c)(3) statu? 

(g Yes ONo 

2. How may fu-tie equivalent employees does 


o 3 or Fewer 

o 4-5 

o 6-14 

o 15-50 

(g 51-100 

o over 100 

3. Wht is the size of the applicant's annual budget? 


o Less 

Tb$150,OO 

o $150,000 - $299,999 

o $300,000 - $499,999 

o $500,000 - $999,999 

(g $1,000,000 - $4,999,999 

4. Is the applicat a fath-basedreligious 

organtion? 

o Yes (g No 

5. Is the applicant a non-religious commty-based 

organtion? 

(g Yes ONo 

6. Is the applicat an intermedar tht wi mage 


o Yes t8 No 

7. Has the applicant ever received a governent 

grt or contrct (Federal State, or local)? 

(g Yes ONo 

8. Is the applicant a loca afliate of a national 

organtion? 

o $5,000,000 or more DYes t8 No 

68


EQUAL OPPORTU 

FOR APPLICANS 



OMB No. 1890-14 

(E. 1/311200) 

i~;~~~!S:§:~~~~~Q¥~~~~è1r~~~li~i!~.ä!¥iiiQY¡~æi~j£~i~l~;~3:~iil¥i:iiill7 

Applicant's (Organiation) Name: House of Merc 


Grant Name: Supoortve Housin2 Pro2ram (SHP) CFA Number: 14.235 

1. Does the applicant have 501(c)(3) statu? 

(8 Yes ONo 

2. How may fu-ti equivalent employees does 


o 3 or Fewer 

o 4-5 

o 6-14 

o 15-50 

(851-100 

o over 100 

3. Wht is the siz of the applicat's anual budget? 


o Less Th 

$150,000 

D $150,000 - $299,999 

o $300,000 - $499,999 

D $500,000 - $999,999 

(8 $1,000,00 - $4,999,999 

4. Is the applicat a faithbasedreligious 

organtion? 

o Yes (8 ,No 

5. Is the applicant a non-religious communty-based 

organtion? 

(8 Yes ONo 

6. Is the applicant an interedi tht wi mage 

the grt on beha of other organtions? 

o Yes (8 No 

7. Has the applicant ever received a governnt 

grant or contract (Federal State, or local)? 

(8 Yes 

DNo 

8. Is the applicant a local affiate of a national 

organtion? 

D $5,000,000 or more DYes (8 No 

69






OMB No, 1890..14 

(E.1/31/2oo6) 

,;f!ut.íos~;:~~t~¥*~íitiÍ~!!,r!~!~!q~~g~~~~i~~tliSfSit~~~~í:iij¡~~~~~:f~alii~: 

;.'~~~k:ii:äUj~~~:~mR~tâ~~~~;~#irQ~~~~:~~~~æRp;~it~riiii.!~; 

:"ra~~~;~~~~~~~~~t~V:~l~~b~ij~~~Çl~~~t~~!~~~~' ';'.',', 

. ~ . '-~. - '~',. -'..' ~~".' -,,';:' ",~..-"'-".'" "_0.' .~,._" _ ~.,., ,. ,-. _..... -".. -".._,.,',.. 'c '''':,_,-.,,,-~,'... ,~__ 

. ","_..'~ ., .', ,c. "~_'~,",'. ,'-¿'C 

~ " '~--",~;~~~',..",. 

~c, 

. ". .' '" "c., .. -.. -"0 '""',--,,~",,- .'.-. -, ..,- .. -',"-" ,-~.- .. -0 'y ",,..'.,. n.,_ . ".. - ".'.' ,,...;;_ _.,' . ._.. ...C" :,0'';" ;;, ',.., __;..,;: .. ;__ ':' '__,';", _ _, _ ":" ." . ~ . .. - -.'. ... ,.- . _, - n. ,'0,,' ~"'. .,.-.. _ ........, "'~~' .. ....." .... 'd'''''''_', .. "'~'"'' ....:.. ," ;0-' ,..,",,.__./,~-,,-. ._ . :.. ;':;, ~ .;-_,:.;;;; ~c~,~~,~ 

~¿liïiûliò~~~uíjmimñlt~ij~~~~~Ü~=~~~m~mi 

,-,,' u- ,.' .,. ", '. .- _ .. .... 

,. '--~.'.', '."'''..- ',Y,.""'",' ..~~.-....,.,.. ,., -, "'c-'''' "'''-'-.''': .., ---""...'"__...,"_...~"".,."'.~~,.,~~~,,'"''.;.''''''.,..,.....,'."'.'..'',-"_'''".Yc,'',"''.'''' ",~,,,,I'.,_,,,,,,,,,,,_,,,,,,,,,,~,-.~,-,_,"''''.._,,~..,~,,,_--__,,.,,, -.,c"",_,,.,,.,,,___,,:,.~o.,~-_~--,,_.. _'" ".O'''''''~'~V_'_'';'''~"",:",,,,,,"%-,.,,,,'''''M'_''''-'-,'.,,, ~,_,~",,, _.,,-/t.;'.'''.-;.kY.'''',',-,. 7__;~.-" ':__..', e....-..",..-'M '. .' '., .~. 

-/-" -. ,', .... -, .' "., '. . ~.,...... - .'N,'~'! -' ", ,-: .-"- - -',- :" ,- ..e". ,. ,.'v _~_"'v. a~ ~"'''. ,- ~"_'.;.'" """"""..",,...~...... "" ~~...'..,_~..,_ ."v ,'..... "_'-"'-""""""''';:,r\,..",.",.~.,.,."".,.-r_'.'..__,,_,_,-,,., ,"C,,"'=_"*ff_'.'" .,....._,. ...'...'"""''~''_-.'--''"....~._"'''..~''.'~,'"..'~''.," ,.. _, ,',' , 

/:, ~,.,;:; ,'_:.,: c' '..-,;~;;..,;,;:"L~.:o-~,~; ,;,::.;~; ';''' ""d~'_.'.~ "~~_-; ~" ";,' ~~ ,.::..;.;;' ,~'-..:;,.~~' ~,;:,~"~.:..::;_~~::::',, ;,;_.;.. -,~_:: ~~;.':;:;c':'::;;:~:~';~;~:"; ,;;';~-~-;;;;;;~:;:,~.~,; :~'..';'~,::;.:~:;~.;;.:."~,~'~::,~,;:;~:;_':::.'::.'~:;~:;~:':~,:~~;:.;,~;:.:~_' :~~;.,~;::;;:~:~:__;~ ~'-.~_ ;..:-~:~;::~ 

Applicant's (Organization) Name: YMCA of Greater Des Moines 

Applicat's DUNS Number: 062773668 

Grant Name: _Transitional Housing Program CFA Number: 14.235 

1. Does the applicat have 501(c)(3) statu? 

4. Is the aplicat a faith-basedreligious 

organtion? 

. Yes DNo . Yes DNo 

2. 'How may fu-ti equivalent employee does 


D 3 or Fewer 

D 4-5 

D 6-14 

D 15-50 

051-100 

. over 100 

3. Wht is the size of the applicat's anual budget? 


D Less Th $150,00 

D $150,000 - $299,999 

D $300,000 - $499,999 

D $500,000 - $999,999 

D $1,000,00 - $4,999,999 

. $5,000,000 or more 

70 

5. Is the applicat a non-religious communty:-based 

orgation? 

. Yes DNo 

6. Is the applicant an intermia tht wi mage 

the grnt on behalf of other organtions? 

DYes .No 

7. Has the applicant ever received a governnt 

grt or contrct (Federal, State, or local )? 

. Yes DNo 

8. Is the applicat a local affiate of a national 

organtion? 

. Yes D No 

SF 424-SUPP (41200)


EQUAL OPPORTU 

FOR APPLICANS 



OMB No. 189014 

(E. 113flOO6) 

;:j5i~~~~~m9~~~~!~.i~_lii!~~~Yâ~J.§ä~g~:gilil~ 

:;¡~~~~:p~~~w~~¥i3i~~~JS~i~ii~tS~,,~.,~' 

:£~éî~~~2æ:~~"llitmmf~£.áô~rüI~~1iã~~~-Æ-.-d,',~,;=::,.:_,...', 

,.". -."",....~,,...~,,"C,."..-.,"'A""'A. ,.."/,."_"-"*."_,,,,,.""~,,.M''';:',~ ....".,......_~.H...."~"'''.~''''_ .. _ . _. .... . . ., 

2:g~g~9ä~ii~ii~',~"., ': '.':::_,' "~'::dd'd-::~::'==;d._"_~d::.~~:~'c".,,,:=~~~~:;." 

~~~~~f~~£~~'--=_:_.,', d 

Applicant's (Organiation) Name: Youth & Shelter Servces Inc. 

Applicant's DUNS Number: 05-6505589 

Grant Name: Li2hthouse Host Home CFA Number: 14.235 

1. Doe the applicatbave 501(c)(3) statu? 

t8Yes DNo 

4. Is the aplicant a fath-based/religious 

organtion? 

DYes t8 No


EQUAL OPPORTU 

FOR APPLICANS 



OMB No. 189014 

(E. 1(311200) 

s~~~r~ï~~=i,l~~l===1l~~i~~fs\'". 

" . -. '..." -.--"""""""'~"'.'.' ,,"',~ ,~, -.-.....". ..,....-,...... .,. -', ,_.,. .-', -'.,-," . ";',.- .,.. .,-',' .':-,,", ".-, .' -",."".. -" '. ," ."~:',.ye.:A'-.""..' -"~;,,,~,, ._, " ,.:.').,..~,_~._... .- " ....-,.. '..~~ ,","_ .,...'C.t..-x.... '~".:;~~ ,......_. o. _.... "":~ ".;..:..",,,,,',..,_:~.,. ,~-..:.. ._-"_.." ;,'co,"'"."', '-.-,' -. ;,."'."- ;,~:_..~ 

f~~~~;~1§~~§î~:!~~mi~~~~iii~~::'.""":::;:"d,.,,'','.. 

.,~..,'r_'"~~""",~',...,,,,,_..._""''''__' ,,', h'_"~';'" - .-,-" .' ~''''."--:.''',.- "', ",',""_"'''' .-,~ ,_~.~,,,'~."" '.-''". ~.-~. ';""-',.,-,~'_'~' '~~"".''- "'~'",.,...~_,., 'J_,. ""'". ..-..""._..-:...'.".- .' ""'''''''''u -",~."_,'y;.~.,",, "'''.~,.u..".,.__ ...-.",..-~..".".~. ~_',' "-~'-Y'~i4-'-'''''-'-'''''''''__'W '~_.- .'''','. .. 

N_'~,,-_,,-'~-Y ,...._..,~.,:;.-' ..-...."- ." .'- ....",~..-,_._.-, -' ,..'.,....' ___..;e,' "~-,.,-...,,.,. '-'.'''';'''',_'''r''':':. 'c.,",.~"". 'M"~ ..,,'., .--.~~.~,...-,."......"..mN._...""r"'_'~.~~..'-_.. ,:-,:'__.."'-..'_'w..~,__.-,_".. ""_......,....~..__,.......,.~,-","".....,..~"._."''',.",_.'',,, '..--_.,.....,,;.~..-~,,~.;,..-c'. __",,,~,,~ 

'" .-: -' ---;:;.~,:~;:_:;';.:;~;:~~:;/;:~: ''-'-:'' -, ,-"",_¡.:.;,_;';.-~::~,;,~':;;~_~.'''~''-''~ -' ';,~:-',~~: :-,:-:~~~::';.~:,-;~,:;:.:;."~ ';~::7;;~:''~'-'--:;;"';;:::;~ ,,,,,,,,.- ~""""':;;~:~,,.;".'~~~"'-~';";1';';':;;~;;;;;:.~,:::::;~''"'',~;'''.:..'c;;~::,,.. """'" .." - ;;;...;-""~"':;-:;"-- ""'~.",.,...,..~.'/"" L ~'~jt ."..t..,,;. 

ii~';~~~~~~~-~~¥~~~~~~l~~~~~~~~7i~~:" 

, ",,-.#~' ,.,.'~".' 

~"'''''', -"",... ',-;.-' 

.--.:".,.'...,....-.-,/--.... 

""'''~''"'~t, 

Applicant's (Organiation) Name: Youth & Shelter Servces Ine. 

Applicat's DUNS Number: 05-6505589 

Grant Name: Buchanan Transitional Livin2: Center CFA Number: 14.235 

1. Do the applicant have 501(cX3) statu? 

I8Yes DNo 

4. Is the applicat a faith-based/religious 

organtion? 

Dyes I8No

SURVEY ON ENSURING 




AND URBAN DEVELOPMENT 

OMB No, 1890-0014 

(E. 1/3112006) 

, 'P.,r,póse:' 't!~:F~Qt:ral:gov~nuentìs ;cotntih9;ensg:th~taii.qullfifi!'tl~PPÍì,alljlts;,siU;óri;lrge~tr9~~rt?gO~~Qr.(a.iih~ 

,£~ed;:~Ve;~ç'qual;npp'(fftyto;Çq~te::f~rl'~~aJ~.Ec' :ln9x4el"la:r;lq~ft~¿a4~¡.taq?!emf1i~ftnA~1l~~ë:~ 

· -i:il~~r~lf~; ~e-al~ä~KiÌl!Fll~r~îit:pP\':~~Qt:æ1i:i~.äijQn~lii~t~ç;ln~~ï?fj~~~~~g~sJto.fil~~s~~:::;:':""" ", " ' 

:"..g~;N~é!Rtj:~~UW~~l1l?e:~~ital~~#!lg~lPill~óll~.1ßil~tlnj:pr!Vlîl~¥m:~~~Y:~l!9fi~9~~Cl~.a!lY-. 

, 'W~Y'il:rifgg;lW~~eCisi()ri.an9~Wi1bj.9Ïa~ifu~a~eiReG~râr;gûa~asi.C~~:#.(ur.;te1P$T_ûa~:ootfecon. 

, '.prö~ssis '~èitiyapprecíatéd;;ConIl:yti91l'jf;th~ ;s$:~~dS4olt:in~ ' , ' , 

. 'ln'Str-uøtönS:for~Snbmittnl!:th~:suW~Vt'l~gQ~P~~~_Y;;W~~\t~~ih~:':ml~~¿,.aR ' 

" :äýélg.~eW"'Alfii~i;~~I~~~iiQmFøWU:Ç(eit:iID;Wl,iòuiaiPQattu.~G¥âie' '~~.g,' 

:'~I~id;:l~gi~mIì~~id~.~~~1iGîlïmi " '''" . .', '. "'~'~' - . '. ".. ..' , ". " .,..... " :~.,." : 

Applicant's (Organiation) Name: Primary Health Care, Inc 


Grant Name: COC-SHP (Enhancement) CFA Number: 14.235 


4. Is the applicant a faith-based/religious 

organtion? 

. Yes ONo o Yes .No 



o 3 or Fewer 

o 4-5 

o 6-14 

o 15-50 

. 51-100 

o over 100 

3. Wht is the siz of the applicant's anual budget? 


o Les Than $150,000 

0$150,000 - $299,999 

o $300,000 - $499,999 

o $500,000 - $999,999 

0$1,000,000 - $4,999,999 

. $5,000,000 or more 

73 

5. Is the applicat a non-religious communty-based 

organtion? 

. Yes ONo 

6. Is the applicant an intermedi that will mage 


. Yes IiNo 

7. Has the applicat ever received a governent 

grt or contract (Federal, State, or local )? 

. Yes ONo 

8. Is the applicant a local affliate of a national 

organtion? 

. Yes o No 

SF 424-SUPP (41200)

SURVEY ON ENSURNG 


FOR ApPLICANS 



OMB No. 1890-014 

(EXP. 11312006) 

, P,.r.pl)S'~: $le.l!ed~ai~govi:~llti~:CQmi~gY:toel!§yì:lui;~tan3lmrl.fi~daRiiiiç.its, :SJIiill~9hlatg~jllgn~atgmI :at'f!if~. ' 

;;:~~d:a~~:~~~~~=::::~~~~I;::i:~~~~t(tl~fl~;t~J~:;~:J~~~~i~~I~\ti;r;~JiliÇants, 

Upon;re~t(lpt,tiç;sureywiIl~pesçparated fr.omtJe;ap.p.licl#,òn.. ;IiQrmfron:provideqOlt:1le sa~y Wiliiòffie'coiiiûerèd:in apy 

wayfu~;alcg .:tg:::(:ciSions:ad:;will;riot~e.iiclèd:in'4eilederlfll¥át4atãbašè;::Wle~:jotiiílPm.t¡l:däta;c(lfëcton" 

. :;rg:cess'is;gr~atly~pprèciatea; 'comptytion.:nfths:sure.y:-i,s:voltiIa' ' 

, ,- -' .. ", -'. ,_, ... ,',",' __ :.,,;. __' _U"'_."_',,',__ _ _.._._ .... 

'iiistr.utiøns;;ør::SUbmrtiir.tlí'ß;S~,~lf'Yqg:lt:wjJjJ.ymg:~rloli~~y:ap~3i~$''flirøi:t;~l~i~ln)i'" ",',' 

: ';';..;dh~~"~'ì~:l.:...Hl':;;.i';~~tt'::~~~:Mv61~~",~;¡;;.._,(...tñt~ti.;~t.~ûè~~..tiO"hl,~~l_~g¡(; , lt~::è,'¡..~j1a. 

;r$:~~~t~tb~~~~l9;~th~~it~¡~~~:,-,"~~CW~tl7"" ~,p~- 'Q~~ ,J~~. ~inJ~ 

-' -', .' .~._,-, -- .".,...".,..... .c,....... .. _'_,-,.. ""-'-""-"'-."_ -, ',',- "_'_," '.....,.._.... ',_', ,"', ' :. ,'_ .,o'....._...__~. .'__ ,-....., .. _, "_ _.,_,__"',._",_._ ,"_'_"_"'__.: __...._',_._.'__,._ ,...._.,.,.:. ...... '.....H _.. 'Y' ,'u'_.'_.". .'_ '_',._ u 

,- ,; ;, .. .,- .~",,: _,ß,..'O." __"-",.",,'_=,._';~"â_",'_": .,.-=,_.."c"",.r::_~""'_ -_......;¿ - ,)x",;,"',~.=A~",':"'",,,_,,:,~-". """",c¡'~"'-"""__.-'"'''''''''~'"'''-'_''_'''''''_c_.'';;''''"._,':,"'. _ =_.'.:"=,__*....""."""""'R_.,.~_._~:_._"'~.~'.,._.. 

Applicant's (Organiation) Name: Primary Health Care, Inc 


Grant Name: COC-SHP (Street Outreach) CFA Number: 14.235 


organtion? 

. Yes ONo o Yes .No 


2. How may ful-ti equivalent employees does 


o 3 or Fewer 

o 4-5 

o 6-14 

o 15-50 

. 51-100 

o over 100 

3. Wht is the size of the applicant's anual budget? 


o Less Th 

$150,000 

0$150,000 - $299,999 

o $300,000 - $499,999 

o $500,000 - $999,999 

0$1,000,000 - $4,999,999 

. $5,000,000 or more 

74 

5. Is the applicat a non-religious communty-based 

organtion? 

. Yes ONo 

6. Is the applicat an intermediar tht will mage 

the grt on beha of other organitions? 

o Yes .No 

7. Has the applicant ever received a governent 

grnt or contrct (FederaL, State, or local )? 

. Yes ONo 


organtion? 

. Yes o No 

SF 424-SUPP (4/2004)



FOR ApPLICANTS 


OMB No. 1890-014 

AN URBAN DEVELOPMENT (EXP. II3112oo6) 

, .P.ui:'Ó-se: tf~F..dtìralg9yen~ntjs conittellto ell\ngtltal1qnali:ftìdaiíplicants, !ìpill or large, non-religious or faith- 

" lia~éaI~liave-;ll;eqi#~p.Rqnuty~q;(;qii~~arE-~~èìä:i;:t~.;wpì4yr'!fi~'fQ5l!itt~ng¡;éitad:tlijif~ri:(t~ppliCäts 

,':îaj:f!c4eril~Qs,.~~~kiE,:nC).PI9ijt;PRVat~~r~~~npiill9~a:~ilg~~t~:~~-s.i~::t9.:tlF9lt#t1~.:~~¥;.; '; 

,U . nreceÌ ',;te,sÙt ,.WiUi:he:sè arted,îröin:te:a "llcatiòii~:moritiõìi\ Û-iaài;¿~:ffe:sií;:~lI iì6fbe.cöiiìd¿;tid::m an ~ 

" . .~".. ~, " ,,~!Jt .'" '.' ,. '..' . ey,.. ....~ d.'.. !It '...,.' .... .,........_._...!RIL.,., """"". . ","".. ..~..~~. '.,..3l_.~ '_"'~" ,.....".,..,"....~~. _',...~,.M', ...... ,.,..._.--"',.,.m.'.,__.,...Y. 

'.',..wa4r~.lùiidÍ1gjfê!#lo;~;~a~I:Jlat~e.:iíaija~î;4te:~~èl;jaItS:Çlf4~é:~rG~~~wl1èCw;:' c:; 

: :pr9~S~ ìs.-g~w;,ap,pi:ëciàtéd~Gorni~GòIÍ;òt11~:s~iis,"Ý~langB~ ,'.., ..,. .. .... ,.: ::.O' .. .;.. ,. .... 

Applicant's (Organiation) Name: City of West Des Moines Human Services 


Grant Name: BU SHP - Transitional Housinl! CFA Number: 14235 

1. Doe the applicant have 501(c)(3) statu? 

DYes 

X.No 



o 3 or Fewer 

o 4-5 

la 6-14 

o 15-50 

o 51-100 

Dover 100 

3. Wht is the size of the applicant's annual budget? 


o Less Than $150,000 

0$150,000 - $299,999 

o $300,000 - $499,999 

.X $500,000 - $999,999 

0$1,000,000 - $4,999,999 

o $5,000,000 or more 


organtion? 

DYes 

X.No 

5. Is the applicat a non-religious commty-based 

organtion? 

~Yes DNo 

6. Is the applicant an intermediar tht will manage 

the grant on behalf of other organtions? 

DYes "No 

7 . Has the applicant ever received a governnt 

grant or 

contrct (FederaL, State, or local )? 

.X Yes DNo 


organtion? 

75 

o Yes 

X. No 

SF 424-SUPP (4/2004)



FOR ApPLICANS 



OMB No, 1890-0014 

(Exp. 1/31/2006) 

,Rur:puse:. ' 'Ie.lederal~govel1enti~;~comitte4Tõ'~iiurg-tlt-aJl;q~1inid :àIlpn~~tsj::Sil.orlaTg.e;'riti1Ì;relg~otis o#art1i~ 

.' 'Piie.aí;~y~;arilI1.oPl?ò'rti:!¥1g:,~ornt~.:nr;F.ê4eri:t!filg~~ln;oi4ër far;~ -:Q*at~Çlerst¡n:t'(~pw~tion:;r~ppficarits. 

", fiir~éijhfngs;Wi~~e.;a:kt,g:ttanprnñt:Pri¥att::rgàlii7,atlóil:(notmcltlaig,pit¥ate:v~i:a~r.tõ::fl7ml::s~s~y,:' , 

lJ,tm:r~~~ipt;~:tÍie:awv.ey::WR~e'seialâttg#~lí:i4yapì#¡çåti~~ li~tròii~~~~;Ori:~~i~:wt'Îot'h~a~edm:aný" ,. 

, wã.Yin/makig~~Qig:ilecísiòîi;aî~:wm:not1)~'içl#i:~:mtf~;i~aeti~lÍ:otrlJaS¿~~-EiÒ1Í';ëip;mih~iá;:cõne.æoii ','.' '.- 

:pr()cess;IS:gleatlyappi:eciated;:compJêtìon;ot1hs 'suqis vólunfury_ " . 

Jnstructí()lis:.or:,sUbIìttnl!:;b~:Sur.eWitg~:¡PJiim~Jt-i4~y,;_.Q~!l::idmat~:m~t\í~~;t,y;Úlm,, " 

";tjl¥~Q~~~;('l~~_¡l't'~iS~~lli~l~liñtmw~~nièim~i2SQßín~ä:~~.,~, Jt:~iiHltlf~, 

d~i~ltøit~y.jl~:~.~:sui~£i(ø~~itiiÝPJi~1i~Ì), '"'''' ,., " "d.',. ," " V.... , "," , 

Applicant's (Organiation) Name: Anawi Housing 


, _', ...-_....._.. 

-,-.-- 

,- 

,-, 

.,__' 

--....".,....-,--..-:;".._.......,....,..'.....,_..,..,.,..._.....y. 

-'-',.. ._,,0 __'_..';,_ ,','" ",',_ ,',' _.? '''''0'' ..... ;,', 

""'.-. , ", 

"~'_h.,.'; ~.."'____."M-_ ~._.-__,_.x_¿",.,.',:,-",'.'.',,,.,,.... ,,,_,c,,,_~,"'',,-:,'-~-,,_", _~-_:.:;-~.::;;;.:.;_-;.:-'''',;_,;:;_x.___:~::;_,~~L-,: _'.,,.,_C-,.___,_,':_',e.,,_,,,.,.;ý..,,.-,,,_, " ~'~~;::;;,:;'::-:~:~~,, ,:;.;:,,;:;,_:~~;_;:::::~_:~:: -, "" :-~. '" 

Grant Name: _Shelter Plus Care CFDA Number: _14.238 

4. Is the applicat a faith-based/re1igious 

organtion? 

. Yes ONo DYes .No 


2. How may ful-ti equivalent employees does 


D 3 or Fewer 

D 4-5 

. 6-14 

o 15-50 

o 51-100 

o over 100 

3. Wht is the siz ofthe applicant's annual budget? 


D Less Th $150,000 

D $150,000 - $299,999 

D $300,000 - $499,999 

D $500,000 - $999,999 

. $1,000,000 - $4,999,999 

a $5,000,000 or more 

5. Is the applicant a non-religious conuunty-based 

organtion? 

. Yes DNo 

6. Is the applicant an intermedi tht will mage 


DYes _No 

7. Has the applicat ever received a governent 

grt or contract (Federai State, or local )? 

. Yes DNo 


organition? 

o Yes 

76 

. No 

SF 424-SUPP (4/2004)

DISCLOSURE OF LOBBYING ACTIVITIES 

Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 

1. Type of Federal Action: 

~ a. contract 

b. grant 

c. cooperative agreement 

d.loan 

e. loan guarantee 

f. loan insurance 

4. Name and Address of Reporting Entity: 

LJ Prime 0 Subawardee 

Tier . if known : 

Department of Housing Services 

100 E. Euclid, Ste 101 

Des Moines, Iowa 50313 

Con ressional District, ifknown: IA03 

6. Federal Department/Agency: 

DEPART. OF HOUSING & URAN DEVELOPMENT 

8. Federal Action Number, if known: 

10. a. Name and Address of Lobbying Registrant 

(if individual, last name, first name, M/): 

N/A 

11 Infoli reue ii ih fo Is ii by tie 31 U.S.C. se 

. 1352. This dis of lo acti Is . mate re of fa 

upo whch reia wa pl by th ti lIe wh li trse was made 

or ente inll. Ths disc Is reir punt II 31 U.S.C. 135 Ths 

inonli wi be re '" Ih Co -i an wi be .va fo 

pu in. Ñf pe wh fa II fie th re discos sh be 

sub II . ci pe of no les th $10,00 an no mo th $100.00 for 

ea su fallA. 

See reverse for ublic burden disclosure. 

2. Status of Federal Action: 3. Report Type: 

lD a. bid/offer/application ~ a. initial filing 

b. initial award b. material change 

c. post-award For Material Change Only: 

year quarter 

date of last report 

Approved by OMB 

0348-0046 

5. If Reporting Entity in No.4 is a Subawardee, Enter Name 

and Address of Prime: 

Con ressional District. if known: 

7. Federal Program Name/Description: 

SUPPORTIV HOUSING PROGRA 

CFDA Number, if applicable: 14.235,14.238 

9. Award Amount, if known: 

$ N/A 

b. Individuals Penorming Services (including address if 

different from No. 1 Oa) 

(last name, first name, M/): 

Signature: 

Print Name: 

Title: MAYOR 

77 

Date: 

Authoried for Locl Reproducton 

Standard For LLL (Rev. 7-97)

Section I: Project Summary Information 

P ar tAG . enerai P rOJec t I norma i t (All ion P rOJ ects ) 

1. Project Priority Number 3. If renewal, list previous Previous Grant Number: 

2. t8 New Project 

(From Project Priority 

grant number & project 

o Renewal Project 

PIN Number: 

Chart in Exhbitl): 1 identifier number (PIN) 

4. HU-Defined CoC Name: 5. CoC Number: 

Des Moines/Polk County CoC IA-502 

6. Applicant's Organiation Name (Legal Name from SF-424) 8. Applicant's DUNS Number 

City Of Des Moines (From SF-424): 

7.0 Check box if Applicant is a Faith-Based Organiation 07-349-8909 

t8 Check box if Applicant has ever received a federal grant, either directly from 

a federal agency or though a state/local agency 

9. Project Applicant's Address (From SF-424) 10. Applicant's Employer 

Street: 100 E. Euclid, Suite 101 Identification Number (EIN) (From 

City: Des Moines State: Iowa Zip:50313 SF-424): 42-6004514 

11. Contact person of Project Applicant: (From SF-424) 

12.0 Check box if Project 

Name: Robert Schulte 

Title: Federal Programs Administrator 

Phone number: (515) 237-1384 

Fax number: (515) 242-2844 

Email Address: RASchulteíadlw!Ov.or 

Applicant is the same as Project 

Sponsor 

13. Project Name: YMCA Permanent Housing Program 14. Project's location 6-digit 

Geographic Code: 191362 

15. Project Address (S+C SRAs, if multiple sites list all addresses including): 18. 0 Check box if Energy Star is 

Street: 101 Locust Street used in this project 

City: Des Moines State: Iowa Zip: 50309 19. Project Congressional Distrct(s): 

16. 0 Check box if project is located in a Rural Area 1A-03 

17. If project contain housing unts, are these unts: 0 Leased? t8 Owned? 

20. Project Sponsor's Organation Name (If different from Applicant) 22. Sponsor's DUNS Number: 

YMCA of Greater Des Moines 06-277-3668 

21. t8 Check box if Project Sponsor is a Faith-Based Organation 

t8 Check box if 

Project Sponsor has ever received a federal grant, either 

directly from a federal agency or though a state/local agency 

23. Project Sponsor's Address (if different from Applicant) 24. Sponsor's Employer 

Street: 101 Locust Street Identification Number (EIN: 

City: Des Moines State: Iowa Zip: 50309 42-0680438 

25. Contact person of Project Sponsor (if diferent from Applicant) 

Name: Vernon Delpesce Phone number: (515) 471-8515 

Title: President/CEO Fax number: (515) 471-8558 

Email Address: vernon.delDesce(a2dmvmca.or!! 

1

Part B: Project Summary Budget 

BL. Su ortive Housin Pro ram (SHP) (All SHP Pro'ects) 

a. SHP Pro ram c. Grant Term (New Projects must be 2 or 3 years; 

b. Component Types (Check only one box) Renewals or HMS projects can be 1, 2 or 3 years) 

D (8 D D D Safe Haven/TH (Check only one box) 

TH PH SSO HMIS D Safe Haven/PH D (8 D 

d. Proposed 

SHP Activities 

1. Acquisition 

2. Rehabiltation 

3. New Construction 

4. Subtotal 

(Lines 1 throu h 3) 

5. Real Property Leasing 

From LeasIn Bud et Cha 

6. Supportive Services 

From Supportve Services Budget Cha 

7. Operations 

From Operating Budget Chart 

8. HMIS 

From HMIS Budget Chart 

9. SHP Request 

(Subtotal lines 4 through 8) 

10. Admiistrative Costs 

to 5% of line 9 

11. Total SHP Request 

(Total lines 9 and 10 

a. S+C Pro ram 

b. Component Types (Check only one box) 

D D D D D 

TRA SRA PRA PRA S+C/SRO 

1. Total S+C Rental Assistance Amount 

from S+C and SRO Budget Chart 

1 Year 2 Years 3 Years 

e. SHP Dollars f. Cash Match g. Totals 

Re uest (CoL. e + Col. 1) 

$49,710 $32,771 $82,409 

$134,098 $46,357 $180,455 

$183,808 Total Budget 

Total (Total SHP 

$9,190 Cash Match Request + Total 

Cash Match) 

$192,998 $82,056 $275,054 

S+C All S+C Pro. ects 

c. Grant Term (Renewals are 1 year only) 

(Check only one box) 

$ 

$ 

D Renewal 

1 Year 

2 

DNew 

5 Years 

DNew 

(PRA, S+C/SRO) 

10 Years 


r AI l"lnnc\

Part C: Point in Time Housing and Participants Chart 

(All roi P ec . st E xcepi t D e d icate d HMIS rOJects P' ) 

1. Housing Type* la. ~ Multi-family 

(Check all that apply) D Single-family 

lb. D Scattered Site 

r8 Project Based 

D Con~re~ate Facilty 

a. Current b. New Effort or c. Projected 

2. Units, Bedrooms, Beds Level Change in Effort Level 

(Point-in- Time) (If Applicable) (column a + col. b) 

Number of Units 0 30 30 

Number of Bedrooms 

Number of Beds 

3. Participants 

a. Number of Families with 

Children (Family Households) 

i. Number of adults in families 

ii. Number of children in families 

iii. Number of disabled in families 

b. Number of Single Individuals and 0 30 30 

Other Households w/o children 

i. Number of disabled individuals 

ii. Number of chronically homeless 

*Housing Types: Multi-family (apartents, duplexes, SROs, other buildings with 2 or more unts); Single-family; 

Congregate Facility (dormtory, baracks, shaed-livinj?). 

Part D: Targeted Subpopulations 

(All Projects Except Dedicated HMIS Projects) 

List the approximate percentages for each homeless subpopulation you expect to serve. If you expect to 

serve subpopulations that fit more then one category (i.e. Severely Mentally II Persons with Chronic 

Substance Abuse), you may place overlapping approximate percentages on the appropriate lines. If this 

is a #1 priority project, it must serve 100% chronically homeless persons to receive the PH bonus. 

2. A roximate Percenta es (%) 

100% 

19% 

9% 

30% 

o 

o 

o 

Part E: Dischar e Polic (Only State & Local Government Ap licants) 

Are there policies and protocols developed or implemented for the discharge of 

persons from publicly funded institutions or systems of care (e.g., health care 

1. r8 Yes 0 No facilities, foster care or other youth facilities, or corrections programs and 

institutions) in order to prevent such discharge from immediately resulting in 

homelessness or requiring homeless assistance for such persons in your 

jursdiction? 

3 

form HUD-40090-2

Part F: Project Leveraging Chart (All Projects) 

HU homeless program funding is limited and can provide only a portion of the resources needed to 

successfully address the needs of homeless families and individuals. HU encourages applicants to 

use supplemental resources, including state and local appropriated funds, to address homeless needs. 

Please be aware that undocumented leveraging claims may result in a re-scoring of your 

application and possible withdrawal of your conditional award(s). For fuher instructions for 

fillng out this section, see the Instructions section. 

Type of 

Contribution 

Source of 

Contribution 

Identify Source as: 

(G) Government* 

or (P) Private 

Date of 

Written 

Commitment 

Value of 

Written 

Commitment 

Example: Child Care CDBG G 2/15/06 $10,000 

Cash ESGP G 4/28/06 $21,000 

Cash FEMA G 2/16/06 $11,768 

Cash V A Per Diem G 4/2/04 $245,918 

Cash Resident's Rent P 4/5/06 $457,623 

*Government sources are appropriated dollars. TOTAL: $736,309 

Part G: Project Participation In Homeless Management Information 

S stems HMIS All Pro' ects Exce t Dedicated HMIS Pro' ects) 

DYes I: No Is this project paricipating in the HMIS? 

by 07/2007 If "Yes," what date did this project begin paricipating in the HMIS? 

"No," enter the date the project anticipates beginning paricipation. 

(mm ear) If 

I: Yes D No Wi~l client-level data be included in the HMIS for all persons served by ths 

ro ect? 

Part H: Renewal Performance (All Renewal Projects) 

1. DYes DNo 

2. DYes DNo 

Are there any unesolved HU monitoring findings, or outstanding audit 

findings related to this project? If "Yes," briefly describe. 

Are there any significant changes that you propose in the project since the last 

fuding approval? Check all that apply: 

D Number of persons served: from _ to 

D Number of units: from_ to- 

D Location of project sites. 

D Line item or cost category budget changes more than 10%. 

D Change in target population. 

D Change in project sponsor. 

D Change in component type. 

D Other: 

Please explain changes: 

4 form HUD-40090-2

H: Renewal Performance (Continued) 

(For all S+C, SHP-PH, SHP-TH, SHP-Safe Haven, and SSG Renewals): 

Use information from the most recently submitted Annual Progress Report (APR) to answer 

questions 3, 4, and 5. If an APR has not yet been submitted for this renewal project, please 

check the N/ A box and skip these Questions. D N/A 

3. Permanent Housing (PH) Performance (To be filled out by all SHP and S+C renewal 

permanent housing projects, including both SHP-PH and SHP-Safe Haven permanent housing). 

Complete the following chart using data based on the preceding operating year from APR Questions 

12(a) and 12(b): 

a. Number of participants who exited PH project(s)-APR Question 12(a) 

b. Number of participants who did not leave the proiect(s)-APR Question 12 (b) 

c. Of those who exited, how many stayed 7 months or longer in PH-APR Question 12(a) 

d. Of those who did not leave, how many stayed 7 months or longer in PH-APR question 12(b) 

e. Percentage of all paricipants in PH projects staying 7 months or longer 

% 

((c + d) divided by (a + b)) x 100 = e. Example: ((16 + 15) divided by (20 + 20)) x 100 = 77.5% 

4. Transitional Housing (TH) Performance (To be filled out by all SHP renewal transitional 

housing projects, including both SHP- TH and SHP-Safe Haven transitional housing). 

Complete the following char using data based on the preceding operating year from APR Question 

14: 

a. Number of participants who exited TH proiect(s)-including unkown destiation 

b. Number of participants who moved to PH-from any destination identified as pernent housing 

c. Of the number of participants who left TH, what percentage moved to PH? 

% 

(b divided by a) x 100 = c Example: (14/18) x 100 = 77.7%. 

5. Supportive Services - Mainstream Programs and Employment Chart 

(To be filled out by all S+C and SHP renewals, except dedicated HMIS projects) 

HU wil be assessing the percentage of clients in your renewal project who gained access to 

mainstream services and, especially, who gained employment. Based on responses to APR Question 

11 complete the following: 

1 2 3 4 

Number of Adults Who Left Income Source N umber of Exiting % with Income 

(Use the same number Adults with Each Source at Exit 

in each row) of Income (CoL. 3 + Col. 1 x 

100) 

Example: 105 a. Social Security Insurance (SSn 40 38.1% 

105 b. Social Security Disabilty 35 33.3% 

Insurance (SSDD 

105 c. Social Security 25 23.8% 

a. SSI 

b. ssm 

c. Social Security 

d. General Public Assistance 

e. T AN 

f. SCHIP 

g. Veterans Benefits 

h. Employment Income 

i. Unemployment Benefits 

i. Veterans Health Care 

k. Medicaid 

1. Food Stamps 

m. Other (please specifv) 

n. No Financial Resources 

5 

form HUD-40090-2

Section II: Project Budgets 

Part I: SHP Project Budgets (All SHP Projects as Applicable) 

11. SHP Leasin Bud et All SHP Pro' ects with Leasin 

Leased Unit s for Housin and/or Services 

a. Name of metropolitan or non-metropolitan Fair Market Rent (FMR) area: 

b. Check the appropriate box that relates your rent to the published FMR: 

D 1 % to 99% ofFMR 

D 100% ofFMR 

D 101 % to 110% of FMR (PHA approval 

letter must be attached). 

D Greater than 110% (H ap rovalletter must be attached). 

c. Size of Units d. Number e. FMR or f. Number of g. Totals 

of Units HUD Paid Rent Months 

SRO x x $ 

o Bedroom x x = $ 

1 Bedroom x x $ 

2 Bedrooms x x = $ 




6 Bedrooms x x $ 

Other: x x $ 

h. Totals: x x = $ 

Leased Strctue(s licable FMR 

Structure 1 x = $ 

Address: 

State: 

Structure 2 x $ 

Address: 

State: Zi : 

6 form HUD-40090-2

12. SHP Supportive Services Budget (All SHP Projects as Applicable) 

SHP Dollars Requested 

Supportive Services Costs Year 1 Year 2 Year 3 Total 

1. Outreach 

Quantity: 

2. Case Management 

Quantity: 1.0 FIE (Salary & Benefits) 

$38,668 - Year 1 

$40,213 - Year 2 

3. Life Skils (outside of case management) 

Quantity: 

4. Alcohol and Drug Abuse Services 

Quantity: 

5. Mental Health and Counseling Services 

Quantity: 

6. mv / AIDS Services 

Quantitv: 

7. Health Related & Home Health Services 

Quantity: 

8. Education and Instruction 

Quantity: 

9. Employment Services 

Quantity: 

10. Child Care 

Quantity: 

11. Transportation 

Quantity: ISO/month x $1 x 24 months = $3,600 

12. Transitional Living Services 

Quantity: 

13. Other (must specify *) 

Quantity: 

14. Total SlI supportive servces dollars 

$24,855 $24,855 $49,710 

requested in lines 1 to 13: ** 

$24,855 $24,855 $49,710 

*If not specified, the costs wil be removed from the budget. 

** Total of Line 14 must match line 6 colum e. on the Project Summary Bud~et. 

15. Total cash match to be spent on SHP 

elhdble supportive service activities. *** 

$15,613 $17,158 $32,771 

*** Cash Match can be spent on any SLI eligible activity (see the chart in Section IILA.3. of the NOFA 

for these activities). The amount ofthe SHP request (entered in line 14) must be no more than 80 percent of 

the total supportive servces budget (i.e., 80 percent ofline 14 plus line 15). The total of Line 15 must match 

line 6, column f. on the Project Summary Budget. 

7 

form HUD-40090-2

13. SHP Operatin~ Bud~et (All SHP Projects with Operating Costs) 


Operating Costs Year 1 Year 2 Year 3 Total 

1. Maintenance/Repair 

Custodial and Maintenance Staff 

$58,870 x .16 x 1.25 benefits = $11,774 - Year 1 


Propert Rental and Maintenance 

$17,579 x .24 x 2 years = $5,624 

2. Staff 

(position, salary, % time, frnge benefits) 

Position - Residence Director 



Position - Administrative/Support staff $22,115 $22,115 $44,230 



Position - Front Desk staff 



3. Utilties 

gas & electrc: 

$9,473/month x .16 x 24 months = $36,376 $44,934 $44,934 $89,868 

water:$1,870/month x .16 x 24 months = $7,180 

~arba~e:$359/month x .16 x 24 months = $1,378 

4. Equipment (leaseluy) 

Quantity: 

5. Supplies 

Quantity: 

$213,263 per year x .16 x 2 years = $69,204 

6. Insurance 

Quantity: 

7. Furnishings 

Quantity: 

8. Relocation 

Quantitv: (number of persons) 

9. Food 

Quantity: 

10. Other Operating Activity: Telephone, 

Postage, Printing and Copying 

Quantity: $5,982 x .16 x 2 years = $1,914 

11. Total SHP operating dollars $67,049 $67,049 $134,098 

requested in lines 1 to 10 above: ** 


** Total of Line II must match line 7 column e. on the Project Summary Budget. 

12. Total cash match to be spent on SHP $22,833 $23,524 $46,357 

eli2ible operatin2 activities. *** 

*** Cash Match can be spent on any SHP eligible activity. The amount of the SHP request (entered in line 

11) must be no more than 75 percent ofthe total operations budget (i.e., 75 percent ofline 11 plus line 12). 

The total of Line 12 must match line 7, column f. on the Project Sumary Budget. 

8 form HUD-40090-2

14. SHP New Project Multiple Structures Budget (All New SHP Projects as 

Applicable) 

To be used only for projects with multiple structures with acquisition, rehabilitation or new construction 

funds. Fill out an additional char for each structure. 

Structure A Structure B 

Address: Address: 

City, State, Zip: City, State, Zip: 

SHP Request Total Budget SHP Request Total Budget 

1. Acquisition i. Acquisition 

2. Rehabilitation 2. Rehabilitation 

3. New Constrction 3. New Constrction 

4. Real Propert 4. Real Propert 

Leasing Leasing 

5. Supportve Services 5. Supportve Services 

6. Operations 6. Operations 

7. HMIS 7. HMIS 

8. Total 8. Total 

15. SHP HMIS Bud~et (All SHP Projects with HMIS Costs) 


HMIS Costs Year 1 Year 2 Year 3 Total 

Equipment 

1. Central Server(s) 

2. Personal Computers and Priters 

3. Networking 

4. Security 

Subtotal: 

Software 

5. SoftarelUser Licensing 

6. Softare Installation 

7. Support and Maintenance 

8. Supporting Softare Tools 

Subtotal: 

Services 

9. Training by Third Paries 

10. Hosting/Technical Services 

11. Programming: Customization 

12. Programming: System Interface 

13. Programing: Data Conversion 

14. Security Assessment and Setup 

15. On-line Connectivity (Internet Access) 

16. Facilitation 

17. Disaster and Recovery 

Subtotal: 

Personnel 

18. Project Management/Coordination 

19. Data Analysis 

9 form HUD-40090-2

20. Programming 

21. Techncal Assistance and Training 

22. Administrative Support Staff 

Subtotal: 

HMIS Space and Operations 

23. Space Costs 

24. Operational Costs 

Subtotal: 

25. Total SHP HMS dollars requested 

in lines 1 to 24 above: * 

* Total of Line 25 must match line 8 column e. on the Proiect Summary Bud2et. 

26. Total cash match to be spent 

on SHP eligible HMS activities: ** 

** Cash Match can be spent on any SHP eligible activity (see the chart in Section II.A.3. of the NOFA for these 

activities). The amount of the SHP HMIS request (entered in line 25) must be no more thn 80 percent of the total HMIS 

budget (i.e., 80 percent ofline 25 plus line 26). 

Part J: Shelter Plus Care and Section 8 SRO Project Budgets 

(All S+C and SRO Projects as Applicable) 

J1. Shelter Plus Care and Section 8 SRO Rental Assistance Budeet 

a. Check the box to indicate the type of program: D S+C T 1 Section 8 SRO 

b. Name of metropolitan or non-metropolitan Fair Market Rent (FMR) area: 

c. Check the appropriate box that relates your rent to the published FMR*: 



D 101 % to 110% ofFMR (PHA approval 


D Greater than 110% (H approval 


d. Size of Units e. Number f. FMR or g. Number of 

SRO 

o Bedroom 

1 Bedroom 

2 Bedrooms 

3 Bedrooms 

4 Bedrooms 

5 Bedrooms 

6 Bedrooms 

Other: 

i. Totals: 

Of Units Actual Rent 

x 

x 

x 

x 

x 

x 

x 

x 

x 

x 

x 

x 

x 

x 

x 

x 

x 

x 

x 

x 

Months 

= $ 

= $ 

= $ 

= $ 

= $ 

= $ 

= $ 

= $ 

= $ 

= $ 

h. Total 

*Please be advised that the actual FMRs used in calculating your S+C or SRO grant will be those in 

effect at the time the grants are approved, which may be higher or lower than the FMRs listed above. 

J2. New Shelter Plus Care Single Room Occupancy (S+C/SRO) and New Section 8 

Sin Ie Room Occu anc SRO Pro' ect Bud et 

a. List below an estimate ofthe total costs of develo ing the S+C/SRO project: 

T e Amount 

Total Rehabilitation Costs (Eligible and Ineligible): 

form HUD-40090-2

Acquisition: 

Other Costs (Eligible & Ineligible, e.g., furniture): 

Total: $ 

b. List any commitments from public and private sources that you are able to provide at this time to 

help cover the costs of developing the project: 

Source Amount 

11 

Total: $ 

form HUD-40090-2

Section III: New Project Narratives 

Part K: General Project Narrative Information 

1. Provide a general description of the new project (use less than one-half page). 

The Riverfront YMCA Residence is a 188 bed facility serving homeless men in our community. 

The YMCA is proposing that 45 beds be designated as Permanent Housing for Chronically 

Homeless men. Each room is single occupancy and equipped with a bed, dresser, desk, chair and 

closet. The YMCA provides all linens and towels for residents. There is a shared bathroom and 

laundry room on each floor. All residents receive around the clock answering service by front desk 

staff, benefit of a secure entry system, and a membership to the YMCA fitness facility. There is a 

common dining area in which residents have access to microwaves, coffee pots and are able to bring 

other cooking devices to prepare their meals. There is also an on-site diner. These men wil receive 

affordable housing and case management services without a restrction on the length of stay. When 

additional resources are needed, case managers wil collaborate with other agencies in the 

communty to address the individual needs. On site, the YMCA has an outreach substance abuse 

counselor from the House of Mercy who is regularly scheduled to provide assessments and referrals 

to drg and alcohol treatment services and there is an HIV/AIS counselor who comes one time per 

month to provide free HIV testing, counseling and referrals if needed. When transportation to off 

site services is a barer, bus tokens wil be provided to the residents. A Licensed Mental Health 

Counselor with Master's level dual diagnosis credentials wil be secured to provide case 

management to the residents in Permanent Housing to assist in meeting the needs ofthe high rate of 

mental ilness and alcohol/drg abuse in the chronically homeless population. 

2. Enter the percentage of homeless participants(s) that wil be served (N/A for dedicated HMIS 

projects): 

4% Persons who came from the street or other locations not meant for human habitation.* 

43% Persons who came from Emergency Shelters.* 

53% Persons in TH who came directly from the street or Emergency Shelters.* 

100% Total of above percentages. Ifthe total is less than 100%, describe very specifically wherE 

the other persons you propose to serve would be coming from, and how these persons would 

meet the HU homeless definition (use less than one-quarer page). 

*This includes persons who ordinarily sleep in one ofthe above places but are spending a short 

time (30 consecutive days or less) in ajail, hospital, or other institution. 

3. Describe the outreach plan to bring these homeless participants into the project. 

A Case Manager is a committee member in the local Continuum of Care and wil utilize the CoC 

network to inform other service providers in the community that the YMCA provides permanent 

housing in addition to its existing transitional housing. As part of a community project to gather 

information for the anual Point in Time surey, a Case Manager will be working with other CoC 

committee members and local authorities to map the city of Des Moines and spend a period oftime in 

summer 2006 canvassing areas where homeless persons are gathered to inform them of services and 

housing available. 

4. Wil basic community amenities (e.g., medical facilities, grocery store, recreation facilities, 

schools, etc.) be readily accessible (e.g., walking distance, near bus line, etc.) to your clients? 

r8 Yes, very accessible D Somewhat accessible D Not accessible 

5. For transitional housing component only: 

List residents' maximum allowable length of stay: months 

12 

form HUD-40090-2

6. For permanent housing for persons with disabilties component where more than 16 

persons wil reside in a structure: Describe what local market conditions necessitate the 

development of a project of this size and how the housing will be integrated into the 

neighborhood. 

7. For Shelter Plus Care TRA projects only: Wil participants be required to live in paricular 

structures or units during the first year and in a paricular area within the locality in subsequent 

years, or to live in a particular area for the entire period of paricipation? DYes D No 

Explain how and why the project will implement this requirement (use less than one-half page). 

8. For Section 8 SRO projects only: 

a. Describe the rehabilitation proposed for the property and the responsibility you and any 

other organizations wil have in operating and maintaining the property. 

b. Include a photograph of the building to be assisted with the address (street, city, zip) on the 

photograph. 

c. For Non-PHA applicants you must submit a certification letter from the PHA that wil 

administer the rental assistance. Please refer to the instructions for letter content. 

9. (SHP ONLY) Wil your proposed project use an existing homeless facility or incorporate 

activities that you are currently providing? r8 Yes D No 

If Yes, check one or more of the activities below that describe your proposed project. 

Facilities that you are currently operating and activities you are currently undertaking to 

serve homeless persons may only receive SHP funding for the four purposes listed below. 

My project wil: 

D Increase the number of 

homeless persons served. 

r8 Provide additional supportive services for residents of supportive housing and/or homeless 

persons not residing in supportive housing. 

D Bring existing facilties up to a level that meets state and local governent health and 

safety standards. Please explain. 

D Replace the loss of nonrenewable fuding from private, Federal, or other sources (except 

from the state or local governent), which wil cease on or before the end of2007. 

By law, no SHP fuds may be used to replace state or local governent funds previously used, 

or designated for use, to assist homeless persons (see 24 CFR 583.150(a)). 

If this (fourth) box is checked, you must fully describe the following in order to be 

eligible for funding: 

a. The source of the nonrenewable fuding, indicating that it is not under the control of 

the State or local governent. 

b. Why it is nonrenewable. 

c. When it wil cease. 

d. Document the specific steps you took to obtain other fuding, why there are no other 

sources of funding and why, without the SHP assistance, the activity wil cease. 

13 form HUD-40090-2

Part L: Supportive Services the Participants Win Receive 

(All new projects . D except d d e icate HMIS P' rOJ ects ) 

1. What types of supportive services are proposed that would fit the needs of the paricipants? 

o Outreach o Health Related & Home Health Services 

~ Case management 

o Education and Instruction 

o Life skills (outside of case management) rg Employment Services 

o Job training o Child Care 

~ Alcohol and Drug Abuse Services 

~ Mental Health and Counseling Services 

rg Transportation 

o Transitional Living Services 

o HN/AIDS Services o Other (must specify *) 

2. Generally speaking, what is the scale (the frequency) of these services? 

Scale: 0 Daily rg Weekly 0 Bi-monthly 0 Monthly 0 Other:_ 

Part M: Accessin Permanent Housin 

1. Describe specifically how paricipants wil be. assisted both to obtain and also remain in 


Case management wil assist men to obtain and remain in permanent housing by assessing the 

individual needs and developing case plans with specific action steps to overcome the barers, such 

money management, gaining an income from employment or benefits, accessing education, physical 

and mental health services, substance abuse services, and local transportation. Case management wil 

discuss YMCA Residence gudelines that are enforced to ensure the safety of all of the residents, staf 

and visitors prior to the admittance to the permanent housing program and wil address any behaviors 

that may threaten their ability to continue to reside in the residence in a timely maner to help preven 

the need for dischar e. 

Part N: Partici ant Self-Sufficienc 

1. Describe specifcally how paricipants wil be assisted both to increase their employment and/or 

income and to maximize their ability to live independently. 

Case managers work with residents to identify barers to job attainment and action steps to overcome 

them. They also collaborate with Iowa Workforce Development and Vocational Rehabilitation and 

make referrals to agencies in the community who are regularly looking for par-time, full-time or 

temporar employees. Once income is obtained, case managers work with individuals to budget 

money or make referrals to payees and other financial management services 

2. If you are proposing to serve persons with disabling conditions, please describe how this project 

will assist these persons to address their needs. 

The facility is wheelchair accessible and there are ADA rooms, there is signage around the building 

and in the elevator in Braille and a TTY phone is available for residents at the front desk. Staff 

works in cooperation with the local police deparment to contact a mental health crisis team for 

residents who escalate to physically threatening themselves or others. In a medical emergency, staff 

wil call 911 for assistance, in addition to the YMCA's requirement that all staff be CPR and first 

aide certified. Other agencies, including those providing outreach case management and visiting 

nurses regularly come to the residence to work with those receivin their services. 

14 form HUD-40090-2

Part 0: Ex erience Narrative 

1. List the specific type and length of experience of all organizations involved in implementing the 

proposed project, including the project sponsor, housing and supportive service providers, and 

any key subcontractors. Describe experience directly related to their role in the proposed project 

as well as their overall experience working with homeless people. For projects contracting for 

and overseeing the construction or rehabilitation of housing or administering rental assistance, 

describe experience, as applicable. A project sponsor must meet the same eligibility standards as 

applicants. 

In its' over 40 years as a housing provider, the YMCA of Greater Des Moines has had significant 

experience in working with homeless individuals. In 1998, the YMCA formalized the transitional 

housing component ofthe Residence Program and began to offer case management and supportive 

services. On average, 160 men are engaged in case management and receive supportive services at 

any given time durg the year. Residents create individualized case plans to develop a plan for self 

suffciency within two years and work with case managers to purue the identified goals and 

objectives. Case managers collaborate with other agencies to provide any wrap around services that 

may be needed. The YMCA is the largest single provider of transitional housing for men in the state 

ofIowa and one ofthe only sin Ie room occu anc facilities. 

2. Have you ever received a Federal grant either directly from a Federal Agency or through a 

state/local agency? t: Yes D No 

If Yes, 

a. List all HU McKinney- Vento Act grants, other than ESG, received after 1999, including 

for each grant: the year awarded, grant number, grant amount, and amounts spent to date. 

Only list HU-issued grant numbers. If you are unclear about the HU grant number 

assigned to any project, please contact your HU field offce for assistance. Add rows as 

needed. 

Year Awarded Grant Number Grant Amount 

b. Please explain any delays in implementing any of the grants listed in (2a) above which 

exceed the applicable timeliness standards described in the Notice of Funding Availability 

(NOF A). 

c. Identify any unresolved HU monitoring findings, or outstanding audit findings related to 

any of the grants listed in (2a). 

3. Is the applicant or sponsor a nonprofit organization (rather than a state or unit of local 

Governent)? t: Yes D No 

If Yes, one of the following must be attached for each organization: 

a. IRS ruling, providing tax-exempt status under Section 501 C (3) of the IRS Code of 1986, as 

amended, or documentation of nonprofit status as described in the Glossary in Section LA.7 of 

the program section of the NOFA. 

b. Public nonprofit community mental health centers must attach a letter or other document 

acceptable to HU from an authorized offcial stating that the organization is a public 

nonprofit organization. 

15 

form HUD-40090-2

Part P: HMIS Narrative (Dedicated HMIS Projects ONLY) 

1. Describe how the CoC's homeless needs wil be assessed, resources allocated, and services 

coordinated more efficiently and effectively through the introduction of a new or expanded CoCwide 

HMIS. 

2. Demonstrate that at least 50 percent of the beds (emergency, transitional and McKinney-Vento 

permanent housing) listed in the "Current Inventory in 2006" categories in the Fundamental 

Components in the CoC System - Housing Inventory Chart wil be included in the CoC-wide 

HMIS. 

3. Name the lead agency designated to oversee the HMIS project. 

4. Provide the timetable for implementing the new or expanded HMIS. 

5. Demonstrate that no state or local governent funds would be replaced with the funding being 

requested ofHU for this project. 

16 

form HUD-40090-2

: YMCA of Greater Des Moines 

: Permanent Housina Proaram 

: Total 

i Continuum of Care 

C9The Center for Applied Management Practices, Inc., 2005. Form HUD 96010(2/2006)

Certification of Consistency 

with the Consolidated Plan 



I certify that the proposed activities/projects in the application are consistent with the jurisdiction's current, approved Consolidated Plan. 

(Type or clearly print the following information:) 

Applicant Name: 

Project Name: 

Location of the Project: 


Program to which the 


Name of 

Certifying Jurisdiction: 

Certifying Offcial 

of the Jurisdiction 

Name: 

Title: 

City of Des Moines, Iowa 

YMCA - Permanent Housing NEW 

Des Moines, Iowa 

2006 Supportive Housing Program (SHP) 


T. M. Franklin Cownie 

Mayor, City of Des Moines, Iowa 

5ignlore. c--~¡ 

Date: MAY 2 2 2006 

ATTST.~C: A\ 

Diane Rauh, C ty Clerk 

18 

form HUD-2991 (3/98)


P ar tAG . enerai P ro,) ec t I norma i t (All ion P rOJ ects ) 


2. r8 New Project 



D Renewal Project 

PIN Number: 

Chart in Exhbit!): -L identifier number (PIN) 

4. HUD-Defined CoC Name: 5. CoC Number: 

Des Moines Polk/County IA-502 

6. Applicant's Organization Name (Legal Name from SF-424) 8. Applicant's DUNS Number 

City of Des Moines (From SF-424): 

7. D Check box if Applicant is a Faith-Based Organization 

07-349-8909 

r8 Check box if Applicant has ever received a federal grant, either directly from 

a federal agency or through a state/local agency 


Street: 100 E. Euclid Avenue Identification Number (EIN) (From 

City: Des Moines State: IA Zip: 50313 SF-424): 42-6004514 


12. D Check box if Project 


Title: Federal Programs Admistrator 

Phone number: 515-283-4151 


Fax number: 515-242-2844 

Email Address:RASchulte~dmiiov.orii Sponsor 

13. Project Name: 

Iowa's Continuum Outcome and Universal Need Toolkit (I-COUNT) 

14. Project's location 6-digit 


15. Project Address (S+C SRAs, ifmultiple sites list all addresses including): 18. D Check box if Energy Star is 

Street: 1111 - 9th Street, Suite 245 used in ths project 

City: Des Moines State: IA Zip: 50314 19. Project Congressional District(s): 

16. D Check box if project is located in a Rural Area 03 

17. If project contain housing unts, are these unts: D Leased? DOwned? 

20. Project Sponsor's Organization Name (If different from Applicant) 22. Sponsor's DUNS Number: 

14-934-1732 

21. D Check box if Project Sponsor is a Faith-Based Organization 

r8 Check box if 




Street: 1111 _9th Street, Suite 245 Identification Numer (EIN): 

City: Des Moines State: IA Zip: 50314 45-1352902 

25. Contact person of Project Sponsor (if different from Applicant) 

Name: Julie Eberbach Phone number: 515-246-6643 

Title: Project Director Fax number: 515-246-6637 

Email Address: julieeberbach~aoi.com 

19


Bl. Supportive Housing Program (SHP) (All SHP Projects) 

a. (8 SHP Program c. Grant Term (New Projects must be 2 or 3 years; 

b. Component Types (Check only one box) Renewals or HMIS projects can be 1, 2 or 3 years) 

o 0 0 (8 0 Safe Haven/TH (Check only one box) 

TH PH SSO HMIS 0 Safe Haven/PH 0 (8 0 

d. Proposed 





4. Subtotal 



From Leasin Bud et Chart 


From Supportve Services Budget Chart 

7. Operations 


8. HMIS 




10. Administrative Costs 

(U to 5% of 

line 9) 


(Total lines 9 and 10) 

B2. Shelter Plus Care S+C 

a. 0 S+C Pro ram 


o 0 0 0 0 




B3. Section 8 Sin Ie Room Oeeu 

a. 0 SRO Program 

b. Com onent TeD (SRO) 

1. Total SRO Rental Assistance Amount 

from SRO Budget Chart 



Re uest (Col. e + Col. f) 

210,000.00 52,500.00 262,500.00 

210,000.00 

10,500.00 

Total 

Cash Match 

220,00.00 52,500.00 

Total Budget 

(Total SHP 

Request + Total 

Cash Match) 

273,000.00 

Iieable - HMIS Pro. eet 



$ 

o Renewal 

1 Year 

o New 

5 Years 

aney (SRO) All Section 8 SRO Pro' ects 

c. Grant Term 

010 Years 

$ 

o New 


10 Years 

20 form HUD-40090-2 

(4/20061


(All P' E D d d HMIS P') . I HMIS P 

fOJects xcept e icate rOJects Not Applicab e- rOject 

1. Housing Type* 

(Check all that apply) 

1 a. D Multi-family 

D Single-family 

D Con2re2ate Facilty 

lb. o Scattered Site 

D Project Based 

2. Units, Bedrooms, Beds 

a. . Current 

Level 

b. New Effort or 

Change in Effort 

c. Projected 

Level 


Number of Units 









b. Number of Single Individuals and 




*Housing Types: Multi-family (apartents, duplexes, SROs, other buildings with 2 or more units); Single-family; 

Congregate Facility (domutory, barracks, shared-living). 

Part D: Targeted Subpopulations Not Applicable - HMIS Project 






roximate Percent a es (%) 

Part E: Dischar e Polic (Onl State & Local Government A licants) 



1. ~ Yes D No facilities, foster care or other youth facilities, or corrections programs and 



jurisdiction? 

21 form HUD-40090-2 

14/2006\


HU homeless program funding is limited and can provide only a portion ofthe resources needed to 

successfully address the needs of homeless families and individuals. HUD encourages applicants to 



application and possible withdrawal of your conditional award(s). For further instructions for 

filling out this section, see the Instructions section. 

Identify Source as: Date of Value of 


Contribution 


Contribution (G) Government* 


Written 

Commitment 

Written 

Commitment 

Example: Child Care CDBG 

Cash CDBG TA 

*Government sources are annropriated dollars. 

G 

G 

2/15/06 

05/15/2006 

TOTAL: 

$10,000 

28,281.00 

$28,281.00 


S stems HMIS HMIS Dedicated Pro. ect 

D Yes D No Is this project participating in the HMIS? 

/ If 

(mmyear) If 

"Yes," what date did this project begin participating in the HMIS? 


D Yes D No Wil client-level data be included in the HMIS for all persons served by this 

roject? 

Part H: Renewal Performance (All Renewal Projects) Not Applicable - New 

1. DYes DNo 

2. DYes DNo 




funding approval? Check all that apply: 

D Number of persons served: from _ to _' 

D Number of 

units: from _ to- 






D Other: 


22 


/;/?nn~\

H: Renewal Performance (Continued) Not Applicable - New 

(For all S+C, SHP-PH, SHP- TH, SHP-Safe Haven, and SSG Renewals): 



check the N/A box and skip these questions. D N/A 



Complete the following char using data based on the preceding operating year from APR Questions 

12(a) and 12(b): 


b. Number of participants who did not leave the project(s)-APR Question 12 (b) 



e. Percentage of all participants in PH projects staying 7 months or longer 

% 





14: 

a. Number of participants who exited TH project(s)-inc1uding unknown destination 

b. Number of participants who moved to PH-from any destination identified as permnent housing 


% 




HU will be assessing the percentage of clients in your renewal project who gained access to 



1 2 3 4 

Number of Adults Who Left Income Source Number of Exiting % with Income 


in each row) of Income (Col. 3 -; Col. 1 x 

100) 

Example: 105 a. Social Security Insurance (SSI) 40 38.1% 


Insurance (SSDI) 


a. SSI 

b. ssm 



e. TANF 

f. SCRIP 





k. Medicaid 

1. Food Stamps 

m. Other (please specify) 


23 


l.d./?OOR\


Part I: SHP Project Budgets Not Applicable - HMIS Project 

11. SHP Leasin Bud et (All SHP Pro' ects with Leasin ) 

Leased Unites) for Housing and/or Services 



D 1% to 99% ofFMR 


D 101 % to 110% ofFMR (PHA approval letter must be attached). 

D Greater than 110% (HUD approval letter must be attached). 

c. Size of Units d. Number e. FMR or 

SRO x 

o Bedroom x 

1 Bedroom x 

2 Bedrooms x 

3 Bedrooms x 

4 Bedrooms x 

5 Bedrooms x 

6 Bedrooms x 

Other: x 

h. Totals: x 

Leased Strcture(s 

Structure 1 

Address: 

Structure 2 

Address: 

of Units HUD Paid Rent 

24 

x 

x 

x 

x 

x 

x 

x 

x 

x 

x 

f. Number of 

Months 

$ 

$ 

= $ 

$ 

$ 

$ 

$ 

= $ 

= $ 

= $ 

licable FMR 

= $ 

State: Zip: 

x $ 

State: Zi : 

g. Totals 


14/?OOf)\

12 . SHP Suppor t iveServices B u d 1ge t (All SHP PrOJ ects as A ~pp l' ica hI) e 

Supportive Services Costs 

1. Outreach 

Quantity: 


Quantity: 


Quantity: 


Quantity: 


Quantity: 

6. mY/AIDS Services 

Quantity: 


Quantity: 


Quantity: 


Quantity: 


Quantity: 


Quantity: 


Quantity: 


Quantity: 

14. Total SHP supportive services dollars 


Year 1 


Year 2 Year 3 Total 


** Total of Line 14 must match line 6 column e. on the Project Summary Budget. 


eli2ible supportive service activities. *** 

*** Cash Match can be spent on any SHP eligible activity (see the chart in Section III.A.3. of the NOFA 

for these activities). The amount of the SHP request (entered in line 14) must be no more than 80 percent of 

the total supportive servces budget (i.e., 80 percent of line 14 plus line 15). The total of Line 15 must match 


25 


(4/2006\

13 . SHP 0'peratin~ B u d l~et (All SHP P roiects wit "hO)perating c osts) 


Operating Costs 


Quantity: 

2. Staff 

(position, salary, % time, fringe benefits) 

3. Utilties 

Quantity: 

4. Equipment (lease/buy) 

Quantity: 

5. Supplies 

Quantity: 

6. Insurance 

Quantity: 


Quantity: 

8. Relocation 

Year 1 Year 2 Year 3 Total 

Quantity: (number of 

persons) 

9. Food 

Quantity: 

10. Other Operating Activity: * 

Quantity: 

11. Total SHP operating dollars 



** Total of Line 11 must match line 7 colum e. on the Project Summry Budget. 


eli1:ible operatin1: activities. *** 

*** Cash Match can be spent on any SLI eligible activity. The amount of the SLI request (entered in line 

11) must be no more than 75 percent of the total operations budget (i.e., 75 percent ofline 11 plus line 12). 

The total of Line 12 must match line 7, column f. on the Proiect Summary Budget. 


Applicable) 


funds. Fill out an additional chart for each structure. 

Structure A 

Address: 

ity, tate, ,ip: 

C S Z' 

i. Acquisition 

2. Rehabilitation 

3. New Constrction 

4. Real Property 

Leasing 


6, Operations 

7. HMIS 

8. Total 

SHP Request Total Budget 

Structure B 

Address: 

ity, tate, .ip: 

C S Z' 





Leasing 


6. Operations 

7. HMIS 

8. Total 


26 form HUD-40090-2 

( d/?OOR\

15 . SHP HMIS B U d Lge t (All SHP P roi ects wit . hHMIS C osts) 



Equipment 

1. Central Server( s) 

2. Personal Computers and Printers 1500.00 1500.00 

3. Networking 100.00 100.00 

4. Security 

Subtotal: 1600.00 1600.00 


5. Softare/User Licensing 2500.00 2500.00 5000.00 

6. Software Installation 

7. Support and Maintenance 9,000.00 10,500.00 19,500.00 

8. Supporting Softare Tools 2,000.00 2500.00 4500.00 

Subtotal: 13,500.00 15,500.00 29,000.00 

Services 


10. Hosting/Technical Services 10,000.00 11,000.00 21,000.00 

11. Programing: Customization 


13. Programming: Data Conversion 


15. On-line Connectivity (Internet Access) 750.00 750.00 1500.00 



Subtotal: 10,750.00 11,750.00 22,500.00 

Personnel 

18. Project Management/Coordination 50,000.00 53,600.00 103,600.00 

19. Data Analysis 15,000.00 15,000.00 40,000.00 


21. Technical Assistance and Training 

22. Administrative Support Staff 4000.00 4000.00 8000.00 

Subtotal: 74,000.00 77,600.00 151.600.00 


23. Space Costs 2500.00 2800.00 5300.00 

24. Operational Costs 5,000.00 5,000.00 10,000.00 

Subtotal: 7,500.00 7,800.00 15,300.00 

25. Total SlI HMS dollars requested 

in lines 1 to 24 above: * 102,350.00 107,650.00 210,000.00 

* Total of Line 25 must match line 8 column e. on the Project Summary Budget. 


on SLI eligible HMS activities: ** 25,588.00 26,912.00 52,500.00 

** Cash Match can be spent on any SHP eligible activity (see the chart in Section IILA.3. of the NOFA for these 

activities). The amount of the SHP HMIS request (entered in line 25) must be no more than 80 percent of the total HMIS 

budget (i,e., 80 percent of line 25 plus line 26). 

27 form HUD-40090-2 

'4,?nnfl\


Not Applicable - HMIS Project 

J1 Sh It PI CdS t 8 SRO R t I A . t B d t 

. e er us are an ec ion en a SSIS ance U ige 

a. Check the box to indicate the type of program: Ds+c D Section 8 SRO 






D Greater than 110% (RUD approval letter must be attached). 

d. Size of Units e. Number f. FMR or g. Number of h. Total 

OfUnIts Actual Rent Months 

SRO x x = $ 


1 Bedroom x x = $ 






Other: x x = $ 

i. Totals: x x = $ 




Sin~le Room Occupancy (SRO) Project Budget 

a. List below an estimate ofthe total costs of developing the S+C/SRO project: 

Type Amount 


Acquisition: 


Total: $ 



Source Amount 

Total: $ 

28 form HUD-40090-2 

,4/?OOR\


Part K: General ProJect Narrative Information 

1. Provide a general description ofthe new project (use less than one-half page). 

Not Applicable - HMIS Project: See Section P Below 

2. Enter the percentage of homeless participants(s) that will be served (N/A for dedicated HMIS 

projects): 

% Persons who came from the street or other locations not meant for human habitation.* 

_ % Persons who came from Emergency Shelters. * 

_% Persons in TH who came directly from the street or Emergency Shelters.* 

_% Total of above percentages. If the total is less than 100%, describe very specifically 

where the other persons you propose to serve would be coming from, and how these persons 

would meet the HU homeless definition (use less than one-quarter page). 

*This includes persons who ordinarily sleep in one of the above places but are spending a short 


3. Describe the outreach plan to bring these homeless participants into the project. 

4. Will basic community amenities (e.g., medical facilities, grocery store, recreation facilities, 


o Yes, very accessible 0 Somewhat accessible 0 Not accessible 




persons will reside in a structure: Describe what local market conditions necessitate the 

development of a project ofthis size and how the housing will be integrated into the 

neighborhood. 

7. For Shelter Plus Care TRA projects only: Will paricipants be required to live in particular 

structures or units durng the first year and in a particular area within the locality in subsequent 

years, or to live in a particular area for the entire period of paricipation? 0 Yes 0 No 





b. Include a photograph ofthe building to be assisted with the address (street, city, zip) on the 

photograph. 

c. For Non-PHA applicants you must submit a certification letter from the PHA that will 


29 form HUD-40090-2 


9. (SHP ONLY) Will your proposed project use an existing homeless facility or incorporate 

activities that you are currently providing? DYes D No 





D Increase the number of homeless persons served. 

D Provide additional supportive services for residents of supportive housing and/or homeless 


D Bring existing facilities up to a level that meets state and local governent health and 


D Replace the loss of nonrenewable funding from private, Federal, or other sources (except 

from the state or local governent), which will cease on or before the end of2007. 

By law, no SHP funds may be used to replace state or local governent funds previously used, 




a. The source of the nonrenewable funding, indicating that it is not under the control of 

the State or local government. 






(All new projects except Dedicated HMIS Projects) 

1. What types of supportive services are proposed that would fit the needs of the participants? 

D Outreach D Health Related & Home Health Services 

D Case management D Education and Instruction 

D Life skills (outside of case management) D Employment Services 

D Job training D Child Care 

D Alcohol and Drug Abuse Services D Transportation 

D Mental Health and Counseling Services D Transitional Living Services 

D HIV/AIDS Services D Other (must specify *) 


Scale: D Daily D Weekly D Bi-monthly D Monthly D Other: _ 

Part M: Accessin Permanent Housin Not Applicable - HMIS Project 

1. Describe specifically how. participants will be assisted both to obtain and also remain in 


30 form HUD-40090-2 


Part N: Partici ant Self-Sufficienc Not Applicable - HMIS Project 

1. Describe specifically how participants will be assisted both to increase their employment and/or 




Part 0: Experience Narrative 







applicants. 

The Iowa Institute for Community Allances (ICA) has been spearheading real time client 

level demographic collection efforts since 1997, guiding the Iowa Balance of State, Des 

Moines/Polk County and Sioux CitylDakota County Continuums through a transition from a 

legacy data collection system to a comprehensive statewide HMIS network. IICA began 

specific HMIS efforts in 2000, determining the best software options for a statewide 

implementation, rollng out the system in 2001 and have been system administrators for the 

Iowa Network since. We currently oversee the Iowa Homeless Management Information 

Network with 346 active network users across 130 agencies (growing to over 450 users this 

year). Our responsibilties as system administrators include but are not limited to: 

· Provision of monthly reports to all provider to ensure data quality, 

· provision of training for new and advanced users, 

· provision of technical assistance by phone and on sight 

· reporting development and design at the local agency level as requested 

· serving as clearinghouse (including design and development) for all system wide 

reporting to State of Iowa and Federal agencies 

The Institute has also provided facilitation leadership for area "nser groups" to develop 

customied solutions for HMIS use at the local jurisdiction level. 

Our principal subcontractor is Bowman Internet Systems, in Shreveport, LA. They are the 

creator of ServicePoint, one of the leading HMIS software tools available. We have partnered 

with Bowman Internet since selecting their software in 2000. They have been instrumental in 

providing support for our statewide rollout, responsive to technical assistance calls and meeting 

any specific needs that the Iowa Project has had. In addition to providing our software, 

Bowman Internet also hosts our HMS server at their home offce in Shreveport LA. Bowman 

Internet Systems also provides our network with Business Objects (Crystal Reports). Business 

Objects is a recognized industry leader in reporting tools. Their products wil interface 

seamlessly into the existing HMIS tool and provide the Des Moines/Polk County CoC service 

agencies, funders, and planning bodies with "state of the art" reporting capacity. 

31 


1.:?OOfl\


statellocal agency? ~Yes DNo 

If Yes, 

a. List all HU McKinney-Vento Act grants, other than ESG, received after 1999, including 



assigned to any project, please contact your HUD field office for assistance. Add rows as 

needed. 

Year A warded Grant Number Grant Amount 

Amount Spent to 

Date 

2003 

2004 

2003 

2005 

2006 

IA26B30lO23 

IA26B40lO23 

IA26B302006 



$155,673 

$758,940 

$167,206 

$81,564 

$89,250 

$155,397 

$40,960 

$127,956 

$0 

$0 



(NOF A). 




Governent)? ~Yes DNo 



amended, or documentation of nonprofit status as described in the Glossary in Section i. A. 7 of 

the program section of the NOF A. 


acceptable to HU from an authorized official stating that the organization is a public 


Part P: HMIS Narrative (Dedicated HMIS Pro'ects ONLY) 


coordinated more effciently and effectively through the introduction of a new or expanded CoCwide 

HMIS. 

Our proposed expansion grant for Des Moines/Polk County wil fund staff, 

hardware/software resources and operating expenses to support three main areas of 

concentration: 

· One full time system administrator working solely with the DSM/olk Continuum 

· Specifically focused resources and effort to expand the existing pilot service 

coordination network with special emphasis on street outreach, supportive services 

and permanent supportive housing providers. 

· One half of a full time staff specialist to support data analysis and reporting 

specifically for Des Moines/Polk County. 

These areas of concentration address more effcient and effective needs assessment by 

expanding our network capacity to direct dedicated staff support to produce specific 

reports and data analysis in response to requests we have received from the Des Moines 

Polk Count Housin Continuum CHC), the Polk Count Human Services Plannin 

32 



Allance, the Polk County Housing Trust Fund and the City of Des Moines. This past year, 

we provided the opportunity for service providers in the continuum the option to 

participate in the Point in Time survey by electronically submitting their data with the use 

of the survey instrument housed on our live network. Des Moines/Polk County area service 

providers were trained on the use of this electronic survey instrument on our training and 

demonstration site prior to the survey date. Additional staff and operating resources would 

allow us to expand the electronic participation by a wider array of service providers 

(including street outreach) and improve the data quality of all participants. We have also 

provided data reports to the PCHC Board of Directors and their Agency Roundtable. The 

overwhelmingly positive response to this reporting capacity has generated a dramatic 

number of requests for reports by local government, planning bodies and program 

advocates. These requests provide a verifable, consistent and real time picture of the needs 

of homeless individuals and their families across the continuum. 

These areas of concentration address more efficient and effective resource allocation by 

allowing demographic data and service transaction trends collected through our network to 

inform the grant application processes for the State of Iowa's Homeless Shelter Operations 

Grant Program (HSOGP), Emergency Shelter Grant Program (ESGP), FEMA, PATH, 

Supportive Housing Grant Program (SHP) and Housing Opportunities for Persons with 

AIS/IV (HOPW A). HMIS data (through a system-generated report) has been a 

required and scored element of the State of Iowa Homeless Assistance Grant Application 

for the past two grant cycles. This grant application is the tool by which the State of Iowa 

distributes both Federal ESGP funds and State HSOGP funds in a single coordinated 

effort. Because of the success of this pilot effort, we have received requests from local 

agencies and the Polk County Housing Continuum's Planning and Strategies Committee to 

replicate this effort within the context of the local application and planning processes for 

the previously listed funding sources. Resources from this SHP expansion grant would 

allow us to do so. 

These areas of concentration wil address more effcient and effective service coordination 

by allowing for expansion of an already strong existing network of emergency and 

transitional housing providers to include a broader array of permanent housing providers 

and street outreach servces. The Des Moines/Polk County implementation of the Iowa 

HMIS network has launched a pilot data sharing network through cooperative business 

agreements among the five most frequently accessed homeless service providers in the 

continuum. Using our HMIS network, this project allows key emergency and transitional 

housing providers, along with the area's largest healthcare and supportive services agency 

to coordinate services for shared clients through a single referral that is initiated from the 

provider that is initially contacted for assistance. Agency staffs that have the first client 

encounter secure the initial basic assessment for the person or family seeking assistance, 

and make the appropriate referrals and then open the client record to the appropriate 

agencies for use when the client arrives for services. This allows the participating agencies 

to effectively track the complete cycle of services and results from the initial inquiry 

through to the housing and service resolutions. This network sharing also provides benefits 

for the clients through a seamless information transfer as they move through the service 

continuum allowing service providers to effectively coordinate services on their behalf. 

Through this grant, we wil be able to develop an even more complete network of service 

provision through expansion to bring on the remaining service providers in the Des 

Moines/Polk County continuum including, but not limited to street outreach, supportive 

service providers and permanent supportive housing providers. 

Simultaneously, we wil expand the use of our HMIS network bed registry to include 

remaining emergency and transitional housing providers to complete the development of a 

highly effective tool for interagency shelter and service referral for clients who come into 

the service system directly through provider contact. We expect to complete this aspect of 

the network's development bv the end of 2009. 

33 



2. Demonstrate that at least 50 percent ofthe beds (emergency, transitional and McKinney-Vento 



HMIS. 

Individuals Familes with Children 

Current Total Beds Percent Current Total Beds Percent 

Beds under in Coverage Beds under in Coverage 

HMIS Continuum HMIS Continuum 

Emergency 290 312 93% 61 115 53% 

Shelter 

Transitional 422 439 96% 277 343 SO% 

Housin~ 

Permanent 67 67 100% 277 277 100% 

Supportive 

Housin2 


Iowa Institute for Community Alliances 


Assuming a July 1,2007 start date for this expansion grant, required new staff or contract 

services would be hired and in place by September 1,2007. These staff 

persons would then 

begin immediately their duties in support of coordination, planning and execution of data 

reporting development (to support local efforts for resource allocation and needs analysis) 

and a timetable for network participation for local agencies with our HMS network (with 

special emphasis on permanent housing and street outreach). Any and all hardware 

purchases would be made sequentially from July 1,2007 through December 31,2007. 

Software purchases and network hosting and support fees would be scheduled for the 

duration of the grant period within the first three months of the grant award date. 

5. Demonstrate that no state or local governent fuds would be replaced with the funding being 


No State or local funding has been replaced for the expansion efforts outlned in this 

application in the past. The Iowa Institute for Community Allances recently renewed our 

contractual relationships with the Iowa Department of Economic Development (State of 

Iowa) and the Iowa Finance Authority through 200S. This contract provides the foundation 

funding for our HMIS network and funded initial project implementation and ongoing 

license support since 2001. 

34 



) ~.\TE¡::!'¡\L. REVEHUE SE¡;~'.. ICE 

DISTRICT DIRECTOR 

POBOX A-3290 OPN 22-2 

CHICAGO, IL 60690 

Dati?: MAY 14 1991 

IOWA INSTITUTE FOR LOW INCOME 

HOUSING ENERGY AND 

TELECOMMUN rCAT IONS 

C/O DOYLE D SANDERS 

321 EAST I4lqLNUT SUITE 200 

DES MOINES, IA 50309 

(ie.:ir Appl iC.:nt: 

DFPARTMEWT üF THE TREASURY 

~ØJlfíJ 

Emp loyer Ident i f ¡ cat i on Number: 

42-1 :3!32902 

Contact l'erson: 

R. Hî;LLACE 

Contact Telephone Number: 

(312) :386-1278 

Accounting Period Ending: 

Dec,?mbi?r 31st: 

Foundation status Classification: 

509 (,)) (1) 

Advdnce Rul ing Period Begins: 

JanlHry 12 1990 

Advance Rul ing Period Ends: 

December 31 1994 

Addendum Applies: 

N., 

Based on information supp! ied, and assuming your operations wi II be as 

stated in your app I i cat i on for recogn i t i on of exempt i on, we have determ i ned you 

are exempt from Federa I income tax under section 501 (a) of the Interna I 

Revenue Code as an organization described in section 501(c)(3). 

Because you are a newty created organiz~tion, we are not nOM mak ing a 

final determination of your foundation status under section 509(a) of the Code. 

Hoi-ever, we have detenilined th..t ,:'i:IJ. can reas,::ndbly be expected t.) be a publ ic- 

Iy supported organizatii:n ~escribed in sections 509(a) (1) and 170Cb) (1) (A) (yi). 

Acc.)rdiiigly, y.:.u will be treat~~d as a publicl~i supp.)t--t~~d .,rg.:inizationt 

and not as a private foundation, during an advance ruling period. This 

advance rul iiig period begins and ends on the dates shown above. 

Wi thin 90 days after the end .of your advance rut iiig period, you must 

~ubmit t.) us inforniatii::i needed to) deterniine whether y.::u have oiet the requirements 

of the app!icable support test during the advance ruling period. If you 

establish that you have been a publicly supported organization, you Hill be 

classified as a section 509(a) (1) or 509(a) (2~ organization as long as you continue 

to meet the requireMents of the appl icable support test. If you do not 

meet the publ ic support requireruents during the advance ruling period, you Hi I I 

be classified as a private foundation for future perii:ds. Also, if you are 

classified as a private foundation, you wi II be treated as a private fi:undation 

fr-)i11 th..~ d.it,? .::f YQur inceptii)n f,::r purposes i:.f -sectii:in':; 507(d) .:lnd 4940. 

Grantors and contr¡b~tors may rely on the determination that you are not a 

private foundation unti I 90 days after the end of your advance rul ing period. 

If you submit the required information within the 90 days, grantors and contribut'jr--; 

ii.:iy continue t" l":dy on th.,? .:1 d v.: n c..: dE-b:~nilinat¡o\i u,nti I t¡¡,, Service 

makes a final determination of your foundation status. 

35 

Letter 1045 CDO/CG)

IOWA INSTITUTE FOR LOW INCOME 

-.2- 

If notic~ that you Hi II no longer be tr~ated ~s a pubt icly supported organization 

is published in the Internal Revenue Bulletin, grantors and contributors 

may not rely on this determination after the date of such publication. 

In addition, if you lose your status as a publ icly supported organization 

and a grantor or contributor Has responsible for, or HiS aware of, the act 

or failure to act, that resulted in your 105s of such status, that person may 

not rely on this determination from the date of the act OF fai lure to act. 

Also, if a grantor or contributor learned that the Service had given notice 

that you Hould be re~oved from classification as a publicly supported organization, 

then that person may not rely on this determination as of the date such 

knec.i1edge "ias acquired.. 

If your sources of support, or your purposes, character, or method of 

eiperation changt?' please It-t us kno,,1 sei He can consider the effect eif the 

change on your exempt status and foundation status.. In the case of an amendment 

te. yeiur eirganizatic'Tlal dCicuinent eil" bYIClHs.'J plf!ase send us a CCiP'! of the 

amended document or bylaHs.. Also, you should inform us of all changt?s in your 

nal(ie eil" address. 

ti:. (if January 1, .1984, YI)U are liable f(ir ta):f:s under the FE-deròl Ins.urance 

Contributions Act (social security taxes) on remuneration of '100 or morf: 

you pay to each of your f!~ployees during a calendar year. You are not liable 

for the tax imposed under the Federal Unemployment Tax Act CFUTA).. 

Organizations that a~e not private foundations are not subject to the private 

foundation e):cise ta):es under Chapter 42 of the Ccide. HCii-evf:r, ~'Ciu are 

nc.t òutc'lIòtically e):E.i!lpt frcim other Federal e):cise ta):es. If you have any 

qUf!stic.ns abeiut e):ci5e, e~pleiyirient, or other Fedl?rëd ta):es, pleas¡~ Ii?t us 

k ne.!-i. 

(tecncirs may d£'duct con,tributions tei YCiu as pro..ided in sectic'Tr 170 of the 

Code. Bequests, legacies~ devises, transfers, 0)" gifts to you or for your use 

are d£oductible feil" Federal estate and gift ta): purpe.ses jf they mE'et the appl ¡cable 

pro..isions of sections 2055,2106, and 2522 of the Code. 

Contribution deductions ~re allQHable to donors only to the exti?nt that 

tht:ir ccintributie'Trs are gifts, Hith TICI cecnsiderati,cin rec!?ived. Tickt?t purchases 

and simi lar paym£onts in conjunction "iith fundraising events may not 

necessarily qualify as deductible contributions, depending on the cireumstanc€'s-. 

9f:e Re'lenue Rul ing 67-246, publ ished in Cumulative BUIII.:tin 19Ò7-2, 

on page 104, Hhleh sets forth guidel ¡nes regarding the deductibi i ity, as charitable 

contributions, of payments mad€' by taxpayers for admission to or other 

participation in fundraising activ¡ti€'~ for charity. 

You are required tú file Form 990, Return of Organization Exempt From 

Income Ta., only if your gross receipts each year are normally more than 

$25,000. HOHever'J jf you receive a Form 990 package in the mai I, please fi Ie 

thE. return E:ven i t you do not €-:i:Cf:t?Ò the gr(is-s, rece i pts. t:=st. If yi:cu ai"€! not 

required to file, simply attach the lab!?l provided, check the box in the head- 

36 

Letter 1045 (DO/CG)

IOWA INSTITUTE FOR iow INCOME 

..-3- 

ing to indicate that your annual gross receipts are normally $25,000 or less, 

and sign the return. 

If a l-i.;.tuxn is reqi,! i r'ed, it must be f i led .by the 15th day of the fifth 

month after the end .)f yo~r annual accounting period. A penalty of $10 a day 

is charged when a return i~ filed late, unless there is reasonable cause for 

the delay. However, the Max imum pena I ty charged cannot eKceed $5,000 or 5 percent 

of your gross receipts for the year, whichever is less. This penalty may 

a I so be charged if a return is not COMp I ete, so p i ease be sure your return is 

COl\lp i ete bef.)re y')U f i I e it. 

You are n,)t requiredt.) file Federal inc.)lle tax returns unless y.)U .are 

subject to the tax on unrel.ated business income under section 511 of the Code. 

If you are subject to this t.ax, you must fi Ie an income tax return on ForM 

990-T, Exempt Org.:iniz.ati')r\ Business Inc'jlte Tal( Return.. In this letter He .are 

not determining whether any of your present or proposed activities are unrei 

ated trade or bus i ness as def i ned insect i on 513 of the Code. 

You need an employer identification nUMber even if you have no eæployees. 

If an employer identification nu~ber was not entered on your application, .a 

number Hi i i be assigned to you and you wi Ii be advised of it. Please use 

number on a Ii returns you f i I e and ¡ n a I i correspondence Hi th the Interna I 

Revenue Service. 

If we have indicated 

in the heading of this letter that an addenduæ 

applies~ the addendum enclosed is an integral part of this letter.. 

Because this letter could help resolve any questions about y~ur exempt 

st~tus and found.ation status, you should keep it in your permanent records. 

If you have any q~estions, please contact the person whose name and 

telephone number are shoHn in the heading of this letter. 

~(jI~~ 

Ene losur'e(s~; 

Form 872-C 

37 

R. S. W¡ntrode, Jr. 

District Director 

Letter 1045 (DO/CG) 

that

: City of Des Moines 

: I-COUNT Network : 

: Total : 

- -- - ._----- 

.. 

1 2 3 4 5 6 7 

l! Continuum of Care : 

I 

'i 

~ 

Policy Planning Programming Measure Impact 

3 6 

Measure Accountability 

#N/A Beds covered by an HMIS data collection and Beds 

reporting system 

I 

1400 I A. Tools for Measurement 

#N/A #N/A Database 

I 

I 

Mgt. Info, System-manual 

#N/A #N/A Technical assistance log 

I 

I 

#N/A #N/A 

B. Where Data Maintained 

I 

I 

#N/A #N/A Centralized database 

I 

I 

#N/A #N/A 

I 

#N/A #N/A 

I 

I C. Source of Data 

#N/A #N/A Counseling reports 

I 

I 

Referrals 

#N/A #N/A Placements 

I 

w 

00 

I 

#N/A #N/A 

I 

D. Frequency of Collection 

I 

I 

#N/A #N/A Upon incident 

I 

I 

#N/A #N/A 

I 

I 

#N/A #N/A 

I 

I 

E. Processing of Data 

#N/A #N/A Relational database 

I 

I 

#N/A #N/A 

I I 

#N/A #N/A 

I I 

#N/A #N/A 

I 

I 

#N/A #N/A 

I I 

Form HUD 96010(2/2006) 

C9The Center for Applied Management Practices, Inc., 2005.








Project Name: 









Name: 

Title: 

Signature: ~.~ 

Date: 


Iowa HMIS Network - IA Institute for Community Allance NEW 






l2;:, 

5. Â:l.O& 

AlT5Tñd\ c- ~~ 

Diane Rauh, City lerk 

39 

form HUD-2991 (3/98)


Part A: General Pro. ect Information (All Projects) 

1. Project Priority Number 


Chart in Exhbitl): 2. 

2. 0 New Project 

i; Renewal Project 

3. If renewal, list previous 


identifier number (PIN) 

4. HU-Defined CoC Name: 

Des Moines/Polk Coun Iowa 

6. Applicant's Organation Name (Legal Name from SF-424) 


7.0 Check box if Applicant is a Faith-Based Organization 

l8 Check box if Applicant has ever received a federal grant, either directly from 

a federal a enc or thou h a state/local a enc 

9. Project Applicant's Address (From SF-424) 

Street: 100 East Euclid, Suite #101 

Ci : Des Moines 


Name: Robert Schulte Phone number: (515) 237-1384 

Title: Federal Program AdDUnistrator Fax number: (515) 242-2844 

Email Address: RASchulte dm oV.or 


House of Mercy Transitional Housing Program 

15. Project Address (S+C SRAs, if multiple sites list all addresses including): 

Street: 1409 Clark Street 

City: Des Moines State: IA Zip: 50314-1964 

16. 0 Check box if project is located in a Rural Area 

17. If ro'ect contain housin unts, are these unts: 0 Leased? i; Owned? 

20. Project Sponsor's Organization Name (If different from Applicant) 

House of Merc 

21. 0 Check box if Project Sponsor is a Faith-Based Organization 

l8 Check box if 

State: IA 


directl from a federal a enc or thou a state/local a enc 

23. Project Sponsor's Address (if different from Applicant) 


Ci: Des Moines State: IA Zi : 50314-1964 


Name: Todd C. Beveridge Phone number: 

Title: Director Fax number: 

Email Address: 

40 

Previous Grant Number: 

IA26BI02003 

PIN Number: 

IA20049 

5. CoC Number: 

1A-502 

8. Applicant's DUNS Number 

(From SF-424): 073498909 

10. Applicant's Employer 

Identification Number (EIN (From 

Zi : 50313 SF-424: 42-6004514 

12. 0 Check box if Project 


Sponsor 


Geogrphic Code: 191362 

18. 0 Check box if Energy Star is 

used in ths project 

19. Project Congressional Distrct(s): 

1A-03 

22. Sponsor's DUNS Number: 

867043655 

24. Sponsor's Employer 

Identification Number (EIN): 

42-1323808 

- 

~


BL. Su ortive Housing Program (SHP) (All SHP Pro'ects) 

a. SHP Pro ram c. Grant Term (New Projects must be 2 or 3 years; 


r8 D D D 0 Safe Haven/TH (Check only one box) 

TH PH SSO HMIS 0 Safe Haven/PH i: 0 0 

d. Proposed 





4. Subtotal 



From Leasin Bud et Char 


From Supportve Services Budget Char 

7. Operations 

From Operatig Budget Chart 

8. HMIS 

From HMIS Budget Ch 






otal lines 9 and 10) 



D D D 0 0 




B3. Section 8 Sin Ie Room Occu 

a. D SRO Pro ram 

b. Com onent TeD (SRO 





Re uest (Co!. e + Co!. 1) 

41,659 284,946 326,605 

234,277 271,059 505,336 

275,936 Total Budget 


13,797 Cash Match Request + Total 

Cash Match) 

289,733 556,005 845,738 

All S+C Pro' ects 



$ 

D Renewal 

1 Year 

o New 

5 Years 

(SRO) (All Section 8 SRO Pro'ects) 

c. Grant Term 

D 10 Years 

$ 

DNew 

(PRA S+C/SRO) 

10 Years 

41 form HUD-40090-2

(All P' E d d ') 

1. Housing Type* la. IZ Multi-family 


roiects xcept De icate HMIS Projects 



D Con!!re!!ate Faciltv 

rg Project Based 


a. Current 

Level 



c. Projected 

Level 

(Point-in-Time) ßf Applicable) (column a + col. b) 



44 

46 

0 

0 

44 

46 

Number of Beds 148 0 148 



Children (Family Households) 43 0 43 

i. Number of adults in families 43 0 43 

ii. Number of children in families 83 0 83 

iii. Number of disabled in famlies 


43 0 43 

Other Households w/o children 22 0 22 

i. Number of disabled individuals 15 0 15 

ii. Number of chronically homeless 3 0 3 


Congregate Facility (doTDtorv, barracks, shaed-living). 







roximate Percenta es (% 

2% 

61% 

87% 

0% 

0% 

70% 

Part E: Disehar e Polie (Only State & Local Government A licants 



1. IZ Yes D No facilities, foster care or other youth facilities, or corrections programs and 



jurisdiction? 

0% 

42 form HUD-40090-2








Type of Source of 


Contribution Contribution (G) Government* Written Written 

or (P) Private Commitment Commitment 

ExamDle: Child Care CDBG G 2/15/06 $10,000 

Cash Mercy Foundation P 04/07/06 $111,685 

Cash Mercy Medical Center P 04/07/06 $444,320 



S stems HMIS (All Pro' ects Exce t Dedicated HMIS Pro' ects) 

~ Yes D No Is this project paricipating in the HMIS? 

05 / 2001 If "Yes," what date did this project begin paricipating in the HMIS? 

mm ear If"No," enter the date the project anticipates beginnng paricipation. 

~ Yes D No Wil client-level data be included in the HMIS for all persons served by this 

roject? 


1. DYes l' No 

2. DYes l' No 

Are there any unresolved HU monitoring findings, or outstanding audit 


- 

Are there any signficant changes that you propose in the project since the last 


D Number of persons served: from to 

- 

D Number of units: from _ to 



o Change in target population. 



D Other: 


43 form HUD-40090-2





check the N/ A box and skip these Questions. o N/A 




12(a) and 12(b): 






% 





14: 

a. Number of partcipants who exited TH project(s)-inc1uding unown destiation 67 

b. Number of participants who moved to PH-from any destiation identified as permanent housing 54 


81% 

(b divided by a) x 100 = c Example: (14/ 18) x 100 = 77.7%. 






1 2 3 4 




100) 

Example: 105 a. Social Secuntv Insurance (SSn 40 38.1% 

105 b. Social Secunty Disabilty 35 33.3% 

Insurance (SSDn 

105 Co Social Secuntv 25 23.8% 

67 a. SSI 3 4.5% 

67 b. ssm 1 1.5% 

67 c. Social Security 0 0% 

67 d. General Public Assistance 0 0% 

67 e. TANF 32 47.8% 

67 f. SCHIP 0 0 

67 g. Veterans Benefits 0 0 


67 i. Unemployment Benefits 0 0 

67 i. Veterans Health Care 0 0 

67 k. Medicaid 9 13.4% 

67 1. Food Stamps 44 66.7% 

67 m. Other (please specify) 4 6% 

67 n. No Financial Resources 0 0 

44 

form HUD-40090-2


Part I: SHP Project Budgets (All SHP Projects as Applicable) (NA) 


Leased Unit(s for Housin and/or Services 


NA 



D ioO%ofFMR 



D Greater than 110% (RU a rovalletter must be attached). 

c. Size of Units d. Number e. FM or f. Number of 


SRO x x = $ 

o Bedroom x x $ 







Other: x x $ 

h. Totals: x = $ 

Leased Strcture(s licable FMR 


Address: 

State: 


Address: 

State: Zi : 

45 

g. Totals 

form HUD-40090-2

12. SHP Supportive Services Bud2et (All SHP Projects as Applicable) 



1. Outreach 

Quantity: 



Quantity: 10 FTE x ($25,520 + $7,140.50) 

Total = $326,605 


Quantity: 


Quantity: 


Quantity: 

6. mvi AIDS Services 

Quantity: 

7. Health Related & Home Health Servces 

Quantity: 


Quantity: 


Quantity: 


Quantity: 


Quantity: 


Quantity: 


Quantity: 

41,659 41,659 

14. Total SHP supportive servces dollars 


41,659 41,65 


** Total of Line 14 must match line 6 column e. on the Proiect SUUll1lU y Bud~ et. 


eligible supportive service activities. *** 28~ 28~ 



the total supportve servces budget (i.e., 80 percent ofline 14 plus line 15). The total of Line 15 must match 

line 6, column f. on the Proiect Summary Budget. 

46 

form HUD-40090-2

13. SHP Operatioe Budeet (All SHP Projects with Operating Costs) 


Operatin2 Costs Year 1 Year 2 Year 3 Total 

1. MaintenancelRepair 

Quantity: 51% of $45,000 Total: $22,950 20,000 20,000 

2. Staff 

. Direct Care Coordinator (IFTE), 82% x 

($33,738 + $9,447) = $35,412 

· Clinical Svcs. Supersor (lFTE), 82% x 

($50,752 + $14,211) = $53,270 

. Data Systems Specialist (IFTE), 82% x 

($38,626 + $10,815) = $40,542 

. Environmental Svcs. Staff (3FTE), 51 % x 

($74,314 + $20,808) = $48,512 

· Dietary Svcs. Staff (4FTE), 70% x ($111,636 + 

$31,258) = $100,026 Total: $277,762 124,277 124,277 

3. Utilties 

Quantity: 51% of $ 140,965 = Total: $71,892 40,000 40,000 

4. Equipment (lease/uy) 

Quantity: 

5. Supplies 

Quantity: 

6. Insurance 

Quantity: 


Quantity: 

8. Relocation 


persons) 

9. Food 

Quantity: 70% of $111 ,277 Total: $79,894 30,000 30,000 


Quantity: 51% of$103,604 Total: $52,838 20,000 20,000 

11. Total SBP operating dollars 

reauested in lines 1 to 10 above: ** 234,277 234,277 

*If not specified, the costs will be removed from the budget. 

** Total of Line 11 must match line 7 column e. on the Proiect Sumary Budget. 

12. Total cash match to be spent on SBP 

elh!ible operatin2 activities. *** 271,059 271,059 




47 

form HUD-40090-2


Applicable) (NA) 



fuds. Fil out an additional char for each structure. 

Address: NA Address: NA 

C" S l 

ity, tate, ip: City, State, Zip: 


i. Acquisition i. Acquisition 



4. Real Propert 4. Real Propert 


5. Supportive Services 5. Supportive Services 

6. Oprations 6. Operations 



48 

form HUD-40090-2

15. SHP HMIS Budi!et (All SHP Projects with HMIS Costs) (NA) 



Equipment 


2. Personal Computers and Printers 

3. Networking 

4. Security 

Subtotal: 


5. Softare/User Licensing 




Subtotal: 

Services 


10. Hosting/Techncal Services 


12. Programing: System Intedace 


14. Securty Assessment and Setup 




Subtotal: 

Personnel 






Subtotal: 




Subtotal: 

25. Total SlI HMS dollars requested 


* Total of Line 25 must match line 8 column e. on the Project Summary Budget. 


on SLI eligible HMS activities: ** 

** Cash Match can be spent on any SHP eligible activity (see the chart in Section III.A.3. of the NOFA for these 


budget (i.e., 80 percent of line 25 plus line 26). 

49 

form HUD-40090-2

Part J: Shelter Pius Care and Section 8 SRO Project Budgets (NA) 


Jl . Sh e terI PI us are CdS an ection 8 SRO enta R I ssistance A. B u d iget 

a. Check the box to indicate the type of program: D S+C (J Section 8 SRO (NA) 






D Greater than 110% (RU approval letter must be attached). 


Of Units Actual Rent Months 

SRO x x = $ 













Single Room Occupancy (SRO) Pro.iect Budget 

a. List below an estimate of the total costs of developing the S+C/SRO :Jroiect: 

Type Amount 


Acquisition: 

Other Costs (Eligible & Ineligible, e.g., furnture): 

Total: $ 



Source Amount 

50 

Total: $ 

form HUD-40090-2

Section III: New Project Narratives (NA) 



NA 

2. Enter the percentage of homeless paricipants(s) that wil be served (N/A for dedicated HMIS 

projects): 

_% Persons who came from the street or other locations not meant for human habitation.* 


_ % Persons in TH who came directly from the street or Emergency Shelters. * 



would meet the HU homeless definition (use less than one-quarer page). 

*This includes persons who ordinarly sleep in one ofthe above places but are spending a short 


3. Describe the outreach plan to bring these homeless paricipants into the project. 


schools, etc.) be readily accessible (e.g., walkng distance, near bus line, etc.) to your clients? 



List residents' maximum allowable length of stay: _ months 




neighborhood. 

7. For Shelter Plus Care TRA projects only: Wil participants be required to live in paricular 

structues or units durng the first year and in a particular area within the locality in subsequent 

years, or to live in a paricular area for the entire period of paricipation? 0 Yes 0 No 

Explain how and why the project wil implement this requirement (use less than one-halfpage). 



other organzations wil have in operating and maintaining the property. 


photograph. 



51 

form HUD-40090-2


activities that you are currently providing? D Yes 0 No 

If Yes, check one or more of the activities below that describe. your proposed project. 


serve homeless persons may only receive SHP funding 




for the four purposes listed below. 





D Replace the loss of nonrenewable fuding from private, Federal, or other sources (except 


By law, no SHP funds may be used to replace state or local governent fuds previously used, 








d. Document the specific steps you took to obtain other funding, why there are no other 


Part L: Supportive Services the Participants Win Receive (NA) 

All new ro . ects exce t Dedicated HMIS Pro' ects 




D Life skills (outside of case management) D Em 10 ent Services 

D Job trainin D Child Care 

D Alcohol and Dru Abuse Services D Trans ortation 

D Mental Health and Counselin Services D Transitional Living Services 

D HIV / AIS Services D Other (must s ecif *) 

2. Generally speaking, what is the scale (the frequency) ofthese services? 

Scale: D Daily D Weekly 0 Bi-monthly D Monthly D Other:_ 

Part M: Accessing Permanent Housing (NA) 

1. Describe specifically how participants wil be assisted both to obtain and also remain in 


52 form HUD-40090-2

Part N: Participant Self-Sufficiency (NA) 

1. Describe specifcally how participants wil be assisted both to increase their employment and/or 



wil assist these persons to address their needs. 

Part 0: Ex erience Narrative A) 

1. List the specific type and lengt of experience of all organzations involved in implementing the 




and overseeing the constrction or rehabilitation of housing or administering rental assistance, 


applicants. 


state/local agency? 0 Yes 0 No 

If Yes, 





needed. 




(NOF A). 

c. Identify any unesolved HU monitoring findings, or outstanding audit findings related to 

any ofthe grants listed in (2a). 

3. Is the applicant or sponsor a nonprofit organzation (rather than a state or unit oflocal 

Governent)? 0 Yes 0 No 

if Yes, one of the following must be attached for each organization: 

a. IRS ruling, providing tax-exempt status under Section 501 C (3) ofthe IRS Code of 1986, as 

amended, or documentation of nonprofit status as described in the Glossary in Section LA. 7 of 





53 

form HUD-40090-2

Part P: HMIS Narrative (Dedicated HMIS Projects ONLY) (NA) 

1. Describe how the CoC's homeless needs will be assessed, resources allocated, and services 


HMIS. 


permanent housing) listed in the "Curent Inventory in 2006" categories in the Fundamental 


HMIS. 



5. Demonstrate that no state or local governent funds would be replaced with the fuding being 


54 

form HUD-40090-2

: Cit of Des Moines 

: House of Merc Transitional Livin 

Total 


ui 

ui 

C9The Center for Applied Management Practices, Inc., 2005. Form HUD 96010(2/2006)








Project Name: 









Name: 


House of Mercy Transitional Housing (renewal) 





SiP~~:: ;l;æß- 

AT:~~~~ 

Diane Rauh. City Clerk 

56 

form HUD-2991 (3/98)

Email Address: tbeveridgea4mercvdesmoines.or 



42-1323808 

22. Sponsor's DUNS Number: 

867043655 

18. i: Check box if Energy Star is 



IA-03 





Sponsor 


Identification Number (EIN) (From 

SF-424): 42-6004514 


IA26B402004 

PIN Number: 

IA20001 

5. CoC Number: 

IA-502 


(From SF-424): 073498909 

57 



17. Ifproject contain housing unts, are these unts: 0 Leased? i: Owned? 

20. Project Sponsor's Organization Name (If different from Applicant) 

House of Merc 

21. o Check box if Project Sponsor is a Faith-Based Organization 

i: Check box if Project Sponsor has ever received a federal grant, either 

directly from a federal agency or though a state/local agenc 





Name: Todd C. Beveridge Phone number: (515) 643-6500 

Title: Director Fax number: (515) 643-6598 

State: IA Zip: 50316 


Street: 1240 East 12th Street 




House of Mercy at Capitol Park 

i: Renewal Project 

2. 0 New Project 

City: Des Moines 




Des Moines/Polk County CoC 

6. Applicant's Organiation Name (Legal Name from SF-424) 


7.0 Check box if Applicant is a Faith-Based Organiation 

i: Check box if Applicant has ever received a federal grant, either directly from 

a federal agency or though a state/local agenc 


Street: 100 East Euclid, Suite #101 

City: Des Moines State: IA Zip: 50313 


Name: Robert A. Schulte Phone number: (515) 237.1384 

Title: Federal Programs Administrator Fax number: (515) 242-2844 

Email Address: RASchultetWdmiwv.or 



Chart in Exhbitl): -- 

Part A: General Proiect Information (All Projects) 

Section I: Project Summary Information


Bl. Su ortive Housin Program (SHP) (All SHP Projects) 

a. r8 SHP Pro ram c. Grant Term (New Projects must be 2 or 3 years; 

b. Component Types (Check only one box) Renewals or HMIS projects can be 1,2 or 3 years) 

D r8 D D D Safe Haven/TH (Check only one box) 

TH PH SSO HMIS D Safe Haven/PH r8 D D 

d. Proposed 





4. Subtotal 


5. Real Propert Leasing 




7. Operations 

From Operatig Budget Char 

8. HMIS 

From HMIS Budget Ch 








a. D S+C Pro ram 


D D D D D 





a. 




153,424 42,547 195,971 

63,213 27,511 90,724 


Total 

Cash Match 

(Total SHP 


10,832 

Cash Match) 

227,469 70,058 297,527 

All S+C Pro' ects 



$ 

$ 

D Renewal 

1 Year 

DNew 

5 Years 

DNew 

(PRA S+C/SRO) 

10 Years 

58 form HUD-40090-2 

( .d?(\(\~\


(All rOJec P . st xcepi E t D ed ica t ed HMIS P rOJec . t) s 

1. Housing Type* la. ~ Multi-family 


lb. rg Scattered Site 


D Congregate Facilty 





Number of Bedrooms 15 0 15 







iii. Number of disabled in families 8 0 8 





*Housing Types: Multi-family (apartents, duplexes, SROs, other buildings with 2 or more units); Single-family; 

Congregate Facility (dormtory, barracks, shared-living). 







roximate Percenta es (%) 

10% 

100% 

90% 

0% 

0% 

80% 

Part E: Disehar e PoUe Onl State & Local Governent A plicants) 



1. (: Yes D No facilities, foster care or other youth facilities, or corrections programs and 



jursdiction? 

59 

0% 

form HUD-40090-2









Contribution 


Contribution 





Written 

Commitment 


Written 

Commitment 

Examole: Child Care CDBG G 2/15/06 $10,000 

Cash 

Cash 

Mercy Medical Center 

Mercy Medical Center 

P 

P 



$42,547 

$27,511 



S stems HMIS (All Pro'ects Exce t Dedicated HMIS Pro'ects 

rg Yes D No Is this project paricipating in the HMIS? 

09 / 05 If "Yes," what date did this project begin participating in the HMIS? 

"No," enter the date the project anticipates beginning participation. 

(mmyear If 

rv ~ Y D es N Will o. client-level t? data be included in the HMIS for all persons served by this 

ro ec . 


1. DYes IZ No 


findings related to ths project? If "Yes," briefly describe. 




D Number of units: from _ to 

~ Location of project sites. 


2.1Z Yes DNo D Change in target population. 



D Other: 

Please explain changes: An executed grant amendment changed the location 

of the Bailey House Project. 26 beds for permanent housing (PH) for persons with 

disabilities. to House of Mercy at Capitol Park. The housing strctue for the PH 

component allows for 16 or fewer persons in a single strctue. As the proiect was 

brought up to full capacity. a second site was added to meet this expectation. 

60 form HUD-40090-2


(For all S+C, SHP-PH, SHP- TH, SHP-Safe Haven, and SSG Renewals): 



check the N/A box and skip these questions. ~ N/A 




12(a) and 12(b): 






% 





14: 

a. Number of participants who exited TH proiect(s)-including unkown destination 

b. Number of participants who moved to PH-from any destination identified as peranent housing 


% 







1 2 3 4 




100) 





a. SSI 

b. ssm 



e. TAN 

f. SCHIP 




i. Veteran Health Care 

k. Medicaid 

1. Food Stas 

m. Other (please specify) 


66 form HUD-40090-2



11. SHP Leasin Bud et (All SHP Pro'ects with Leasin 

Leased Unit s for Housin and/or Services 








c. Size of Units d. Number e. FMR or f. Number of 

of Units HUn Paid Rent Months 

SRO x x $ 









h. Totals: x x = $ 

Leased Strctue( s licable FMR 


Address: 

State: Zip: 


Address: 

State: Zi : 

67 

g. Totals 


I A ('lnnc\

12. SHP Supportive Services Bud2et All SHP Proiects as Applicable) 


1. Outreach 

Quantity: 


Year 1 



Quantity: 2.5 FTE ~ $13.43 per hr. x 2,080 hrs. 

($69,836) + 29% Benefit ($20,252) = $90,088 


Quantity: 


75,424 75,424 

Quantity: IFTE ~ $ i 7 per hr. x 2,080 ($35,360) 

+ 29% Benefit ($10,254) = $45,614 


35,000 35,000 

Quantity: .2FTE ~ $18 per hr. x 2,080 hrs. 

($7,488) + 29% Benefit ($2,172) = $9,660 

6. mv/AIS Services 

Quantitv: 


Quantitv: 


4,000 4,000 

Quantity: .IFTE ~ $17 per hr. x 2,080 hrs. 

($3,536) + 29% Benefit ($1,025) = $4,561 


2,000 2,000 


($7,072) + 29% Benefit ($2,051) = $9,123 


5,000 5,000 

Quantity: 3 slots per day ~ $34 per slot x 241 

days = $24,582 


Quantity: 


Quantity: 

13. Other Clinical Supervision 

22,000 22,000 


($9,568) + 29% Benefit ($2,775) = $12,343 

10,000 10,000 

14. Total SlI supportive services dollars 

153,424 153,424 

reauested in lines 1 to 13: ** 


** Total of Line 14 must match line 6 column e. on the Proiect Summry Budget. 

15. Total cash match to be spent on SlI 

42,7 42,7 

elii?:ible supportive service activities. *** 

*** Cash Match can be spent on any SHP eligible activity (see the chart in Section IILA.3. of the NOF A 



line 6, column f. on the Proiect Summary Budget. 

68 


I A ''lnnc\

13. SHP Operatin2 Bud2et (All SHP Projects with Operating Costs) 


Operating Costs Year 1 Year 2 Year 3 Total 


Quantity: $700 per month = $8,400 4,517 4,517 

2. Staff 

Quantity: .2FTE (l $19.49 per hr. x 2,080 hrs. 

($8,108) + 29% Benefit ($2,351) = $10,229 7,000 7,000 

3. Utilties 

Quantity: $2,000 per month = $24,000 23,000 23,000 

4. Equipment (leaselbuy) 

Quantity: 

5. Supplies 

Quantity: 

6. Insurance 

Quantity: $.20 per square foot x 7,550 = $1,510 500 500 

7. Furnishings -Replacement Furishings 

Quantity: 2 - bunk beds ($1,120); 1 - ladder and 

railing ($253); 4 - mattesses ($720); 3 - desks 

($1,776); 3 - dressers ($1,836) = $5,705 2,696 2,696 

8. Relocation 


persons) 

9. Food 

Quantity: 

10. Other Operating Activity: Securty 

Quantity: Securty servces x 8 hrs. per day 

($14.00 per hr.) x 365 days = $40,880 25,500 25,500 


requested in lines 1 to 10 above: ** 63,213 63,213 

*1£ not specified, the costs will be removed from the budget. 

** Total of Line II must match line 7 column e. on the Project Summry Budget. 


eli2ible operatinl! activities. *** 27,511 27,511 


11) must be no more than 75 percent ofthe total operations budget (i.e., 75 percent of line 11 plus line 12). 

The total of Line 12 must match line 7, column f. on the Project Summary Budget. 

69 

form HUD-40090-2


Applicable) (NA) 



funds. Fil out an additional char for each structure. 

Address: NA Address: NA 



1. Acquisition 1. Acquisition 


3, New Constrction 3. New Constrction 

4. Real Property 4. Real Propert 






15. SHP HMIS Bud2et (All SHP PrQiects with HMIS Costs) 



Equipment 



3. Networking 

4. Securty 

Subtotal: 






Subtotal: 

Services 




12. Programing: System Interface 






Subtotal: 

Personnel 



70 

form HUD-40090-2


21. Techncal Assistance and Training 


Subtotal: 




Subtotal: 



* Total of Line 25 must match line 8 column e. on the Proiect Summarv Budeet. 



** Cash Match can be spent on any SHP eligible activity (see the char in Section IILA.3. of the NOF A for these 

activities). The amount of the SHP HMIS request (entered in line 25) must be no more thn 80 percent of the total HMIS 

bud~et (i.e., 80 percent ofline 25 plus line 26). 

71 


(4?OOR)


(All S+C and SRO Projects as Applicable) (NA) 

Jl Sh It PI CdS t 8 SRO R t I A . t B d t 

. e er us are an ec ion en a SSIS ance u ige 

a. Check the box to indicate the type of program: D S+C (J Section 8 SRO 





D 101 % to 110% of FMR (PHA approval letter must be attached). 

D Greater than 110% (HU approval letter must be attached). 



SRO x x = $ 










*Please be advised that the actual FMRs used in calculating your S+C or SRO grant wil be those in 



Sin21e Room Occupancy (SRO) Pro_iect Budget 

a. List below an estimate of the total costs of developing the S+C/SRO Jroject: 

Type Amount 


Acquisition: 

Other Costs (Eligible & Ineligible, e.g., furntue): 

Total: $ 



Source Amount 

72 

Total: $ 


IAI'lnnl:\

Section III: New Project Narratives (NA) 



NA 

2. Enter the percentage of homeless paricipants(s) that will be served (N/A for dedicated HMIS 

projects): 

_ % Persons who came from the street or other locations not meant for human habitation. * 



_ % Total of above percentages. If the total is less than 100%, describe very specifically 



*This includes persons who ordinarly sleep in one of the above places but are spending a short 





DYes, very accessible D Somewhat accessible 0 Not accessible 





development of a project ofthis size and how the housing wil be integrated into the 

neighborhood. 

7. For Shelter Plus Care TRA projects only: Wil paricipants be required to live in paricular 

structues or unts durng the first year and in a particular area within the locality in subsequent 

years, or to live in a paricular area for the entire period of participation? DYes 0 No 

Explain how and why the project wil implement this requirement (use less than one-half page). 





photograph. 



73 


IAl?nn¡:1





serve homeless persons may only receive SHP fundingfor thefour purposes listed below. 


o Increase the number of 


o Provide additional supportive services for residents of supportive housing and/or homeless 


o Bring existing facilities up to a level that meets state and local governent health and 


o Replace the loss of nonrenewable funding from private, Federal, or other sources (except 






a. The source ofthe nonrenewable funding, indicating that it is not under the control of 





sources of fuding and why, without the SHP assistance, the activity will cease. 


All new ro . ects exce t Dedicated HMIS Pro' ects A 



o Case mana ement 0 Education and Instrction 

case mana ement) 0 Em loyment Services 

o Life skills (outside of 

o Job trainin 0 Child Care 

o Alcohol and Dru Abuse Services 0 Trans ortation 

o Mental Health and Counselin Services 0 Transitional Livin Services 

o HN/AIDS Services 0 Other (must s ecif *) 

2. Generally speakng, what is the scale (the frequency) ofthese services? 

Scale: 0 Daily 0 Weekly 0 Bi-monthly D Monthly 0 Other:_ 


1. Describe specifically how participants will be assisted both to obtain and also remain in 


74 


/ A ~,)(\(\/0 \

Part N: Partici ant Self-Sufficienc (NA) 

1. Describe specifcally how paricipants wil be assisted both to increase their employment and/or 




Part 0: Ex erience Narrative A) 




as well as their overall experience workig with homeless people. For projects contracting for 



applicants. 


state/local agency? DYes D No 

If Yes, 

a. List all HU McKiey-Vento Act grants, other than ESG, received after 1999, including 




needed. 


b. Please explain any delays in implementing any ofthe grants listed in (2a) above which 


(NOF A). 



3. Is the applicant or sponsor a nonprofit organization (rather than a state or unit oflocal 

Governent)? DYes D No 

UYes, one of the following must be attached for each organization: 







75 


fd/?OOR\

Part P: HMIS Narrative (Dedicated HMIS Projects ONLY) (NA) 



HMIS. 




HMIS. 





76 

form HU-40090-2 

fA I?()\t'\

1 

.. 

(ÇThe Center for Applied Management Practices, Inc., 2005. Form HUD 96010(2/2006)








Project Name: 









Name: 


House of Mercy at Capital Park (renewal) 


2006 Shelter Plus Care (S+C) 



Til, I M~::(, /es MO;~, IO/J V 

Signature: ~ 


AmST.ì:-: ~~ 

Diane Rauh, City Clerk 

78 

form HUD-2991 (3/98)


P tAG I P t I £ t" (All ) 

. ar . en era ro.1 ec norma ion Projects 




2. o New Project IA26B102002 



(8 Renewal Project 

PIN Number: N/A 

Chart in Exhibit 1 ): _5_ identifier number (PIN) 

4. HUD-Defined CoC Name: 5. CoC Number: 

Des Moines/Polk County CoC IA-502 

6. Applicant's Organization Name (Legal Name from SF-424) 8. Applicant's DUNS Number 

City Of Des Moines 


(8 Check box if Applicant has ever received a federal grant, either directly from 


(From SF-424): 

07-349-8909 


Street: 100 E. Euclid, Suite 101 Identification Number (EIN) (From 

City: Des Moines State: Iowa Zip:50313 SF-424): 42-6004514 




Phone number: (515) 237-1384 

Fax number: (515) 242-2844 

Email Address: RASchulte~dmgov.or 



Sponsor 

13. Project Name: YMCA Transitional Housing Program 14. Project's location 6-digit 



Street: 101 Locust Street used in this project 

City: Des Moines State: Iowa Zip: 50309 19. Project Congressional District(s): 

16. 0 Check box if project is located in a Rural Area IA-03 

17. Ifproiect contain housing units, are these unts: 0 Leased? (8 Owned? 


YMCA of Greater Des Moines 06-277-3668 

21. (8 Check box if Project Sponsor is a Faith-Based Organization 


directlv from a federal agency or though a state/local agency 

(8 Check box if 


Street: 101 Locust Street Identification Number (EIN: 

City: Des Moines State: Iowa Zip: 50309 42-0680438 


Name: Vernon Delpesce Phone number: (515) 471-8515 

Title: President/CEO Fax number: (515) 471-8558 

Email Address: vernon.delpesce(ii¡diiviica.org 

79 




Bl. Supportive Housing Program (SHP) (All SHP Projects) 

a. (8 SHP Pro ram c. Grant Term (New Projects must be 2 or 3 years; 


o 0 C8 D D Safe Haven/TH (Check only one box) 

TH PH SSO HMIS D Safe Haven/PH C8 D D 

d. Proposed 





4. Subtotal 

(Lines 1 through 3) 




From Supportive Services Budget Chart 

7. Operations 


8. HMIS 



lines 4 through 8) 

(Subtotal 


(U to 5% of line 9) 




a. 0 S+C Pro ram 

ODD D D 


TRA SRA PRA PRAR S+C/SRO 






$97,349 $38,370 $135,719 

$97,349 Total Budget 


$4,868 Cash Match Request + Total 

Cash Match) 

$102,217 $38,370 $140,587 

(All S+C Pro' ects 



o Renewal 

1 Year 

o New 

5 Years 

B3. Section 8 Sin Ie Room Occu ancy (SRO) (All Section 8 SRO Pro'ects) 


c. Grant Term 

b. Com onent TeD (SRO) 

D 10 Years 



$ 

$ 

o New 


10 Years 

80 form HUD-40090-2 

14/?OOhl


(All roi ects P' xcept E D ed icate d HMIS P' rOJects ) 

1. Housing Type* la. (8 Mult-family 

(Check all that apply) o Single-family 

lb. 0 Scattered Site 

(8 Project Based 

o Con~re~ate Facilty 



(Point-in- Time) (If ADDlicable) (column a + co!. b) 

Number of Units 120 transitional 120 transitional 




(188 total units) (188 total units) 







Other Households w/o children 163 

i. Number of disabled individuals 95 

ii. Number of chronically homeless 4 

*Housing Types: Multi-family (aparents, duplexes, SROs, other buildings with 2 or more units); Single-family; 

Congregate Facility (donntory, baracks, shared-living). 







1. Homeless Subpopulations 2. Approximate Percenta~es (%) 

Chronically Homeless (as defined by HUD) 2% 

Severely Mentally ILL 19% 

Chronic Substance Abusers 9% 

Veterans 30% 

Persons with HIV/AIDS 0 

Victims of Domestic Violence 0 

Unaccompanied Youth 0 

(Under 18 years of a2e) 

Part E: Dischar e Polic (Only State & Local Government Applicants) 



1. (8 Yes 0 No facilities, foster care or other youth facilities, or corrections programs and 



. urisdi cti on? 

81 form HUD-40090-2 



HU homeless program funding is limited and can provide only a portion ofthe resources needed to 

successfully address the needs of homeless families and individuals. HUD encourages applicants to 






Contribution 


Contribution 





Written 

Commitment 


Written 

Commitment 

Example: Child Care 

Cash 

Cash 

Cash 

CDBG 

ESGP 

FEMA 

Resident's Rent 

G 

G 

P 

G 2/15/06 

4/21/05 



$10,000 

$13,440 

$7,532 

$304,399 


Documentation shows leveraging commitments totaling $490,391 to the YMCA Men's Residence 

Program. These commitments are for all programs of the Men's Residence. This application is for 120 

beds of the 188 total beds to be designated for Permanent Housing, equating to sixty four percent of 

total occupancy. The amounts listed in the Project Leveraging Chart above reflect sixty four percent of 

total dollar commitments to correspond with sixty four percent occupancy. 


S stems HMIS (All Pro'ects Exce t Dedicated HMIS Projects) 

~ Yes 0 No Is this project paricipating in the HMIS? 

"Yes," what date did this project begin paricipating in the HMIS? 

OS/2001 If 

(mmyear) If 


~ Yes 0 No Wi~l client-level data be included in the HMIS for all persons served by this 

pro ect? 


1. 0 Yes ~No 



82 



2. 0 Yes rg No 




D Number of units: from to- 

D Location ofproject site;- 





D Other: 



(For all S+C, SHP-PH, SHP-TH, SHP-Safe Haven, and SSO Renewals): 



check the N/A box and skiD these questions. D N/A 




12(a) and 12(b): 




d. Ofthose who did not leave, how many stayed 7 months or longer in PH-APR question 12(b) 


% 




Complete the following chart using data based on the preceding operating year from APR Question 

14: 

a. Number ofoarticioants who exited TH project(s)-including unlalOWl destination 

343 

b. Number of participants who moved to PH-from anv destination identified as permanent housinl! 

110 



32% 






1 2 3 4 



in each row) 

of Income (Col. 3 7 Co!. 1 x 

100) 

ExamDle: 105 a. Social Security Insurance (SSn 40 38.1% 




a. SSI 16 4.6 

83 form HUD-40090-2 


. SSDI 7 2 

c. Social Security 7 2 

d. General Public Assistance 19 5.5 

e. TANF 0 0 

f. SCHIP 0 0 

g. Veterans Benefits 5 1.5 

h. Employment Income 53 15.5 

i. Unemployment Benefits 3 .8 

i. Veterans Health Care 0 0 

k. Medicaid 0 0 

i. Food Stamps 4 1. 

m. Other (please specify) 3 .8 

n. No Financial Resources 226 66 

84 






Leased Unites) for Housing and/or Services 









SRO x x $ 









h. Totals: x x $ 

Leased Strctue(s licable FMR 


Address: 

State: Zip: 


Address: 

State: Zi : 

85 form HUD-40090-2 


12 . SHP Supportive Services B u d (get (All SHP Proi ects as A \.pp. l ica bI) e 


1. Outreach 

Year 1 



Quantity: 3.0 FTE (Salary & Benefits) 

3 ca $38,668 = $116,004 - Year 1 


Quantity: 

3. Life Skills (outside of case management) 

Quantity: 


Quantity: 


Quantity: 

6. mvi AIDS Services 

Quantity: 


Quantity: 


Quantity: 


Quantity: 


Quantity: 


Quantity: 480/month x $1 x 12 months = $5,760 


Quantity: 

13. Other: Residence Director 

Case Management Supervision 

Quantity: 0.25 FTE (Salary & Benefits) 

$13,975 - Year 1 

$97,349 $97,349 

14. Total 8HP supportive services dollars 


$97,349 $97,349 


* * Total of Line 14 must match line 6 column e. on the Proj ect Summary Budget. 


elii?ible supportive service activities. *** $38,390 " $38,390 

*** Cash Match can be spent on any SHP eligible activity (see the chart in Section I1I.A.3. of the NOFA 


the total supportive services budget (i.e., 80 percent ofline 14 plus line 15). The total of Line 15 must match 


86 



13 . SHP 0'peratin~ B u d l~et (All SHP PrOJects wit 'hOJperating c osts) 




Quantity: 

2. Staff 


3. Utilties 

Quantity: 

4. Equipment (leasefbuy) 

Quantity: 

5. Supplies 

Quantity: 

6. Insurance 

Quantity: 


Quantity: 

8. Relocation 



persons) 

9. Food 

Quantity: 


Quantity: 

11. Total SlI operating dollars 




12. Total cash match to be spent on SLI 

elieible operatin~ activities. *** 



The total of Line 12 must match line 7, colum f. on the Project Summary Budget. 


Applicable) 


funds. Fil out an additional chart for each strcture. 

Structure A 

Address: 

Citv, State, Zip: 






Leasing 


6. Operations 

7. HMIS 

8. Total 

87 

Structure B 

Address: 

C" itv, S tate, Z'ip: 




4. Real Propert 

Leasing 


6. Operations 

7. HMIS 

8. Total 




IS . SHP HMIS B U d 1get (All SHP P roiects wit . hHMIS C osts) 



Equipment 



3. Networking 

4. Security 

Subtotal: 


5. Software/User Licensing 



8. Supporting Software Tools 

Subtotal: 

Services 

9. Training by Third Parties 









Subtotal: 

Personnel 



20. Programing 



Subtotal: 




Subtotal: 

25. Total SHP HMIS dollars requested 


* Total of Line 25 must match line 8 column e. on the Pro,ject Summary Bud2et. 



** Cash Match can be spent on any SHP eligible activity (see the chart in Section IILA.3. of 

activities). The amount of the SHP HMIS request (entered in line 25) must be no more than 80 percent of 


88 

the NOFA for these 

the total HMIS 






. e er us are an ec ion en a SSIS ance u i~e 

a. Check the box to indicate the type of program: Ds+c o Section 8 SRO 









SRO x x = $ 













Sin21e Room Occupancy (SRO) Project Bud2et 

a. List below an estimate of the total costs of developing the S+C/SRO project: 

Type Amount 


Acquisition: 


Total: $ 



Source Amount 

89 

Total: $ 





1. Provide a general description ofthe new project (use less than one-half 

page). 


projects): 



_% Persons in TH who came directly from the street or Emergency Shelters. * 




*This includes persons who ordinarily sleep in one of the above places but are spending a short 





D Yes, very accessible D Somewhat accessible D Not accessible 






neighborhood. 

7. For Shelter Plus Care TRA projects only: Will paricipants be required to live in paricular 

structures or units during the first year and in a particular area within the locality in subsequent 

years, or to live in a paricular area for the entire period of paricipation? DYes D No 

Explain how and why the project will implement this requirement (use less than one-half 




page). 


photograph. 



90 




activities that you are currently providing? 0 Yes 0 No 





o Increase the number of homeless persons served. 








or designated for use, to assist homeless persons (see 24 CFR 583. 150(a)). 



a. The source ofthe nonrenewable funding, indicating that it is not under the control of 



c. When it will cease. 


sources of funding and why, without the SHP assistance, the activity will cease. 


r All new projects except Dedicated HMIS Projects) 

1. What types of supportive services are proposed that would fit the needs of 

the paricipants? 


o Case management o Education and Instruction 

o Life skills (outside of case management) o Employment Services 

o Job training o Child Care 

o Alcohol and Drug Abuse Services 

o Mental Health and Counseling Services 

o HIV / AIDS Services 

2. Generally speaking, what is the scale (the frequency) of 

o Transportation 

o Transitional Living Services 

o Other (must specify *) 

these services? 

Scale: 0 Daily 0 Weekly 0 Bi-monthly 0 Monthly 0 Other: _ 




91 form HUD-40090-2 



1. Describe specifically how participants will be assisted both to increase their employment and/or 











applicants. 



If Yes, 



Only list HUD-issued grant numbers. If you are unclear about the HU grant number 

assigned to any project, please contact your HUD field offce for assistance. Add rows as 

needed. 



Date 


exceed the applicable timeliness standards described in the Notice of 

Funding Availability 

(NOF A). 

c. Identify any unresolved HUD monitoring findings, or outstanding audit findings related to 






amended, or documentation of nonprofit status as described in the Glossary in Section I.A.7 of 





92 






HMIS. 



Components in the CoC System - Housing Inventory Chart will be included in the CoC-wide 

HMIS. 




requested ofHUD for this project. 

93 

form HU-40090-2 



: ~iverfront YMCA Transitional Housin~ 

: 

- ..;1, 

: Total 

; 

: 

- u_.p'-___.... ''''U~. 

: 

I 

-l~;"" 

~ 

, ' 

1 2 3 4 

Policy 5 

Planninçi Proçiramming 

6 

Measure 

7 

c f Homeless individuals Impact 

Case Management-all 

Measure Accountability 

lack the skills and 

Participants Homeless participants moved to permanent 

Participants 

500 housing - all 

income to obtain and I 

Employment assistance.all 

250 

I A. Tools for Measurement 

maintain their 

Participants Homeless participants obtained employment-all 

Participants Intake log 

permanent housing. 125 I 

Transportation-all 

125 I Mgt. Info. System-automated 

Participants Beds covered by an HMIS data collection and 

Beds Plans 

250 reporting system 

I 

188 

I 

Questionnaire 

#N/A 

#N/A 

I 

I B. Where Data Maintained 

#N/A 

#N/A Individual case records 

I 

I 

Centralized database 

#N/A #N/A 

I 

I 

#N/A 

#N/A 

I 

C. Source of Data 

#N/A Referrals 

I 

Employment records 

#N/A Health records 

I 

Legal documents 

#N/A Payment vouchers 

I D. Frequency of Collection 

#N/A Monthly 

I 

#N/A 

I 

CD 

~ 

#N/A 

I 

#N/A 

I 

#N/A 

I 

I 

#N/A 

#N/A 

I 

#N/A #N/A 

I 

I 

I 


#N/A #N/A Computer spreadsheets 

I 

I 

Statistical database 

#N/A #N/A 

I 

#N/A #N/A 

I 

I 

#N/A #N/A 

I 

I 

I 

#N/A #N/A 

I 

I 

(9The Center for Applied Management Practices, Inc., 2005. 

Form HUD 96010(2/2006)



u.s. Department of Housing 





Project Name: 









Name: 


YMCA - Transitional Housing (renewal) 





s¡gn:~::~C~. 

Date: 

.5 2. 2. .ùto 

ATTEST: 


95 

form HUD-2991 (3/98)



1. Project Priority Number 2. 0 New Project 

(From Project Priority 1' Renewal Pro1iect 

Chart in Exhbit!): _6 i. J 

4. HO-Defined CoC Name: 

Des MoinesIolk Coun CoC 



7. Check box if Applicant is a Faith-Based Organiation 

t8 Check box if Applicant has ever received a federal grant, either diectly from 

a federal a enc or thou h a state/local a enc 


Street: 100 E. Euclid, Suite 101 

Ci : Des Moines State: IA 



identifier number (PIN 

Zi : 50313 


Name: Robert Schulte Phone numer: 515-237-1384 

Title: Federal Program Administrator Fax number: 515-242-2844 

13. Project Nam: 

Lighthouse Host Home 

Email Address: RAchulte d oV.or 

15. Project Address (S+C SRAs, ifmultiple sites list all addresses includig): 

Street: 1216 Martin Luther King Parkway 

City: Des Moines State: IA 

16. D Check box if project is located in a Rural Area 

17. If ro' ect contain housin unts, are these unts: 0 Leased? 0 Owned? 

20. Project Sponsor's Organtion Name (If dierent from Applicant) 

Youth and Shelter Servces, Inc 

21. Check box if Project Sponsor is a Faith-Based Organiation 

Project Sponsor ha ever received a federal grant, either 

t8 Check box if 

diectl from a federal a enc or thou h a state/local a enc 

23. Project Sponsor's Address (if dierent from Applicant) 

Street: 1219 Buchanan 

Ci : Des Moines State: IA Zi : 50316 


Name: JimMcWeeny Phone 

Zip: 50314 

numer: 515-265-1222 

Title: Resources Coordintor Fax number: 515-266-8377 

Email Address: 'mcween 

96 


IA26B302002 

PIN Number: IA20031 

5. CoC Numr: IA502 


(From SF-424): 073498909 


Identication Numer (ErN (From 

SF-424 : 42-6004514 



Sponsor 


Geographic Code: 199153 & 191362 

18. (8 Check box if Energy Sta is 

used in th project 


IA03 

22. Sponsor's DUNS Numer: 

05-50-5589 


Identication Numer (ErN: 

42-1051609 

ss.ames.Ia.us


Bl. Su ortive Housin Pro ram (SHP) (All SHP Pro'ects) 

a. (8 SHP Pro ram c. Grant Term (New Projects must be 2 or 3 years; 


(8 0 0 0 0 Safe Haven/TH (Check only one box) 

TH PH SSO HMIS 0 Safe Haven/PH t8 0 0 

d. Proposed 





4. Subtotal 





From Supportive Services Budget Cha 

7. Operations 

From Operatig Budget Chart 

8. HMIS 

From HMS Budget Cha 






lines 9 and 10) 

(Total 


a. D s+c Pro ram 


o 0 0 0 0 






b. Com onent TeD SRO 





Re uest (Co!. e + Co!. t) 

$10,833 $10,833 

$165,338 $41,335 $206,673 

$96,489 $32,163 $128,652 

$1,012 $253 $1,265 

$273,672 

$13,683 

All S+C Pro. ects 

Total 

Cash Match 

$287,355 $73,751 

Total Budget 

(Total SHP 


Cash Match) 

$361,106 



$ 

$ 

97 

o Renewal 

1 Year 

o New 

5 Years 

o New 

(PRA S+C/SRO) 

10 Years 




(All fOJ ects P' xcept E D d e icate d HMIS P' rOJects ) 

1. Housing Type* la. k8 Multi-family 



D Conereeate Facilty 

C8 Project Based 


a. Current 

Level 



c. Projected 

Level 

(Point-in- Time) (If ADDlicable) (column a + col. b) 

Number of Units 1 1 

Number of Bedrooms 8 8 

Number of Beds 20 20 

3. Participants 8 8 



i. Number of adults in families 10 10 

ii. Number of children in families 10 10 







Congregate Facility (dormtorv, baracks, shaed-living). 







1% 

1% 

50% 

50% 

Part E: Dischar e Polic Onl State & Local Government A licants) 



1. i: Yes D No facilities, foster care or other youth facilities, or corrections programs and 



jurisdiction? 

98 form HUD-40090-2 








filling out this section, see the Instrctions section. 






Cash HHS TLP G 1/14/05 $78,112 

Cash Polk County G 4/14/05 $ 4,500 

Cash US Cellular P 12/28/05 $14,450 

Cash Praire Meadows P 12/14/05 $5,000 

Cash Citigroup Fdn P 9/6/05 $5,000 

Cash MaxImus Fdn P 3/27/06 $5,000 

Cash Greater DM Fdn. P 1/4/06 $5,000 

Cash Chsalis Fdn P 11/22/05 $ 10,000 

Cash United Way P 5/15/06 $112,042 



i: Yes DNo 

(All Projects Exce t Dedicated HMIS Pro'ects) 

Is this project paricipating in the HMIS? 

If "Yes," what date did this project begin paricipating in the HMIS? 

If"No," enter the date the project anticipates beginnng paricipation. 

Wil client-level data be included in the HMIS for all persons served by this 

ro . ect? 


1. DYes r8 No 



99 form HUD-40090-2 


2. DYes ~No 




D Number of units: from _ to _' 






D Other: 






check the N/A box and skip these Questions. D N/A 




12(a) and 12(b): 

a. Number of participants who exited PH proiect(s)-APR Question 12(a) NA 

b. Number of participants who did not leave the project(s)-APR Question 12 (b) NA 

c. Ofthose who exited, how many stayed 7 months or longer in PH-APR Question 12(a) NA 

d. Of those who did not leave, how many stayed 7 months or longer in PH-APR question 12(b) NA 

e. Percentage of all parcipants in PH projects staying 7 months or longer 

% 





14: 

a. Number of participants who exited TH proiect(s)-including unknown destination 12 

b. Number of participants who moved to PH-from any destination identified as peranent housing 

c. Of the number of paricipants who left TH, what percentage moved to PH? 







1 2 3 4 



in each row) of Income (Col. 3 + Col. 1 x 

100) 




105 c. Social Securit 25 23.8% 

12 a. SSI 

100 


(4/2006\ 

9 

75%

12 b, ssm 

12 c. Social Security 

12 d. General Public Assistance 

12 e. T ANF 11 91.6% 

12 f. SCRIP 

12 g. Veterans Benefits 

12 h. Employment Income 9 75% 

12 i. Unemployment Benefits 

12 i. Veterans Health Care 

12 k. Medicaid 12 100% 

12 1. Food Stas 12 100% 

12 m. Other (please specify) child 3 25% 

support 

12 n. No Finncial Resources 

101 form HUD-40090-2 




11. SHP Leasin Bud et All SHP Pro'ects with Leasin 

Leased Unites for Housin and/or Services 








SRO 

o Bedroom 

1 Bedroom 

2 Bedrooms 

3 Bedrooms 

4 Bedrooms 

5 Bedrooms 

6 Bedrooms 

Other: 

h. Totals: 

Leased Strctue(s 

Structure 1 

Address: 

Structure 2 

Address: 

NA x 

of 

NA x 

Units HUD Paid xRent 

NA x 

NA x 

NA x 

NA x 

NA 

for Housin 

102 

Months 

g. Totals 

= NA 

= NA 

NA 

NA 

= NA 

NA 

NA 

= NA 

NA 

NA 

= 

licable FMR 

12= $10,833 

State: 

x $ 

State: Zi : 



12 . SHP Suppor t iyeServices B u d l2et (All SHP P rOJects . as A ipp I. icahI) e 


1. Outreach 

Year 1 



Quantity: 

1 Lighthouse Coordinator (~42% of$26,141) 

$10,979 $10,979 

I Assoc. ServcesDirector(~38% of$39,179) 


$14,888 $14,888 

Quantity: 

4 Youth Specialists (~90% of$17,OOO) 

$61,200 $61,200 

1.2 FIE Youth Specialists (~$8.61/h. x 2,496 

hrs) 


Quantity: 


Quantity: 


Quantity: 

6. my/AIS Services 

Quantity: 


Quantity: 


$21,640 $21,640 

Quantity: 

1 Education Liaison ((i50% of$25,061) 

9. Employment Servces 

Quantity: 


$12,530 $12,530 

Quantity: $9,153 $9,153 

1 Child & Family Advocate ((a35% of 

$26,150) 

1 1. Transportation 

Quantity: 

12. Transitional Livig Services 

Quantity: 


Quantity: 

Supportive Servces Benefits ((i26.8%) 


$34,948 $34,948 


$165,338 $165,338 


** Total of Line 14 must match line 6 column e. on the Project Summar Budget. 


eli~ible supportive service activities. *** 

$41,335 - 1,335 



the total supportive services budget (i.e., 80 percent of line 14 plus line 15). The total of Line 15 must match 


103 form HUD-40090-2 


13 . SHP 0,pera t 109 B d u t 12e(All SHP PrOJects wit 'hOJperating c osts) 




Quantity: 

2. Staff 


Year 1 

$8,660 


$8,660 

1 Office Manager (~45% of$23,145) 

1 Special Services Liaison (~35% of$24,300) 

.25 FTE Street Outreach Counselor (~$9.50 an 

hr.) 

$10,415 

$8,505 

$4,940 

$10,415 

$8,505 

$4,940 

1 Servces Director (~35% of $44,866) 

1 Resources Coordinator (~28% of$31,683) 

Operations Staff benefits ((c26.8%) 

3. Utilties 

$15,698 

. $8,871 

$12,980 

$15,698 

$8,871 

$12,980 

Quantity: 

Electrcity 

Gas 

Waste 

Water 


Quantity: 

5. Supplies 

$6,000 

$3,000 

$1,750 

$1,200 

$6,000 

$3,000 

$1,750 

$1,200 

Quantity: 

Offce 

Kitchen 

Household 

Printing/copying 

6. Insurance 

$3,395 

$2,000 

$4,181 

$1,236 

$3,395 

$2,000 

$4,181 

$1,236 

Quantity: 


Quantity: 

8. Relocation 

$2,533 $2,533 


persons) 

9. Food 

Quantity: 


Quantity: 

Mileage $1,120 $1,120 

11. Total SBP operating dollars $96,489 $96,489 



** Total of Line 11 must match line 7 colum e. on the Project Summry Budget. 

12. Total cash match to be spent on SBP $32,163 $32,163 

eligible operatin2 activities. *** 


11) must be no more than 75 percent of the total operations budget (i.e., 75 percent of line 11 plus line 12). 

The total of Line 12 must match line 7, column f. on the Project Summary Budget. 


Applicable) 

104 




funds. Fill out an additional char for each structure. 

Structure A 

Address: 



Structure B 

Address: 

C" lt, S tate, Z',ip: 


C S Z' 

i. Acquisition 1. Acquisition 



4. Real Property 4. Real Property 






15. SHP HMS Budget (All SHP Projects with HMIS Costs) 



Equipment 



3. Networking 

4. Securty 

Subtotal: 






Subtotal: 

Services 










Subtotal: 

Personnel 





22. Administrative Support Staff $1,012 $1,012 

105 form HUD-40090-2 

(4(?OOR\




Subtotal: 

Subtotal: 

25. Total SHP HMS dollars requested $1,012 $1,012 


* Total of Line 25 must match line 8 column e. on the Pro.iect Summary Budget. 

26. Total cash match to be spent $253 $253 


** Cash Match can be spent on any SHP eligible activity (see the char in Section IILA.3. of the NOFA for these 






. e er us are an ec ion en a SSIS ance u 12e 

a. Check the box to indicate the type of program: L J S+C (J Section 8 SRO 









SRO NA x = NA 

o Bedroom NA x = NA 

1 Bedroom NA x = NA 

2 Bedrooms NA x = NA 





Other: NA x = NA 

i. Totals: NA x = NA 




Sin Ie Room Occu anc SRO Pro. ect Bud et 

a. List below an estimate of the total costs of developing the S+C/SRO roject: 

T e Amount 


Ac uisition: 


106 form HUD-40090-2 

(A I?MIl' I

Total: $ 



Source Amount 

Total: $ 

107 form HUD-40090-2 

(41200fì\





projects): 



_% Persons in TH who came directly from the street or Emergency Shelters. 













persons will reside in a structure: Describe what local market conditions necessitate the 

development of a project of this size and how the housing wil be integrated into the 

neighborhood. 

7. For Shelter Plus Care TRA projects only: Wil paricipants be required to live in particular 

structures or units durng the first year and in a paricular area within the locality in subsequent 

years, or to live in a particular area for the entire period of paricipation? 0 Yes 0 No 

Explain how and why the project wil implement this requirement (use less than one-half page). 





photograph. 



108 form HUD-40090-2 

IAl?nn~\ 

*




Facilties that you are currently operating and activities you are currently undertaking to 



o Increase the number of 






o Replace the loss of nonrenewable fuding from private, Federal, or other sources (except 


By law, no SHP fuds may be used to replace state or local governent fuds previously used, 









sources of fuding and why, without the SHP assistance, the activity wil cease. 


(All new ro . ects exce t Dedicated HMIS Pro' ects) 

1. What types of supportive services are proposed that would fit the needs of the parcipants? 

o Outreach 0 Health Related & Home Health Services 

o Case management 0 Education and Instruction 

o Life skils outside of case mana ement) 0 Em loyment Services 

o Job training 0 Child Care 

o Alcohol and Dru Abuse Services 0 Trans ortation 

o Mental Health and Counselin Services 0 Transitional Livin Services 

o HIV/AIS Services 0 Other (must s ecif *) 


Scale: 0 Daily 0 Weekly 0 Bi-monthly 0 Monthly 0 Other:_ 




109 


( .!?OOR\


1. Describe specifically how paricipants will be assisted both to increase their employment and/or 





1. List the specific type and length of experience of all organzations involved in implementing the 






applicants. 



If Yes, 





needed. 

Year Awarded Grant Number 


Grant Amount 

Date 



(NOF A). 







amended, or documentation of nonprofit status as described in the Glossary in Section I.A.7 of 





110 


(..?nn~\




HMIS. 




HMIS. 



5. Demonstrate that no state or local governent fuds would be replaced with the fuding being 


111 form HUD-40090-2 

1.4l?oom


: LiQhthouse : i 

: Total t: 

~---- - ._---_.. 


-- 

: 

, 

, 

1 2 3 4 5 6 

Policy Planning 

7 

Programming Measure Impact Measure Accountabiliy 

B 1 Homeless individuals Employment assistance-all 

Participants Homeless participants obtained employment-all Participants 


20 

income to obtain and I 20 


Education-all 


Participants Homeless participants obtained employment-all Participants Mgt. Info. System-manual 

permanent housing. 20 I 20 I Database 

Life skils-non case management-all 

Participants Homeless participants obtained employment-all Participants Interviews 

20 

I 20 I Mgt. Info. System-automated 

Child care-all Participants Homeless participants obtained employment-all Participants Mgt. Info. System-manual 

20 

I 20 



Participants Homeless participants obtained employment-all Participants Agency database 

20 I 20 I 

#N/A #N/A 

I 

B 1 There is a lack of Housing placement-all Participants Homeless persons residing in permanent Participants 

permanent 

20 

supportive housing over six months-all 

supportive housing 

I 

20 I C. Source of Data 

for homeless 

#N/A #N/A Employment records 

individuals with I 

I 

Placements 

disabilities and their #N/A #N/A 

families. 

I 

.. 

N 

i 

I 

#N/A #N/A 

D. Frequency of Collection 

I 

I 

#N/A #N/A Weekly 

I 

i 

Monthly 

#N/A #N/A Quarterly 

B 1 There is a lack of Alcohol or drug abuse services-all Participants Homeless participants moved to permanent Participants 

permanent 

2 

housing - all 

I 

2 


i E. Processing of Data 


for homeless 

Participants Homeless participants moved to permanent Participants Statistical database 

individuals with 

20 

housing - all 

I 

20 i Manual talles 

disabilities and their Health care services-other-all Participants Homeless participants moved to permanent Participants Computer spreadsheets 

families. 20 housing - all 

I 

20 I 

Mental health services-all Participants Homeless participants moved to permanent Participants 

2 

housing - all 

I 

I 

2 I 

I 

#N/A #N/A 

i I 

#N/A #N/A 

i I 

~The Center for Applied Management Practices, Inc., 2005. Form HUD 96010(2/2006)








Project Name: 









Name: 


Iowa Homeless Youth Center - Light house Hose Home (renewal) 

1216 Martin Luther King Jr. Parkway 

Des Moines, IA 50314 

2006 Supportive Housing Program 

City of Des Moines, IA 


Title: 


l-~~ 

Signature: 


Date: 

AnEST'~ 

Diane Rauh, ty Clerk 

113 

form HUD-2991 (3/98)


P ar tAG . 

enera I P ro.1 t ecI norma fi t" ion (All P fOJects ) 


2. o New Project 


IA26b302003 


r8 Renewal Project 

PIN Number: 1A0032 

Char in Exhbit!): _7_ identifier number (PIN 

4. HU-Defined CoC Name: 5. CoC Number: IA 502 

Des MoineslPolk County CoC 



(From SF-424): 073498909 

7.0 Check box if Applicant is a Faith-Based Organition 

r8 Check box if Applicant has ever received a federal grant, either directly from 

a federal agency or though a statellocal agency 


Street: 100 E. Euclid, Ste. 101 Identification Numer (EIN) (From 

City: Des Moines State: IA Zip: 50313 SF-424): 42-6004514 



Title: Federal Program Administrator 

Phone numr: 515-237-1384 

Fax number: 515-242-2844 

Email Address: RASchulte~dDlov.or 



Sponsor 


Buchanan Transitional Living Center 

14. Project's location 6-dgit 

Geogrphic Code: 199153 & 191362 

15. Project Address (S+C SRAs, ifmultiple sites list all addresses includig): 18. r8 Check box if Energy Sta is 

Street: 1219 Buchanan 


City: Des Moines State: IA Zip: 50314 19. Project Congressional 

16.0 Check box ifproject is located in a Rural Area 

Distrct(s):IA 03 

17. Ifproiect contain housing unts, are these unts: 0 Leed? 0 Owned? 

20. Project Sponsor's Organation Name (If dierent from Applicant) 22. Sponsor's DUNS Numr: 

Youth and Shelter Servces, Inc. 05-505589 

21. 0 Check box if Project Sponsor is a Faith-Based Organation 

t8 Check box if Project Sponsor ha ever received a federal grt, either 

diectly from a federal agency or though a statellocal agency 


Street: 1219 Buchanan Identification Numr (EIN: 



Name: Jim McWeeny Phone number: 515-265-1222 

Title: Resources Coordintor Fax number: 515-266-8377 

Email Address: imcweeny(ayss.ames.ia.us 

114


(All roiec P . st xcept E D ed icate d HMIS rOJects p. ) 

1. Housing Type* 1a. 0 Multi-family 



(8 Project Based 

r8 Con2re2ate Facilty 





Number of Bedrooms 5 5 

Number of Beds 8 8 







b. Number of Single Individuals and 8 8 



ii. Number of chronically homeless 1 1 


Congregate Facilty (dormtory, baracks, shaed-living). 








1% 

17% 

10% 

Part E: Dischar e Polic Onl State & Local Government A licants) 



1. (8 Yes D No facilities, foster care or other youth facilities, or corrections programs and 



jurisdiction? 

116 

31% 

17% 


(4/?OOR\


HU homeless program fuding is limited and can provide only a portion ofthe resources needed to 




application and possible withdrawal of your conditional award(s). For furher instructions for 




Contribution 


Contribution (G) Government* 


Written 

Commitment 

Written 

Commitment 

Example: Child Care 

Cash 

Value of Volunteer Hrs 

Cash 

Cash 

Cash 

CDBG 

Variety Club ofIA 

IHYC Volunteer Hr. 

HHS Basic Center 

State of IA ESGP 

DM -CDBGIESG 

P 

P 

G 

G 

G 

G 2/15/06 

8/25/05 


7/29/05 


11/21/05 

$10,000 

$16,208 

$30,260 

$19,678 

$31,000 

$24,132 



S stems HMIS All Projects Exce t Dedicated HMIS Pro' ects) 

r8 Yes 0 No Is this project participating in the HMIS? 

/ If "Yes," what date did this project begin paricipating in the HMIS? 

(mm ear) If"No," enter the date the project anticipates beginnng paricipation. 

r8 Yes 0 No Wil client-level data be included in the HMIS for all persons served by this 

roject? 

Pa r t H . 

Renewai P er tì ormance (All Renewa1 P rOJec . t) s 



1. 0 Yes l' No 

117 form HUD-40090-2 


2. DYes r8 No 



o Number of persons served: from _ to _' 

o Number of units: from _ to _' 

o Location of project sites. 



o Change in project sponsor. 

o Change in component type. 

D Other: 










12(a) and 12(b): 

a. Number of participants who exited PH project(s)-APR Question 12(a) NA 

b. Number of participants who did not leave the proiect(s)-APR Question 12 (b) NA 

c. Of those who exited, how many stayed 7 months or longer in PH-APR Question 12(a) NA 

d. Of those who did not leave, how many stayed 7 months or longer in PH-APR question 12(b) NA 


% 





14: 

a. Number of participants who exited TH project(s)-including unknown destination 28 

b. Number of participants who moved to PH-from any destination identified as peranent housing 20 


71% 







1 2 3 4 




100) 




105 c. Social Secunty 25 23.8% 

28 a. SSI 

118 form HUD-40090-2 

'.iI?OOR\

28 b. ssm 

28 c. Social Securty 

28 d. General Public Assistance 

28 e. T ANF 

28 f. SCHIP 

28 g. Veterans Benefits 


28 i. Unemployment Benefits 

28 i. Veterans Health Care 

28 k. Medicaid 14 50% 

28 i. Food Stamps 16 57% 

28 m. Other (please specify) foster 1 .03% 

care stipend 

28 n. No Financial Resources 2 .07% 

119 









D l%to 99% ofFMR 






SRO NA x = NA 

o 1 Bedroom NA NA x x = NA 

2 3 Bedrooms NA x = NA 

4 5 Bedrooms NA x NA 

6 Bedrooms NA x NA 

Other: h. Totals: NA NA x x = NA 

Leased Structure Strctue s for Housin 1 licable x = FMR $ 

Address: 

Structure 2 

Address: 

120 

State: 

x $ 

State: Zi : 


IAl?nn¡:\

12. SHP Supportive Services Budget All SHP Projects as Applicable) 



1. Outreach 

Quantity: 


Quantity: $13,022 $13,022 

1 Case Manager (~50% of $26,045) 


Quantity: 

3 FT Youth Specialists (cm30% of$18,638) 


Quantity: 


Quantity: 

6. HI/ AIS Services 

Quatity: 


Quantitv: 


Quantity: 


Quantity: 


Quantitv: 


Quantity: 


Quantity: 


$16,774 $16,774 

Quantity: $4,983 $4,983 

Supportive Serce Benefits (~18% of salary) 



$3,77 $3,77 


** Total of Line 14 must match line 6 column e. on the Project Summary BudJlet. 


elii!ible supportive servce activities. *** 

I 

$8,69 I $8,69 



the total supportive servces budget (i.e., 80 percent ofline 14 plus line 15). The total of 

line 6, column f. on the Project Summry Budl!et. 

Line 15 must match 

121 


l4I?OOR\

13. SHP Operatio2 Bud2et (All SHP Projects with Operating Costs) 


Operatiu2 Costs Year 1 Year 2 Year 3 Total 


Quantity: 

2. Staff 


I Assoc. Services Director (~35% of $39, 179) $13,713 $13,713 

2 FT Youth Specialists (~40% of$17,000) $13,600 $13,600 

1 Offce Manager (~10% of$23,145) $2,314 $2,314 

1 Bookkeeper (~23% of $23,000) $5,290 $5,290 

I Volunteer Coordinator (~20% of$24,300) $4,860 $4,860 

.3 FTE PT Relief Specialists ((a$8.5 hr x 624 hrs $5,304 $5,304 

3. Utilties 

Quantity: 

Telephone & Cellular Phone $1,000 $1,000 

4. Equipment (lease/buy) 

Quantity: 

5. Supplies 

Quantity: 

Desktop offce supplies $515 $515 

Postage & Shipping $1,000 $1,000 

Household Supplies $1,854 $1,854 

6. Insurance 

Quantity: $1,302 $1,302 


Quantity: 

8. Relocation 

Ouatity: (number of persons) 

9. Food 

Quantity: 


Quantity: 

Operating Staff benefits (a 18% $8,115 $8,115 


requested in lines 1 to 10 above: ** $58,867 $58,867 


** Total of Line 11 must match line 7 colum e. on the Project Summry BudlZet. 


elii!:ble operatin2 activities. *** $19,623 

G,623 


11) must be no more than 75 percent ofthe total operations budget (i.e., 75 percent ofline 11 plus line 12). 



Applicable) 

122 

form HUD-40090-2


funds. Fill out an additional chart for each structure. 

Structure A 

Address: 

ity, tate, ip: 

C S Z' 


Structure B 

Address: 

C lty, S tate, Z',ip: 





4. Real Property 4. Real Propert 






15. SHP HMIS Budget (All SHP Projects with HMIS Costs) 



Equipment 



3. Networking 

4. Securty 

Subtotal: 


5. SoftarelUser Licensing 




Subtotal: 

Services 

9. Trainng by Third Paries 









Subtotal: 

Personnel 





22. Administrative Support Staff $ i,o i 2 $ i,o i 2 


I A i')nnt:n




Subtotal: 

Subtotal: 

25. Total SHP HMS dollars requested $1,012 1,012 


* Total of Line 25 must match line 8 column e. on the Project Summary Budeet. 

26. Total cash match to be spent $253 $253 


** Cash Match can be spent on any SHP eligible activity (see the chart in Section II.A.3. of the NOFA for these 





J1 Sh It PI CdS 8 SRO R I A. B d t 

. e er us are an ection enta ssistance u iiie 

a. Check the box to indicate the type of proeram: (J S+C (J Section 8 SRO 


c. Check the appropriate box that relates your rent to the published FM*: 

o 1% to 99% ofFMR 

o 100%ofFMR 

o 101 % to 110% ofFMR (pHA approval letter must be attached). 

o Greater than 110% (B approval letter must be attached). 

d. Size of Units e. Number f. FM or g. Number of h. Total 


SRO NA x = NA 

o Bedroom NA x = NA 

1 Bedroom NA x = NA 






Other: NA x = NA 

i. Totals: NA x = NA 




Sin Ie Room Occu anc SRO Pro. ect Bud et 


T e Amount 

Total Rehabilitation Costs (Eli ible and Ineligible): 

Acquisition: 


124 form HUD-40090-2

Total: $ 



Source Amount 

Total: $ 

125 form HU-40090-2 






projects): 












DYes, very accessible 0 Somewhat accessible 0 Not accessible 




persons will reside in a strctue: Describe what local market conditions necessitate the 


neighborhood. 

7. For Shelter Plus Care TRA projects only: Will paricipants be required to live in paricular 

structures or units durng the first year and in a paricular area within the locality in subsequent 

years, or to live in a paricular area for the entire period of participation? 0 Yes 0 No 




other organizations will have in operating and maintaining the property. 


photograph. 



126 form HUD-40090-2













nonrenewable funding from private, Federal, or other sources (except 

D Replace the loss of 













All new ro' ects exce t Dedicated HMIS Pro' ects 

1. What types of supportive servces are proposed that would fit the needs of the paricipants? 



D Life skils outside of case mana ement D Em 10 ent Servces 

D Job training D Child Care 


D Mental Health and Counselin Services D Transitional Livin Services 

D HIV / AIDS Services D Other (must s ecif *) 

2. Generally speakng, what is the scale (the frequency) of these services? 

Scale: D Daily D Weekly D Bi-monthly D Monthly D Other:_ 


1. Describe specifically how paricipants wil be assisted both to obtain and also remain in 


127 form HUD-40090-2 

fA I'nrip.i











and overseeing the construction or rehabilitation of housing or adinistering rental assistance, 


applicants. 



If Yes, 




assigned to any project, please contact your HU field office for assistance. Add rows as 

needed. 




(NOF A). 




Governent)? D Yes D No 





b. Public nonprofit communty mental health centers must attach a letter or other document 



128 form HUD-40090-2 





HMIS. 




HMIS. 





129 form HUD-40090-2 



: BUCHANAN : 

-- 

Policy Planning Programming Measure Impact Measure Accountability 

: Total : 

- ---- - ._---_. 

i Continuum of Care : 

1 2 3 4 5 6 

B 1 Homeless individuals Employment assistance-all 



Participants 

income to obtain and 8 I 

Education-all 

8 I A. Tools for Measurement 



Participants Mgt. Info. System-manual 

permanent housing. 8 I 


8 I Interviews 


Participants Mgt. Info. System-automated 

8 I 8 


I Pre-post tests 

Participants Homeless participants obtained employment-all Participants 

I 8 I B. Where Data Maintained 

#N/A #N/A Agency database 

I 

#N/A #N/A 

I 

I 

Participants 

8 


Participants Employment records 

8 

I 

Placements 

Participants Waiting lists 

I 


8 

housing - all 

I 


housing - all 

B 1 There is a lack of Housing placement-all 

permanent 



for homeless 

individuals with 8 

I 

-i 

Wo 


housing - all 

disabilities and their Life skills-non case management-all 

families. 

8 

8 I 

I 

#N/A 

#N/A 


#N/A 

#N/A Quarterly 

I 

I 

Monthly 

#N/A #N/A Weekly 

I 

I 

Participants Homeless participants moved to permanent Participants 

housing - all 

2 

I 



housing - all 

8 I Manual tallies 


housing - all 

I 

2 I 

8 I 

B 1 Homeless individuals Alcohol or drug abuse services-all 


income to obtain and 



permanent housing, 

Health care services-other-all 

8 I 

8 I 


housing - all 

8 

I 


housing - all 

Legal-all 

8 I 

Mental health services-all 

4 I 

4 I 

#N/A #N/A 

I 

I 


C9The Center for Applied Management Practices, Inc., 2005.








Project Name: 









Name: 


Iowa Homeless Youth Ctr. - Buchanan Transitional Living (renew) 

1216 Martin Luther King Jr. Parkway 

Des Moines, IA 50314 

2006 Supportive Housing Program 

City of Des Moines, IA 


Title: Mayor, City of Des Moines, Iowa 

S;~am" ~.~ 


AmST: t; -Ie := 


131 

form HUD-2991 (3/98)





Chart in Exhbit1): 

8 


Des Moines,Iolk Count CoC 




(8 Check box if Applicant has ever received a federal grant, either directly from 

a federal a enc or thou h a state/local a ency 


Street: 100 East Euclid, Suite 101 

Ci : Des Moines 

2. D New Project 

~ Renewal Project 




State: IA 


Name: Robert Schulte Phone number: 515-247-1384 

Title: Federal Programs Adllnistrator Fax number: 515-242-2844 

Email Address: RASchulte 

13. Project Name: Primary Health Care Street Outreach 


Street: 100 E. Euclid, Suite 101 

City: Des Moines State: IA Zip: 50313 


17. If ro' ect contain housin units, are these unts: 0 Leased? 0 Owned? 

20. Project Sponsor's Organation Name (If different from Applicant) 

Primar Health Care, Inc. 

21. Check box if Project Sponsor is a Faith-Based Organation 

(8 Check box if 

Project Sponsor ha ever received a federal grant, either 


IA26B302005 

PIN Numer: 20034 

5. CoC Number: IA-502 


(From SF-424): 07-349-8909 


Identification Number (EIN (From 

Zi : 50313 SF-424: 42-6004514 

dm oV.or 

directl from a federal a enc or thou a state/local a enc 


Street: 979 Oakridge Drive 

Ci : Des Moines State: IA 


Name: Bobbretta Brewton Phone numer: 515-248-1511 

Title: Director of Outreach Project Fax number: 515-248-1510 

Email Address: bbrewton 

132 

12. D Check box if Project 


Sponsor 



18. D Check box if Energy Sta is 


19. Project Congressional Distrct( s) 

IA-03 

22. Sponsor's DUNS Numer: 

843498812 


Identification Numer (EIN): 

Zi : 50314 42-1350092 

hcinc.net


BL. Su ortive Housin Program (SHP) (All SHP Projects) 

a. r8 SHP Pro ram c. Grant Term (New Projects must be 2 or 3 years; 


o 0 r8 0 0 Safe Haven/TH (Check only one box) 

TH PH SSO HMIS 0 Safe Haven/PH rg 0 0 

d. Proposed 





4. Subtotal 






7. Operations 

From Operatig Budget Cha 

8. HMIS 










o 0 0 0 0 





a. 



Re uest (CoL. e + Col. t) 


243,913 60,960 304,873 




Cash Match) 

256,109 60,960 317,069 



$ 

$ 

o Renewal 

1 Year 

o New 

5 Years 

o New 

(PRA S+C/SRO) 

10 Years 

133 form HUD-40090-2 


Part C: Point in Time Housing and Participants Chart N/ A 

/ All Proiects Except Dedicated HMIS Proiects) 

1. Housing Type* 

(Check all that apply) 

1a. D Multi-family 

D Single-family 

D Conereeate Facilty 




a. Current 

Level 



c. Projected 

Level 

lPoint-in- Time) (If Applicable) (column a + col. b) 














*Housing Types: Multi-family (aparents, duplexes, SROs, other buildigs with 2 or more unts); Single-family; 

Congregate Facility (dormtory, barracks, shared-living). 







1. Homeless Subpopulations 2. Approximate Percentages (%) 

Chronically Homeless (as defined by HUD) 15% 

Severely Mentally ILL 25% 

Chronic Substance Abusers 25% 

Veterans 5% 

Persons with HIV / AIDS 1% 

Victims of Domestic Violence 1% 

Unaccompanied Youth 30% 

(Under 18 years of aee) 

Part E: Dischar e Polic (Only State & Local Government Ap licants) 



1. (g Yes D No facilities, foster care or other youth facilities, or corrections programs and 



. ursdiction? 

134 form HUD-40090-2













Medical Visits: 381 visits pe Priry Health (P) 4/1 0/06 $60,960 

year at approximately Care. 

$160.00 per visits 

Clinic Host Site House of Mercy (P) 4/10/06 $8,160 

Facilty and Administrative Priry Health (P) 4/27/06 $59,636 

Costs Care 

*Government sources are appropriated dollars. TOTAL: $ 128,756 


S stems HMIS (All Pro' ects Except Dedicated HMIS Projects) 

(8 Yes 0 No Is this project paricipating in the HMIS? 

7/2001 If "Yes," what date did ths proj ect begin paricipating in the HMIS? 

"No," enter the date the project anticipates beginnng paricipation. 

(mm ear) If 

(8 Yes 0 No Wi~l client-level data be included in the HMIS for all persons served by ths 

ro ect? 

P ar tH . 

Renewai P er fì ormance (All Renewai p' roiec t) S 

1. DYes r8 No 



135 form HUD-40090-2 

I A l'lnna\

2. DYes r8 No 




D Number of 

units: from _ to_. 

D Location ofproject sites. 





D Other: 






check the N/ A box and skip these Questions. D N/A 




12(a) and 12(b): 

a. Number of paricipants who exited PH project(s)-APR Question 12(a) 




e. Percentage of all partcipants in PH projects staying 7 months or longer 

% 





14: 

a. Number of participants who exited TH project(s)-including unown destination 

b. Number of participants who moved to PH-from any destination identified as permanent housing 

c. Of the number of paricipants who left TH, what percentage moved to PH? 

% 







1 2 3 4 



in each row) of Income (CoL. 3 -; Col. 1 x 

100) 





719 a. SSI 22 3% 

136 form HUD-40090-2

719 b. ssm 14 2% 

719 c. Social Securty 1 0% 


719 e. TAN 15 2% 

719 f. SCHIP 0 0% 

719 ~. Veterans Benefits 3 0% 


719 i. Unemployment Benefits 5 1% 

719 j. Veterans Health Care 0 0% 


719 1. Food Stamps 106 15% 


719 n. No Finncial Resources 574 80% 

137 form HUD-40090-2


Part I: SHP Project Budgets (All SHP Projects as Applicable) N/A 

11. SHP Leasin Bud et (All SHP Pro'ects with Leasin ) 

Leased Unites) for Housin and/or Services 



01% to 99% ofFMR 

o 100% ofFMR 

o 101 % to 110% of FMR (PHA approval letter must be attached). 

o Greater than 110% (RU approval letter must be attached). 


of Units HUn Paid Rent Months 

SRO x x = $ 









h. Totals: x x $ 

Leased Strctue s licable FMR 


Address: 

State: Zip: 


Address: 

State: Zi : 

138 form HUD-40090-2

12. SHP Supportive Services Bud2et All SHP Proiects as Applicable) 



1. Outreach 

Quantity: 2.6 Outreach Workers ~ $ 

2080; +25% benefits 


14.96/h x 

$101,130 $101,130 

Quantity: 2.25 Case Managers ~ $17.01/h x 

2080; + 25% benefits 


Quantity: 


$99,509 $99,509 

Quantity: Chemical Dependency Counselor 0.5 

FTE ~ $15/h x 2080 + 18.95% FB's 


Quantity: 

6. Il/AIDS Services 

Quantity: 


Quatity: 


Ouantity: 


Quantity: 


Quantity: 


Quantity: 

$18,556 $18,556 

Staff mileage: 120 miles/month ~ $.445/mi; 

$640 year 

Client Cab/Bus: $100/mo tokens, $IOO/mo bus 

passes; $2,400 year $10,840 $10,840 

Out of Town Transporttion: $50/mo; $600/yeaT 

Auto expense/repairs/registration: $125/mo; 

$1,500 year 

Gas: $350/mo; $4,200 year 

Vehicle Insurance: $125/mo; $1500 year 


Quantity: 


Quantity: 


$13,878 $13,878 

$23,913 $23,913 



** Total of Line 14 must match line 6 column e. on the Project Summary Bud~ et. 

15. Total cash match to be spent on SHP I 

eli2:ible supportive service activities. *** $(~ $(,9 

*** Cash Match can be spent on any SHP eligible activity (see the chart in Section III.A.3. ofthe NOF A 




139 form HUD-40090-2

13. SHP Operating Budget (All SHP Projects with Operating Costs) N/ A 


Operatin2 Costs Year 1 Year 2 Year 3 Total 


Quantity: 

2. Staff 


3. Utilties 

Quantity: 

4. Equipment Qeaselbuy) 

Quatity: 

5. Supplies 

Quantity: 

6. Insurance 

Quantity: 


Quantity: 

8. Relocation 


persons) 

9. Food 

Quantity: 


Quantity: 


reauested in lines 1 to 10 above: ** 


** Total of Line 11 must match line 7 column e. on the Proiect Sumar Budget. 


eli2ible operatin2 activities. *** 

*** Cash Match can be spent on any SLI eligible activity. The amount of the SlI request (entered in line 

11) must be no more than 75 percent of the total operations budget (i.e., 75 percent of line 11 plus line 12). 



Applicable) N/ A 

140 

form HUD-40090-2





funds. Fil out an additional chart for each structure. 

SHP Reauest Total Budget SHP Request Total Budl!et 




4. Real Propert 4. Real Property 


5. Supportive Services 5. Supportive Servces 




is. SHP HMIS Budget (All SHP Projects with HMIS Costs) N/A 



Equipment 



3. Networking 

4. Securty 

Subtotal: 






Subtotal: 

Services 

9. Trainng by Third Paries 









Subtotal: 

Personnel 





141 form HUD-40090-2


Subtotal: 




Subtotal: 



* Total of Line 25 must match line 8 column e. on the Pro,ject Summar v Bud2et. 



** Cash Match can be spent on any SHP eligible activity (see the cha in Section II.A.3. of the NOFA for these 




(All S+C and SRO Projects as Applicable) N/ A 

Jl . Sh e er It us PI are CdS an f ec 8 ion SRO R t en I a A SSIS . ance t B u d iget 

a. Check the box to indicate the type of program: (J S+C (J Section 8 SRO 









d. Size of Units e. Number f. FM or g. Number of h. Total 


SRO x x = $ 













Single Room Occupancy (SRO) Project Budget N/ A 


Type Amount 


\cquisition: 

142 form HUD-40090-2

Other Costs (Eligible & Ineligible, e.g., fuiture): 

Total: $ 



Source Amount 

143 

Total: $ 

form HUD-40090-2


Part K: General Project Narrative Information N/A 



projects): 

% Persons who came from the street or other locations not meant for human habitation. * 

_% Persons who came from Emergency Shelters.* 

_ % Persons in TH who came directly from the street or Emergency Shelters. * 











List residents' maximum allowable lengt of stay: months 


persons wil reside in a structue: Describe what local market conditions necessitate the 


neighborhood. 


structures or units during the first year and in a paricular area within the locality in subsequent 

years, or to live in a paricular area for the entire period of participation? 0 Yes 0 No 






photograph. 



144 

form HUD-40090-2





serve homeless persons may only receive SHP funding 




for the four purposes listed below. 





o Replace the loss of nonrenewable fuding from private, Federal, or other sources (except 



or designated for use, to assist homeless persons (see 24 CFR 583 .150( a)). 








sources of fuding and why, without the SHP assistance, the activity will cease. 


(All new projects except Dedicated HMIS Projects) N/ A 



o Case management o Education and Instruction 

o Life skills (outside of case management) o Employment Services 

D Job training o Child Care 

o Alcohol and Drug Abuse Services o Transportation 

D Mental Health and Counseling Services o Transitional Living Services 

o HIV / AIS Services D Other (must specify *) 


Scale: 0 Daily 0 Weekly 0 Bi-monthly 0 Monthly 0 Other:_ 

Part M: Accessing Permanent Housing N/ A 



145 form HUD-40090-2

Part N: Participant Self-Sufficiency N/ A 





Part 0: Experience Narrative N/ A 





and overseeing the construction or rehabilitation of housing or administerig rental assistance, 


applicants. 



If Yes, 





needed. 




(NOF A). 







amended, or documentation of nonprofit status as described in the Glossary in Section LA.? of 





146 form HUD-40090-2

Part P: HMIS Narrative (Dedicated HMIS Projects ONLY) N/A 



HMIS. 




HMIS. 



5. Demonstrate that no state or local governent fuds would be replaced with the fuding being 


147 


IAI')nn~\


: Street Outreach 

: Total 

1 Continuum of Care 

.. 

~CI 

(§The Center for Applied Management Practices, Inc., 2005. Form HUD 96010(2/2006)



u.s. Department of Housing 





Project Name: 









Name: 


Primary Health Care - Outreach (renewal) 





Title: 

'/~ß 


Signature: 

D"tiAY 2 2 2006 

ATTm ~ ~ 


149 

form HUD.2991 (3/98)


P tAG . ar . en era i P ro J ec t I norma £ f ion (All fOJects P ) 


1. Project Priority Number 3. If renewal, list previous 





Chart in Exhbitl): _9_ identifier number (PIN) 

PIN Number: 20034 

4. In-Defined CoC Name: 5. CoC Number: 

Des Moines/Polk County CoC 1A-502 





a federal a~ency or though a state/local agency 

(From SF-424): 073498909 


Street: 100 E. Euclid, Suite 101 Identification Numer (EIN) (From 

City: Des Moines State: IA Zip: 50313 SF-424): 426004514 




Phone number: 515-237-1384 

Fax number: 515-242-2844 

Email Address: RASchulte~dnmov.or 



Sponsor 

13. Project Name: Primary Health Care Enhancement 14. Project's location 6-digit 



Street: 100 E. Euclid, Suite 101 used in ths project 

City: Des Moines State: IA Zip: 50313 19. Project Congressional Distrct(s): 

16. 0 Check box if project is located in a Rural Area IA-03 

17. Ifproiect contain housing units, are these unts: 0 Leased? 0 Owned? 

20. Project Sponsor's Organation Name (If different from Applicant) 22. Sponsor's DUNS Number: 

Priry Health Care, Inc. 843498812 


o Check box if Project Sponsor has ever received a federal grant, either 



Street: 979 Oakridge Identification Number (EIN: 



Name: Bobbretta Brewton Phone number: 515-248-1511 

Title: Director of Outreach Project Fax number: 515-248-1510 

Email Address: bbrewton~phcinc.net 

150


Bl. Su portive Housin Pro ram (SHP) (All SHP Projects) 

a. ~ SHP Pro ram c. Grant Term (New Projects must be 2 or 3 years; 


o 0 ~ 0 0 Safe Haven/TH (Check only one box) 

TH PH SSO HMIS 0 Safe Haven/PH ~ 0 0 

d. Proposed 





4. Subtotal 



From Leasin Bud et Cha 



7. Operations 

From Operating Budget Ch 

8. HMIS 









o 0 0 0 0 


TRA SRA PRA PRA S+C/SRO o Renewal 

1 Year 




a. 0 SRO Pro ram 






Re uest Col. e + Col. 1) 

$ 

80,952 20,320 101,272 




Cash Match) 

85,000 20,320 105,320 

o New 

5 Years 

(SRO) (All Section 8 SRO Pro'ects 

c. Grant Term 

010 Years 

$ 

o New 

(PRA S+C/SRO) 

10 Years 

151 form HUD-40090-2

Part C: Point in Time Housing and Participants Chart N/ A 


1. Housing Type* 1a. 0 Multi-family 



o Congregate Facilty 

o Project Based 


a. Current 

Level 



c. Projected 

Level 

(Point-in- Time) (If Applicable) (column a + coi. b) 















Congregate Facility (dormtory, baracks, shared-living). 








100% 

25% 

25% 

5% 

0% 

1% 

0% 

Part E: Dischar e Polic (Only State & Local Government Applicants) 



1. rg Yes 0 No facilities, foster care or other youth facilities, or corrections programs and 



'urisdiction? 

152 foIT HU-40090-2




use supplemental resources, including state and local appropriated fuds, to address homeless needs. 





Contribution 


Contribution 





Written 

Commitment 


Written 

Commitment 

Examole: Child Care 

Household Goods and 

Varous Other Donations 

Medical Visits 127 visits 

per year at approximtely 

$160.00 per visit 

CDBG 

Kathy Garon 

Priry Health Care 

G 

(P) Community V oluntee 

Coordinator 

(P) 


April 8, 2006 

April 10, 2006 

$10,000 

$6,000 a year 

$20,320 

Facility and Adnùstrativ Pri Health Care 

Costs 

(P) April 27, 2006 $17,768 

*Government sources are appropriated dollars. TOTAL: $ 44,088 


S stems HMIS (All Pro'ects Except Dedicated HMIS Projects) 

(8 Yes D No Is this project paricipating in the HMIS? 

07/2001 If "Yes," what date did this proj ect begin paricipating in the HMIS? 

mmyear) If"No," enter the date the project anticipates beginning paricipation. 

/' Y D N Wil client-level data be included in the HMIS for all persons served by this 

IL es o. t? 

ro ec . 


1. DYes (8 No 



153 

form HUD-40090-2

2. DYes I: No 




D Number of units: from _ to _' 






D Other: 






check the N/ A box and skip these Questions. o N/A 




12(a) and 12(b): 


b. Number of participants who did not leave the proiect(s)-APR Question 12 (b) 


d. Ofthose who did not leave, how many stayed 7 months or longer in PH-APR question 12(b) 






14: 

a. Number of partcipants who exited 1H project(s)-including unown destination 

b. Number of paricipants who moved to PH-from any destination identified as pernent housinl! 


% 







1 

Number of Adults Who Left 

(Use the same number 

in each row) 

2 

Income Source 

3 

Number of Exiting 

Adults with Each Source 

of Income 

4 

% with Income 

at Exit 

(CoI. 3 -; Coi. 1 x 

Examole: 105 

105 

a. Social Security Insurance (SSn 

b. Social Security Disabilty 


40 

35 

100) 

38.1% 

33.3% 

105 

86 


a. SSI 

25 

8 

23.8% 

10.8% 

154 


%

86 b. ssm 4 4.7% 



86 e. TANF 0 0% 

86 f. SCHIP 0 0% 

86 g. Veterans Benefits 2 2.3% 

86 h. Emplovment Income 15 17.4% 

86 i. Unemoloyment Benefits 1 1% 

86 j. Veterans Health Care 0 0% 


86 L. Food Stamps 48 56% 


86 n. No Financial Resources 21 24% 

155 

form HU-40090-2 

IAI..nnc\


Part I: SHP Project Budgets (All SHP Projects as Applicable) N/A 

11. SHP Leasin Bud et (All SHP Pro.ects with Leasin ) 

Leased Unites) for Housin and/or Services 




0100% ofFMR 

o 101 % to 110% of FMR (PHA approval letter must be attached). 

o Greater than 110% (RU approval letter must be attached). 



SRO x x = $ 









h. Totals: x $ 

Leased Strctue s and/or Services - No A lIcable FMR 


Address: 

State: 


Address: 

State: Zi : 

156 

g. Totals 

form HUD-40090-2

12. SHP Supportive Services Budget All SHP Projects as Applicable) 



1. Outreach 


Quantity: 0.4 FfE Outreach Worker (8 $15/h x 

832; +25% Benefits 


$15,600 $15,600 

Quantity: 1.0 Licensed Mental Health Counseloi 

~ $21.50/h x 2080; +25% Benefits 


Quantity: 


Quantity: 


Quantity: 


Quantity: 


Quantity: 


Quantity: 


Quantity: 


Quantity: 


Quantity: 

Staff mileage: 45 miles/month (8$.445/mi; $240 

year 

Client Cab/Bus: $25/mo tokens, $25/mo bus 

$55,900 $55,900 

passes; $600 year 

$7,892 $57,892 

Yehicle Lease: $385/mo; $4,620 year 

Auto expense/repairs/registration: $332 year 

Gas: $50/mo; $600 year 

Vehicle Insurance: $125/mo; $1500 year 


Quantity: 

13. Other (must specifY *) 

Quantity: 

Supplies: Office supplies $30/mo = $360 year 

Cell Phones/agers: $50/mo x 2 staff= $1,200 

year 

14. Total SlI supportive services dollars ~ 


$1,560 $1,500 

$1 

*1f not specified, the costs will be removed from the budget. 


15. Total cash match to be spent on SHP $2,3~ 

eligible supportive service activities. *** 

Description: 127 visits for the year at 

approximately $160 per visit 

$2,3~ 

approximately 

$160 per visit 

157 form HUD-40090-2 

I A i,"n"c\

*** Cash Match can be spent on any SHP eligible activity (see the chart in Section IILA.3. ofthe NOF A for 

these activities). The amount of 

total supportive servces budget (i.e., 80 percent ofline 14 plus line 15). The total of 

column f. on the Project Sumary Budget. 

the SHP request (entered in line 14) must be no more than 80 percent of the 

158 

Line 15 must match line 6, 


J.I i..nna\

13 . SHP 0'pera f IDl! B d u t il!e(All SHP P rOJects wit "hOJperating C os t) s N/A 




Quantity: 

2. Staff 


3. Utilties 

Quantity: 


Quantity: 

5. Supplies 

Quantity: 

6. Insurance 

Ouantity: 


Ouantity: 

8. Relocation 

Ouantity: (number ofDersons) 

9. Food 

Quantity: 


Quantity: 





** Total of Line 11 must match line 7 column e. on the Project Summry Budget. 


elii!ible operatine activities. *** 


11) must be no more than 75 percent of 

the total operations budget (i.e., 75 percent of 

The total of Line 12 must match line 7, column f. on the Project Summry Budget. 

line 11 plus line 12). 


Applicable) N/A 

159 form HUD-40090-2 

i A l"lnni:n


funds. Fill out an additional char for each structure. N/ A 



C S Z' 






Leasing 


6. Operations 

7. HMIS 

8. Total 

City, State, Zip: 






Leasing 

5. Supportve Services 

6. Operations 

7. HMIS 

8. Total 

15. SHP HMIS Bud2et (All SHP PrQjects with HMIS Costs) N/ A 

Equipment 





3. Networking 

4. Securty 

Subtotal: 






Subtotal: 

Services 

9. Trainig by Third Paries 









Subtotal: 

Personnel 





160 


fA l#'f'nt:\





Subtotal: 

Subtotal: 

25. Total SHP IIS dollars requested 


* Total of Line 25 must match line 8 column e. on the Pro.iect Summary Bud~et. 


on SHP eligible IIS activities: ** 

** Cash Match can be spent on any SHP eligible activity (see the chart in Section III.A.3. of 

activities). The amount of the SHP HMIS request (entered in line 25) must be no more than 80 the percent NOFA of for the these total HMIS 


Part J: Shelter Pius Care and Section 8 SRO Project Budgets 


J1. Shelter Plus Care and Section 8 SRO Rental Assistance Budget N/ A 

a. Check the box to indicate the type of pro~ram: r 1 s+c (J Section 8 SRO 



o 1 % to 99% ofFMR 

o 100%ofFMR 

o 101 % to i 10% of FMR (PHA approval letter must be attached). 

o Greater than 1 i 0% (RU approval letter must be attached). 



SRO x x = $ 










*Please he advised that the actual FMRs used in calculating your S+C or SRO grant will he those in 

effect at the time the grants are approved, which may he higher or lower than the FMRs listed above. 


Single Room Occupancy (SRO) Project Budget N/ A 

a. List below an estimate of the total costs of developing the S+C/SRO project: 

Type Amount 


161 

Acquisition: 


IAvinnc\

Other Costs (Eligible & Ineligible, e.g., 

furniture): 

Total: $ 



Source Amount 

Total: $ 

162 form HUD-40090-2 

i ;ii?nn¡:\


Part K: General Project Narrative Information N/ A 

1. Provide a general description ofthe new project (use less than one-half 

page). 

2. Enter the percentage of homeless paricipants(s) that wil be served (N/A for dedicated HMIS 

projects): 



_% Persons in TH who came directly from the street or Emergency Shelters. * 








schools, etc.) be readily accessible (e.g., walkng distance, near bus line, etc.) to your clients? 







neighborhood. 


strctures or units during the first year and in a paricular area within the locality in subsequent 

years, or to live in a particular area for the entire period of participation? 0 Yes 0 No 

Explain how and why the project will implement this requirement (use less than one-half 

page). 



other organzations will have in operating and maintaining the property. 


photograph. 



163 


'AI"'"f'~\




Facilities that you are currently operating and activites you are currently undertaking to 



o Increase the number of homeless persons served. 











a. The source ofthe nonrenewable fuding, indicating that it is not under the control of 







(All new ro'ects exce t Dedicated HMIS Pro'ects) N/A 


D Outreach 0 Health Related & Home Health Services 

D Case mana ement 0 Education and Instrction 

D Life skills (outside of case mana ement) 0 Em loyment Services 

D Job trainin 0 Child Care 

D Alcohol and Drug Abuse Services 0 Trans ortation 

D Mental Health and Counselin Services 0 Transitional Livin Services 

D HN / AIDS Services 0 Other must s ecify *) 


Scale: 0 Daily 0 Weekly 0 Bi-monthly 0 Monthly D Other:_ 

Part M: Accessin Permanent Housin N/ A 



164 form HUD-40090-2 

I A l'lnna\

Part N: Participant Self-Sufficiency N/ A 

1. Describe specifcally how paricipants will be assisted both to increase their employment and/or 




Part 0: Ex erience Narrative N/A 





and overseeing the construction or rehabilitation of housing or administerig rental assistance, 


applicants. 



If Yes, 





needed. 



exceed the applicable timeliness standards described in the Notice of 

Funding Availability 

(NOF A). 



3. Is the applicant or sponsor a nonprofit organzation (rather than a state or unit oflocal 



a. IRS ruling, providing tax-exempt status under Section 501 C (3) of 

the IRS Code of 1986, as 






165 

form HUD-40090-2




HMIS. 




HMIS. 





166 


( 41?riri¡:\


i 

: Enhancement : 

I 

.. 

- ---'1"------- ..-...~. 

: Total : 

In Continuum of Care : 

1 2 3 4 

Policy PlanninQ 

5 

ProQramminQ 

6 

Measure 

3 Impact 

7 Homeless individuals Outreach-all 

Measure Accountabiliy 


2 2 


Participants 


income to obtain and I 

10 180 

4 





Participants Intake log 

permanent housing. 100 housing - all 

I 

Housing placement-all 

100 I Other: Encounter Log 


Participants Other: Referral Log 


I 

50 

Employment assistance-all 

I Other: Exit/Outcome Sheet 


Participants 

50 I 50 

Alcohol or drug abuse services-all 



Participants Other: Service Point 


I 

50 

Health care services-other-all 

I 

Specialized database 


Participants Other: Excel Spreadsheet 

300 hOUSing - all 

I 

200 

I 

#N/A 

#N/A 

I 


#N/A 

#N/A Other: On-site 

I 

I 

Other: Iowa Homeless Network 

#N/A 

#N/A 

.. 

0) 

.. 

I 

I 

#N/A 

#N/A 


#N/A Monthly 

I 

#N/A 

I 

#N/A #N/A 

I 

I 

#N/A #N/A 

I 

I 

I 


#N/A #N/A Other: Automated Database 

I 

I 

Other: Client Files 

#N/A #N/A 

I 

I 

#N/A #N/A 

I 

I 

#N/A #N/A 

I 

I 

#N/A #N/A 

I 

I 


(§The Center for Applied Management Practices, Inc., 2005.








Project Name: 









Name: 


Primary Health Care - Enhancement (renewal) 





Sign~~:~:¡~~jL , 


Date: 

ATTST'~-Å 

168 

form HUD-2991 (3/98)


P ar tAG . enerai P ro J ec t I norma fi t ion (All P rOJects ) 


1. Project Priority Number 3. If renewal, list previous 




Chart in Exhbitl): 10 i: Renewal Project 


PIN Number: 

IA2002 

4. HU-Defmed CoC Name: 5. CoCNumber: 

Des MoineslPolk County IA-502 


City of Des Moines (From SF-424): 073498909 

7. o Check box if Applicant is a Faith-Based Organiation 


a federal agency or through a state/local agencv 


Street: 100 East Euclid, Suite 101 Identification Numer (EIN (From 




Name: Robert Schulte Phone number: 515-237-1384 


Title: Federal Programs Administrator Fax number: 515-242-2844 

Email Address:RAchulte(Qdm2ov.or~ Sponsor 

13. Project Name: 14. Project's location 6-digit 

West Des Moines Human Services Transitional Housing Program Geographic Code: 199153 


Street: SEE ATTACHMENT used in ths project 

City: State: Zip: 19. Proj ect Congressional Distrct( s) 

16. 0 Check box if project is located in a Rural Area 1A03 

17. If project contain housing units, are these unts: ~ Leased? DOwned? 


City of West Des Moines Human Services 61-873-4032 

21. 0 Check box if Project Sponsor is a Faith-Based Organiation 


rg Check box if 

diectly from a federal agency or though a state/local agency 

23. Project S~onsor's Address (if different from Applicant) 24. Sponsor's Employer 

Street: 318 5 Street 

City: West Des Moines State: IA Zip: 50265 


42-6005359 


Name: Sue Paterson-Nielsen Phone number: 515-273-0633 

Title: Director Fax number: 515-222-3669 

Email Address: sue.paterson-nielsen~wdm-ia.com 

169 

.

West Des Moines Human Services Project Addresses: 

1.3 bedroom - 513 8th Street, West Des Moines, IA 50265 

2.3 bedroom - 107 4th Street, West Des Moines, IA 50265 

3. 3 bedroom - 200 3rd Street #1, West Des Moines, IA 50265 

4. 2 bedroom - 200 3rd Street #2, West Des Moines, IA 50365 

170


Bl. Su ortive Housing Program (SHP) (All SHP Projects) 

a. i: SHP Pro ram c. Grant Term (New Projects must be 2 or 3 years; 

b. Component Types (Check only one box) Renewals or HMS projects can be 1,2 or 3 years) 

r8 0 0 0 0 Safe Haven/TH (Check only one box) 

TH PH SSO HMIS 0 Safe Haven/PH r8 0 

d. Proposed 





4. Subtotal 






7. Operations 


8. HMIS 





to 5% of line 9) 




1 Year 2 Years 

e. SHP Dollars f. Cash Match 

Re uest 

o 

3 Years 

g. Totals 

(CoL. e + Col. l) 

$36,000.00 $36,000.00 

$47,167.00 $29,453.00 $76,620.00 

$83,167.00 

$ 4,158.00 

S+C All S+C Pro' ects 


D 0 D D D 









Total 

Cash Match 

$87,325.00 $29,453.00 

Total Budget 

(Total SHP 


Cash Match) 

$116,778.00 



$ 

$ 

D Renewal 

1 Year 

DNew 

5 Years 

DNew 


10 Years 

171 form HUD-40090-2


(All rot P' ects E xcept D d e icate d HMIS Projects . ) 

1. Housing Type* 1a. cg Multi-family 

(Check all that apply) cg Single-family 

lb. IZ Scattered Site 

o Project Based 

D Cone:ree:ate Facilty 



(Point-in-Time) ßf Applicable) (column a + col. b) 





a. Number of Families with 4 2 6 



ii. Number of children in familes 13 8 21 







Congregate Facility (dormtorv, baracks, shared-living). 




serve subpopu1ations that fit more then one category (i.e. Severely Mentally II Persons with Chronic 




o 

25% 

25% 

o 

o 

25% 

Part E: Dischar e Polic (Only State & Local Government A licants 



1. i: Yes D No facilities, foster care or other youth facilities, or corrections programs and 



jurisdiction? 

172 form HUD-40090-2 

o






application and possible withdrawal of your conditional award(s). For fuher instructions for 







State Grant ESG G 7/01/05 $21,500.00 

Trust Fund Individual contribution P 4/06/06 $10,000.00 

*Government sources are appropriated dollars. TOTAL: $31,500.00 


All Pro. ects Exce t Dedicated HMIS Pro' ects) 


If "Yes," what date did this project begin paricipating in the HMIS? 

If "No," enter the date the project anticipates beginnng paricipation. 


roject? 

P ar tH . Renewai P er fì ormance (All Renewa1 P rOJec . t) s 



1. DYes i; No 

2. ~ Yes DNo 




i; Number of units: from four to six. 






D Other: 

Please explain changes: We are currently applying for local funds to expand 

our Transitional Housing program by two units. 

173 form HUD-40090-2









12(a) and 12(b): 



c. Of those who exited, how many staved 7 months or longer in PH-APR Question 12(a) 



% 

((e + d) divided by (a + b)) x 100 = e. Example: ((16 + 15) divided by (20 + 20)) x 100 = 77.5% 




14: 

a. Number of participants who exited TH project(s)-including unown destiation 2 

b. Number of participants who moved to PH-from any destination identified as permanent housing 1 


50% 







1 2 3 4 



in each row) of Income (Cot 3 +- Cot 1 x 

100) 

ExamDle: 105 a. Social Security Insurance (SSI) 40 38.1% 




2 a. SSI 0 0 

2 b. ssm 0 0 

2 c. Social Security 0 0 

2 d. General Public Assistance 0 0 

2 e. T ANF 1 50% 

2 f. SCHIP 0 0 

2 g. Veterans Benefits 0 0 


2 i. Unemployment Benefits 0 0 

2 j. Veterans Health Care 0 0 


2 i. Food Stamps 2 100% 

2 ID. Other - child support 1 50% 

2 n. No Financial Resources 0 0 

174 

form HUD-40090-2




Leased Unites for Housin and/or Services 


Des Moines, IA MSA 


r: 1 % to 99% of FMR 





of Units BUD Paid Rent Months 

g. Totals 

SRO x x = $ 



2 Bedrooms Ix $550.00x 12= $ 6,600.00 

3 Bedrooms 3x $725.00x 12= $26,100.00 





h. Totals: x x $32,700.00 

Leased Strcture s and/or Services - No A licable FMR 

Structure 1 $275x 12 = $ 3,300.00 

Address: 

State: IA Zi : 50265 


Address: 

State: Zi : 

175 

form HUD-40090-2

12 . SHP Suppor t iveServices B U d li!et (All SHP P rOJeets . as A \.pp l' iea bl) e 


1. Outreach 

Year 1 



Quantity: 260.4 hours Outreach salary and 

benefits (í$ I 9.20 per hour 

$5,000.00 $ 5,000.00 


Quantity: 1 FfE and benefits 


Quantity: 


Quantity: 

$62,620.00 $62,620.00 


Quantity: 1 PTE 100 hrs ~ $30.00 per hour 

6. mv/AIS Services 

Quantity: 


Quantity: 


$ 3,000.00 $ 3,000.00 

Quantity: Parcipant scholarships maximum 

$1,000 per year each 


Quantity: 


$ 2,000.00 $ 2,000.00 

Quantity: 3 children ~ $25.00 per week for 40 

weeks 


$ 3,000.00 $ 3,000.00 

Quatity: 66 rides ~ $15.15 per ride 


Quantity: 


Quantity: 

$ 1,000.00 $ 1,000.00 

14. Total SlI supportive services dollars 

$47,167.00 $47,167.00 



** Total of Line 14 must match line 6 column e. on the Project Summry Bud~ et. 

15~ Total cash match to be spent on SlI 

elil!ible supportive service activities. *** 

$2,453.00 $2,453.00 



the total supportive servces budget (i.e., 80 percent of line 14 plus line 15). The total of Line 15 must match 


176 


I A J'\t'nc\

13. SHP Operatine Budeet (All SHP Projects with Operating Costs) 


Operatiu2 Costs Year 1 Year 2 Year 3 Total 

1. MaintenancelRepair 

Quantity: 

2. Staff 


3. Utilties 

Quantity: 

4. Equipment (Iease/buy) 

Quantity: 

5. Supplies 

Quantity: 

6. Insurance 

Quantity: 


Quantity: 

8. Relocation 

Quantity: (number of persons) 

9. Food 

Quantity: 


Quantity: 



*1f not specified, the costs will be removed from the budget. 

** Total of Line i 1 must match line 7 co1un e. on the Project Sumary Budget. 


elit!ible operatiniz activities. *** 


11) must be no more than 75 percent ofthe total operations budget (i.e., 75 percent of line 11 plus line 12). 



Applicable) 





City, State, 

Zip: 





Leasing 


6. Operations 

7. HMIS 

8. Total 

SHP Reauest Total Budget 

City, State, Zip: 

I. Acquisition 




Leasing 


6. Operations 

7. HMIS 

8. Total 


177 form HUD-40090-2

15. SHP HMIS Budeet (All SHP Proiects with HMIS Costs) 



Equipment 



3. Networking 

4. Security 

Subtotal: 


5. Software/User Licensing 




Subtotal: 

Services 










Subtotal: 

Personnel 




21. T echncal Assistance and Training 


Subtotal: 




Subtotal: 



* Total of Line 25 must match line 8 column e. on the Project Summar ¡r Budget. 



** Cash Match can be spent on any SHP eligible activity (see the cha in Section IILA.3. of the NOFA for these 


budget (i.e., 80 percent ofline 25 olus line 26). 

178 form HUD-40090-2 

IAI'lOn&:\



Jl Sh It PI CdS f 8 SRO R t I A . B d t 

. e er us are an ec ion en a ssistance u ige 

a. Check the box to indicate the type of program: L J S+C D Section 8 SRO 









SRO x x = $ 








, 

Other: x x 

= $ 


*Please be advised that the actual FMRs used in calculating your s+c or SRO grant will be those in 



Sinele Room Occupancy (SRO) Pro.iect Budeet 


Type Amount 


Acquisition: 

Other Costs (Eligible & Ineligible, e.g., furntue): 

Total: $ 

b. List any commitments from public and private sources that you are able to provide at ths time to 


Source Amount 

Total: $ 

179 form HUD-40090-2 

IAI')nna:\





projects): 


_% Persons who came from Emergency Shelters.* 










D Yes, very accessible 0 Somewhat accessible 0 Not accessible 


List residents' maximum allowable lengt of stay: _ months 




neighborhood. 


structues or units durng the first year and in a particular area within the locality in subsequent 

years, or to live in a paricular area for the entire period of paricipation? 0 Yes 0 No 




other organzations wil have in operating and maintaining the property. 


photograph. 



180 form HUD-40090-2 

I A l)nn~\


activities that you are currently providing? D Yes D No 


Facilties that you are currently operating and activities you are currently undertaking to 









D Replace the loss of nonrenewable funding from private, Federal, or other sources (except 













All new ro' ects exce t Dedicated HMIS Pro' ects 




D Life skills (outside of case mana ement) D Em 10 ent Services 



D Mental Health and Counselin Services D Transitional Living Services 

D HIV/AIS Services D Other (must s ecif *) 




1. Describe specifically how participants wil be assisted both to obtain and also remain in 


181 


( ",.,(l(lA\













applicants. 



If Yes, 





needed. 




(NOF A). 




Governent)? DYes DNo 



amended, or documentation of nonprofit status as described in the Glossary in Section I. A. 7 of 





182 form HUD-40090-2 

( dl?()()R\




HMIS. 




HMIS. 





183 




: WDM HS Transitional Housing 

: Total 


.. 

CI 

~ 

(§The Center for Applied Management Practices, Inc., 2005. Form HUD 96010(2/2006)








Project Name: 









Name: 

Title: 


West Des Moines - Transitional Housing (renewal) 

West Des Moines, Iowa 





Sign"",,, 

Da~-= I Lg.ii ( , ~ 

AmST'~ 


185 

form HUD-2991 (3/98)


P ar tAG . 

enerai P ro.1 ec t I norma fi f ion (All P rOJects ) 


1. Project Priority Number 3. Ifrenewal, list previous 

2. o New Project IA6C302007 




PIN Number:IA20004 

Chart in Exhbit!): -- identifier number (PIN) 

4. HU-Defined CoC Name: 5. CoCNumber: 

Greater Des Moines/Polk County 1A-502 

6. Applicant's Organation Name (Legal Name from SF-424) 8. Applicant's DUNS Number 



(From SF-424): 

07-349-8909 




Street: 100 East Euclid, Suite 101 Identification Numer (EIN) (From 




Name: Bob Schulte Phone number: 515-237-1384 

Title: Federal Programs Administrator Fax number: 515-242-2844 

Email Address:RAchulte~dIDov .or!! 


Sponsor 


Anawim Housing Shelter Plus Care 


Geographic Code: 191362/199153 

/ 

15. Project Address (S+C SRAs, if multiple sites list all addresses including): 18. i: Check box if Energy Star is 

Street: SEE A TT ACHMENT used in ths project 

City: State: Zip: 19. Project Congressional District(s): 


17. If project contain housing units, are these unts: i: Leased? 0 Owned? IA-03 


Anawim Housine 603586278 


i: Check box if Project Sponsor ha ever received a federal grant, either 

diectly from a federal agency or though a state/local agency 


Street: 921 6th Ave. Suite B Identification Number (EIN: 



Name: Bil Swanson Phone number: 515-244-8308 

Title: Shelter Plus Care Administrator Fax number: 515-244-7977 

Email Address: bil~anawimhousine.ore 

186

S+C Unit Address 

2714 Ingersoll 50312 

810 SW Payton 50315 

1433 6th Ave. 50314 

828 12th Street 50265 

709 17th Street 50314 

820 12th Street 50265 

712 13th Street 50265 

2917 Grand Ave. 50312 

526 Clifton 50315 

2847 Indianola Ave. 50315 

5555 SW 9th 50315 

2400 Hickman 50310 

3310 E. 36th Court 50317 

2201 26th Street 50310 

1869 SE Virçiinia Circle 50315 

1914 Casady 50315 

1912 Casady 50315 

3807 University 50311 

7405 SW 12th 50315 

1302 E. Watrous Ave. 50315 

3013 Dubuque 50317 

3931 E. 23rd St. 50317 

3405 Woodland Avenue 50265 

1245 6th Ave. 50314 

3710 56th Street 50310 

2847 Indianola Ave. 50315 

706 SE 7th St. 50315 

3727 University Ave. 50311 

729 17th 50314 

4151 E. University 50317 

814 Taylor 50315 

3808 6th Ave. 50313 

1325 12th Street 50314 

2201 26th Street 50310 

2330 Hickman Rd. 50310 

615 SE Hackley 50315 

187

1914 Kinq Ave. 50320 

3825 66th 50322 

3406 E. Arthur 50317 

1800 Grand 50265 

2031 Maple 50317 

2140 Grand Ave. 50265 

524 Clifton 50315 

3205 Grand Ave. 50312 

2105 SW 9th 50315 

1107 Burnham Ave. 50315 

3003 Cambridqe 50313 

2124 Grand Ave. 50265 

404 Fulton 50315 

70816th 50314 

686 19th 50309 

1444 E. Walnut 50316 

617 Hackley 50315 

1450 1/2 NE 14th Street 50313 

716 16th 50309 

51628th 50312 

3401 6th Ave. 50313 

3830 6th Ave. 50313 

3809 University Ave. 50311 

2400 Hickman Rd. 50310 

4150 Maple Street 50317 

1426 Penn. Ave. 50316 

1433 1/2 Dean Avenue 50316 

2236 Capitol Ave. 50317 

202 SW Philp 50314 

188


BL. Su ortive Housin Pro ram (SHP) (All SHP Pro'ects) 

a. D SHP Pro ram c. Grant Term (New Projects must be 2 or 3 years; 


D D D D D Safe Haven/TH (Check only one box) 

TH PH SSO HMIS D Safe Haven/PH D D D 

d. Proposed 





4. Subtotal 

(Lines 1 throu h 3 


From Leasin Bud et Cha 



7. Operations 

From Operatig Budget Char 

8. HMIS 

From HMIS Budget Char 




(U to 5% of line 9) 





D ~ D D D 











Re uest (Col. e + Col. 1) 

Total 

Cash Match 

Total Budget 

(Total SHP 


Cash Match) 




(8 Renewal 

1 Year 

$723,384 

DNew 

5 Years 

(SRO) (All Section 8 SRO Pro'ects) 

c. Grant Term 

D 10 Years 

$ 

DNew 

(PRA S+C/SRO) 

10 Years 

189 form HUD-40090-2


(All P' E D d d HMIS P' ) 

roi ects xcept e icate rOJects 

1. Housing Type* 1a. r8 Multi-family 


lb. r8 Scattered Site 


D Con!!re!!ate Facilty 



(Point-in-Time) (If ADDlicable) (column a + coI. b) 















Congregate Facility (domutorv, baracks, shared-living). 







roximate Percenta es (% 

5% 

34% 

23% 

5% 

5% 

30% 

Part E: Dischar e Polic (Onl State & Local Governent A licants) 



1. r8 Yes D No facilities, foster care or other youth facilities, or corrections programs and 



jursdiction? 

0% 

190 form HUD-40090-2









Contribution 


Contribution 





Written 

Commitment 


Written 

Commitment 


*Government sources are appropriated dollars. TOTAL: $ 


(All Pro'ects Exce t Dedicated HMIS Pro'ects) 


If "Yes," what date did this project begi paricipating in the HMIS? 

If"No," enter the date the project anticipates beginning paricipation. 


roject? 


1. DYes ~No 



191 


IAI?nn¡:\



i: Number of persons served: from 205 to 210. 

i: Number of 

units: from 102 to 107. 



2. i: Yes DNo D Change in target population. 



D Other: 

Please explain changes: We tr to maximize utilization of avaIlabli 

funds 





check the N/ A box and skip these questions. D N/A 




I2(a) and 12(b): 

a. Number of participants who exited PH project(s)-APR Question 12(a) 49 

b. Number of participants who did not leave the project(s)-APR Question 12 (b) 114 

c. Of those who exited, how many stayed 7 months or longer in PH,-APR Question 12(a) 46 

d. Of those who did not leave, how many stayed 7 months or longer in PH-APR question 12(b) 76 

e. Percentage of all parcipants in PH projects staying 7 months or longer 

75% 





14: 

a. Number of participants who exited TH project(s)-including unown destination 

b. Number of participants who moved to PH-from any destination identified as permanent 

housing 


% 







1 2 3 4 

Number of Adults Who Income Source Number of Exiting % with Income 

Left (Use the same number Adults with Each Source at Exit 

in each row) of Income (Col. 3 + Col. 1 x 100) 

Example: 105 a. Social Security Insurance (SSO 40 38.1% 


Insurance (SSDO 


192 form HUD-40090-2 

I A I~"u''\nc\

26 a. SSI 4 15% 

26 b. SSDI 1 4% 

26 c. Social Security 1 4% 


e. TAN 

f. SCHIP 

l!. Veterans Benefits 

26 h. Emplovment Income 6 23% 

i. Unemoloyment Benefits 


k. Medicaid 

26 i. Food Stamos 11 42% 

m. Other (olease specify) 

n. No Finncial Resources 

193 form HUD-40090-2 

I A l'lnn&:\



11. SHP Leasin Bud et (All SHP Pro"ects with Leasin 







D Greater than 110% (RU approval 



c. Size of Units d. Number e. FM or f. Number of g. Totals 


SRO x x $ 








Other: x = $ 

h. Totals: x = $ 

Leased Strctue s licable FMR 


Address: 

State: 


Address: 

State: Zi : 

194 form HU-40090-2

12. SHP Supportive Services Bud~et (All SHP Projects as Applicable) 



1. Outreach 

Quantity: 


Quantity: 


Quantity: 


Quantity: 


Quantity: 


Quantity: 


Quantity: 


Quantity: 


Quantity: 


Quantity: 


Quantity: 


Quantity: 


Quantity; 




** Total of Line 14 must match line 6 colum e. on the Project Sumary Bud~et. 


elii!ible supportive service activities. *** 



the total supportive services budget (i.e., 80 percent ofline 14 plus line 15). The total of Line 15 must match 


195 form HUD-40090-2 

fAI'lnt'C\

13 . SHP 0'pera ting B u d l~et (All SHP PrOJects wIt 'hOJperating c osts) 


Operatin~ Costs 


Quantity: 

2. Staff 


3. Utilties 

Quantity: 


Quantity: 

5. Supplies 

Quantity: 

6. Insurance 

Quantity: 


Quantity: 

8. Relocation 



persons) 

9. Food 

Quantity: 


Quantity: 




** Total of Line II must match line 7 colum e. on the Project Sumary Budget. 


elIi!ible operatin2 activities. *** 

*** Cash Match can be spent on any SHP eligible activity. The amount oftht( SHP request (entered in line 

II) must be no more than 75 percent ofthe total operations budget (i.e., 75 percent ofline II plus line 12). 

The total of Line 12 must match line 7, column f. on the Project Summry Budget. 


Applicable) 

To be used only for projects with multiple strctures with acquisition, rehabilitation or new construction 


Structure A 

Address: 

C itv, S tate, Z'ip: 






Leasing 


6. Operations 

7. HMIS 

8. Total 

Structure B 

Address: 

ity, tate, ip: 

C S Z' 





Leasing 


6. Operations 

7. HMIS 

8 Total 


196 form HUD-40090-2 

fA L'LI'f'C\

15. SHP HMIS Budget (All SHP Projects with HMIS Costs) 



Equipment 



3. Networking 

4. Security 

Subtotal: 






Subtotal: 

Services 


10. Hosting/echncal Services 



13. Programng: Data Conversion 





Subtotal: 

Personnel 






Subtotal: 




Subtotal: 



* Total of Line 25 must match line 8 column e. on the Pro.iect Summarv Budget. 



** Cash Match can be spent on any SHP eligible activity (see the chart in Section IILA.3. of the NOFA for these 



197 form HUD-40090-2



Jl . Sh e er It us PI are CdS an t ec 8 ion SRO R t en I a A SSIS . ance t B u d L~et 

a. Check the box to indicate the type of program: (8 S+C L J Section 8 SRO 




k8 100% ofFMR 


o 101 % to 110% ofFMR (PHA approval 

o Greater than 110% (RU approval 




SRO x x = $ 


1 Bedroom 36 539 12= $232,848 

2 Bedrooms 44 657 12= $346,896 

3 Bedrooms 12 841 12= $121,104 

4 Bedrooms 2 939 12= $22,536 




i. Totals: 94 x = $723,384 




Sin~ie Room Occupancy (SRO) Project Bud~et 

a. List below an estimate of the total costs of developing the S+C/SRO Jroject: 

Type Amount 


Acquisition: 

Other Costs (Eligible & Ineligible, e.g., fuitue): 

Total: $ 



Source Amount 

Total: $ 

198 form HUD-40090-2 

IAI')nnt=\





projects): 








time (30 consecutive days or less) in a jail, hospital, or other institution. 




DYes, very accessible D Somewhat accessible D Not accessible 


List residents' maximum allowable lengt of stay: _ months 




neighborhood. 


structures or unts durng the first year and in a particular area within the locality in subsequent 

years, or to live in a paricular area for the entire period of participation? DYes D No 






photograph. 



199 form HUD-40090-2


activities that you are currently providing? D Yes D No 


Facilites that you are currently operating and activities you are currently undertaking to 









nonrenewable funding from private, Federal, or other sources (except 

D Replace the loss of 


By law, no SHP fuds may be used to replace state or local governent fuds previously used, 




a. The source ofthe nonrenewable fuding, indicating that it is not under the control of 







(All new ro . ects exce t Dedicated HMIS Pro' ects 




D Life skills outside of case mana ement) D Em 10 ent Services 



D Mental Health and Counselin Services D Transitional Livin Services 

D HN / AIS Services D Other (must s ecify *) 






200 form HUD-40090-2


1. Describe specifically how paricipants wil be assisted both to increase their employment and/or 











applicants. 



If Yes, 





needed. 




(NOF A). 





If Yes, one of the following must be attached for each organzation: 


amended, or documentation of nonprofit status as described in the Glossary in Section lA.7 of 





201 form HUD-40090-2




HMIS. 




HMIS. 



5. Demonstrate that no state or local governent fuds would be replaced with the funding being 


202 form HUD-40090-2

ë el 

§. ~ 

o 0 ~ 

~ S E 

~!: ~ 

c:!'z 

jg i: -= 

=i ~ ~ 

-g:! to.. E~ 

~9 Q 

ëii :: '" 

U 

:i 

o 

N 

'" 

'0 ~ 

ë 6 

~ l5 

R~ 

el co 

o :: 

~ 0 

ii ÍD ÍD 

o 1í .. ice 

ii t: '" 

:i c 

rn W 

f! 

.~ (/ ü ~ .. ß 

:: (/ a 

£.2~E 

E ~ ~:: 

'§ 2 ~ 

.: ê Q) ~ :¡ § 

() 

cu Q; 

E E 

~ ~ 

Z Z 

.. .. 

= u 

5 .~ 

:= e 

i: i: 

~ 

;i 

.. Ql 

"tQ 

~ u 

'6i 

Q 

.. ~ 

:¡ E 

i: ~ 

W i. 

.. Q i. 

i: 

i: 

;: 

:: 

~ 

:. 

I1 

l' C :: 

a 

() 

() 

.: 

.. 

i: ãi 

Q) :i 

E æ 

e E 

:i E 

:: CI 

Q) ~ 

:¡ (/ 

~ .g 

II E 

Õ ë5 

o :: 

Ic: 

~ ~ ~ 

:: l! l! ~ 

CD ~ ë3 I- 'u I- Z 

ü 

Ii ~ 

E 

(I :e :e 'I 

~ ~ It ~ 

ë CI_ 

55 1ü 

E ~ 

~ § 

£: E 

Ol x 

C "eñ 

:§ Q; 

~ ~ 

", Ol 

c: c: 

~ .~ 

CI 0 

a. .i 

~ g? 

Æ :e 

CI 0 

§ 8: 

:i ~ 

~ Ol c: 'ëi :5 

.~ L: "0 

~ ~ j æ 

~ .~ ~ -m.~ . 

æ15§:§~.~ 

E8:-:06~E 

~ ~ .E .c 13 ~ 

'C ai 

i: 

1i CI 

i: tó 

'¡ .g 

:¡ 1i 

J! "0 

lG '" 

a g CI 

e Ol 

ai ci 

.i 

== 

ai 

", 

ë CI 

J! E 

lG il 

a Oi 

.. ro 

o CI 

ai ", 

tJ ro 

.. CI 

:i .. 

o 

en 

o 

i: 

o 

;: 

tJ 

.! 

Õ 

.. 

o 

o 

~ 

i: 

ai 

:i 

C" 

e 

LL 

ci 

ci ci ~ ~ ci ci ci ci ci ci ci ci ci ci ci 

I- Z -z - z - z - Z -z - z - z - z ~ z ~z I- Z I- Z - Z - Z I- 

'I 'I 'I 'I 'I 'I 'I 'I 'I 'I 'I 'I 'I 'I 'I 

~ $1 

c: 

:: ro 

(/ a. ci ci ci ci ci ci ci ci ci ci ci ci ci ci ci ci ci 

-. I1 'õl- ZL- ZL- ZL- ZL- ZL- ZL- zi- ZL- z- z- z- z- zr- zr- z- z- zl- 

(I :e 'I 'I 'I 'I 'I 'I 'I 'I 'I 'I 'I 'I 'I 'I 'I 'I 'I 

~ to 

0. It 

g 

'E ,2 

~ E ã 

..." co 1: 

a 

~ 

c: 

;t 

L- Q) 

a. E 

CI 

c. 

ro 

a. 

Ol 

c: 

ëii 

:: 

o 

:i 

Ql Õ 

.! ~ 

N C.! 

C to 

ll ", 

a.~ 

CI 

.i 

l- 

- 

I.~ 

.- ei 

a. -. C" 

.6 Ó 

ë CI 

c: 

ro 

E 

1¡ 

a. 

B 

"0 CI 

,. 

o 

E 

", 

ë co 

:Q'~ 

t: e 

co .i 

a. c. 

i: I 

Q) Ol 

Qi .S 

E 

o 

", 

:: 

:i2 

203 

'" 

:ë o 

:: 

lG-lG 

a 

.. oCl 

i: 

¡¡¡ 

II 

ai 

tJ 

E 

c. 

i. 

", 

ãí 

CI 

.i ", 

"0 

ro 

CI 

5- 

", 

1¡ 

:; a. 

E 

o 

ü 

(õ oN-- 

N 

o ..oCD 

O' 

o 

:: 

J:EL- 

a 

u. 

Ii 

oN 

Ò 

C 

iñ 

(I 

() 

t5 ~a. 

-C(I 

E 

Q) 

0) 

lt 

C 

lt 

~ 

"0 

.~ 

a. a. 

.: 

L- 

.E L- 

(I 

C (I 

ü Q) 

.. 

iê)








Project Name: 









Name: 

Title: 


ANAWIM - Permanent Supportive Housing (renewal) 


2006 Shelter Plus Care (S+C) 




Sign.un. c4.~::~ ' 


Am~~Kk 


204 

form HUD-2991 (3/98)

06-1011 - City of Des Moines

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?