Omaha/CB Assessment Phase II: Permanent Supportive Housing Referral
Phase II Assessment Process
a. Verify chronic homeless eligibility, per HUD standards, including disability status and upload documents in HMIS.
b. Complete the DLA 20 assessment and record the score in HMIS. The DLA 20 score must identify sever service needs, as evidenced by meeting the pre-determined threshold. (Threshold scores are currently being determined for PSH review. Additionally, training for completing the DLA 20 will be scheduled so that access points and outreach workers understand the instrument).
c. Submit the referral to the Homeless Review Team (HRT) for discussion, prioritization, and possible referral to PSH vacancies

PLEASE NOTE: COMPLETION OF A REFERRAL IS NOT A GUARANTEE OF PLACEMENT - Referring Agencies are strongly encouraged to attend the Homeless Review Team (HRT) work group meetings to further review your referral. Meetings are held weekly - 9 am on Thursdays at Community Alliance, 4001 Leavenworth St, Omaha, NE 68105.

Email address *
Head of Household Client ID # *
Your answer
Household Type *
Household Size *
Your answer
DLA Score
Your answer
Referring Agency *
Your answer
Referring Worker *
Your answer
Referring Worker Contact Phone Number *
Your answer
Is household Chronically Homeless? *
***IF HOUSEHOLD IS NOT CHRONICALLY HOMELESS: STOP HERE - HOUSEHOLD IS NOT ELIGIBLE FOR A REFERRAL TO PERMANENT SUPPORTIVE HOUSING*** Household is chronically homeless if one household member has a disabling condition AND has been homeless for 12 consecutive months or has had 4 or more episodes of homelessness in the past 3 years totaling 12 months. For more information :
Reason for referral - Select one of the options below: *
Never submit passwords through Google Forms.
This form was created inside of Together. Report Abuse - Terms of Service