SCC HMIS Data Request Form
Thank you for your interest in requesting data. Please submit any data request to the Bitfocus System Administration team after completing the required fields below. Once submitted, a member of the team will respond to the email provided within 24 hours to confirm whether the request can be completed. Please expect a minimum of 2 business days to fulfill all requests. For complex data requests this may take more time. For requests received after 2:00 PM, a response will be provided within 24 hours beginning the next business day. Please note that responses to all HMIS Data Requests, sent close to business and government holidays, may be impacted due to scheduling and availability.
Email address *
Name *
Your answer
Agency or Entity Name *
Your answer
Date of Request *
MM
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DD
/
YYYY
Completion Date Requested *
MM
/
DD
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YYYY
Report Specifications
Data Request Summary *
Your answer
Reporting Period Start Date *
MM
/
DD
/
YYYY
Reporting Period End Date *
MM
/
DD
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YYYY
City name (if applicable)
Your answer
HMIS Program(s) to INCLUDE *
HMIS programs can be a specific Agency, HMIS Program or Project Type (ES, TH, RRH, PSH, etc.) or HMIS System Wide
Your answer
HMIS Program(s) to EXCLUDE *
Enter in N/A, if not applicable
Your answer
Report Details
Desired Reporting Outcomes: Describe the purpose of Data Analysis report (what is the message the data is meant to communicate and who is the audience?) *
Your answer
Scope of Data Request *
Required
Priority *
Very high
Very low
Internal Use Only
Please DO NOT complete the following field. It is not required to process your HMIS Data Request.
Completion Date (Bitfocus, Inc. Only)
MM
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DD
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YYYY
Submit
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