Documenting Client Eligibility and Homeless Status for the DCA ESG Program
ESG sub-grantees are required to document homeless or at-risk status as part of the intake process for participants. Eligibility and documentation requirements are set forth by the ESG Interim Rule and DCA. For details, please refer to the
DCA
ESG Guidebook
. This page contains a list of DCA documents provided for this purpose, and indicated which documents are required for ESG sub-grantees.
Homeless Status Documentation Forms
-
Homeless
Verification Form - Emergency Shelter, Hotel-Motel Vouchers, and Supportive Services Only
(not required, but use is suggested)
-
Homeless
Verification Form - Rapid Re-Housing
(not required, but use is suggested)
- Homeless Verification Form - Prevention (not required, but use is suggested)
-
Homeless
Verification Form - Street Outreach
(not required, but use is suggested)
-
Third
Party Homeless Certification Form
(This form should be used to obtain third party written certification when it is not otherwise available.)
-
Staff
and Oral Third Party Certification Form
(required for oral third party and staff observation certification of homelessness)
-
Self-Certification
Form
(required for client self-certification of homelessness)
Chronic Homeless Documentation Forms
-
Chronic
Homeless Certification
(required for all chronically homeless participants)
-
Chronic
Homeless Third Party Certification
(This form should be used to obtain third party written certification for chronic homelessness when it is not otherwise available.)
-
Chronic
Homeless Self Declaration
(required for chronic homeless if third party verification is not available)
-
Chronic
Homeless Self Declaration - Spanish Translation
Income Forms and Resources
-
Income
Verification Form
(This form should be used to obtain third party documentation of income or benefits when source documents are not available.)
-
Income
Self Declaration Form
(required if third party verification is not available)
-
Prevention
Income Calculation Worksheet
-
Rapid
Re-Housing Income Calculation Worksheet
- Area Median Income
- When calculating 30% income eligibility for prevention intake, 90 day prevention recertification, or annual rapid re-housing recertification, note that the “Extremely Low Income (ELI) families" limits do NOT apply to the ESG program. ESG does not use the ELI measure to establish income limits but instead uses the 30% of Area Median Income (AMI) limits. Please use the 30 percent AMI tables. If ESG recipients/subrecipients were to use the ELI standard, some participants for ESG might be falsely determined to be eligible for assistance, when actually their incomes were over 30 percent AMI.
Recertification for Homelessness Prevention
-
Household
Recertification for Homelessness Prevention
(required every 90 days for all Homelessness Prevention households)