Homeless Management Information Systems (HMIS) / Federal Register FR 4848-N-02 / Page 45924

Veterans Information— Continued: Q: “Did you serve in a war zone?”
Q: “What war zone(s) (choose all that apply)?”
Q: “What was the number of months served in a war zone?”
Q: “Did you ever receive hostile or friendly fire in a war zone?”
Q: “What branch of the military did you serve in?”
Q: “What type of discharge did you receive?”
Children's Education: Q: “Is [name of child] currently enrolled in school?”
If child is currently enrolled, ask:
Q: “What is the name of the child's school(s)?”
Q: “What type of school is it? Is it a public or private school?”
If child is currently not enrolled in school, ask:
Q: “When was [name of child] last enrolled in school?”
Q: “I'm going to read a list of problems that you may have had getting your child into a school. Please tell me if you have experienced any of these problems for [name of child].” (Ask each.)

EXHIBIT 6: REQUIRED RESPONSE CATEGORIES FOR PROGRAM-SPECIFIC DATA ELEMENTS

	Response category
	Source of income	Amount from source $
3.1 Income and source
Source and amount of income	1 = Earned Income	_ _ _ _ .00
	2 = Unemployment Insurance	_ _ _ _ .00
	3 = Supplemental Security Income or SSI	_ _ _ _ .00
	4 = Social Security Disability Income (SSDI)	_ _ _ _ .00
	5 = A veteran's disability payment	_ _ _ _ .00
	7 = Worker's compensation	_ _ _ _ .00
	8 = Temporary Assistance for Needy Families (TANF) (or use local program name)	_ _ _ _ .00
	9 = General Assistance (GA) (or use local program name)	_ _ _ _ .00
	10 = Retirement income from Social Security	_ _ _ _ .00
	11 = Veteran's pension	_ _ _ _ .00
	12 = Pension from a former job	_ _ _ _ .00
	13 = Child support	_ _ _ _ .00
	14 = Alimony or other spousal support	_ _ _ _ .00
	15 = Other source	_ _ _ _ .00
	16 = No financial resources	..............
Total monthly income		_ _ _ _ .00

	Response category
3.2 Source of non-cash benefit
Source of non-cash benefit	1 = Food stamps or money for food on a benefits card 2 = MEDICAID health insurance program (or use local name) 3 = MEDICARE health insurance program (or use local name) 4 = State Children's Health Insurance Program (or use local name) 5 = Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) 6 = Veteran's Administration (VA) Medical Services 7 = TANF Child Care services (or use local name) 8 = TANF transportation services (or use local name) 9 = Other TANF-funded services (or use local name) 10 = Section 8, public housing, or other rental assistance 11 = Other source
3.3 Physical disability	0 = No 1 = Yes
3.4 Developmental disability	0 = No 1 = Yes
3.5 HIV/AIDS	0 = No 1 = Yes
3.6 Mental Health
Mental health problem	0 = No 1 = Yes
Expected to be of long-continued and indefinite duration and substantially impairs ability to live independently.	0 = No 1 = Yes
3.7 Substance Abuse
Substance abuse problem	1 = Alcohol abuse 2 = Drug abuse 3 = Dully diagnosed