Utah HMIS

Forms

HMIS Forms

UHMIS End-User Agreement

How to fill out

for Instructions click here

UHMIS Informed Consent Release Form

2021 UHMIS Informed Consent Release Form – Spanish

This Spanish Informed Consent

This Spanish Informed Consent was translated using a Spanish dialect that may not translate fully for some Spanish speakers. A Spanish-speaking staff person should ensure clients understand the document and that any questions they have are answered.

Note the 2021 version is still in use for the Spanish translation, a new version of the 2024 UHMIS Informed Consent Release Form will be available soon.

UHMIS Privacy Posting

2021 UHMIS Privacy Posting – Spanish

This Spanish Informed Consent

This Spanish Privacy Posting was translated using a Spanish dialect that may not translate fully for some Spanish speakers. A Spanish-speaking staff person should ensure clients understand the document and that any questions they have are answered.

Note the 2021 version is still in use for the Spanish translation, a new version of the 2024 UHMIS Privacy posting will be available soon.

New UHMIS Agency Access Request Form

UHMIS Contributing HMIS Organization (CHO) Partner Agreement

Memorandum of Understanding example

EXAMPLE – UHMIS Data Sharing Memorandum of Understanding

Used when one agency asks another to enter data into its UHMIS project(s).

It may be altered to fit the agency’s agreement needs.

Basic Assessment Forms

Basic Assessment Form 

(Updated 9/29/25 for the 2026 Data Standards)

Use this form as a guide to collect all the 2026 HUD HMIS Data Standard

Use this form as a guide to collect all the 2026 HUD HMIS Data Standard for most programs, for Entry Assessment, Annual Assessment, and Exit Assessment.

Agencies may customize this form, and UHMIS System Administrators can provide a Word Document upon request. This form is designed to collect the Universal Data Standard elements required for all projects, and it does not collect all of the required elements for specialized projects such as HOPWA, RHY, PATH, and SSVF.

Night-By-Night Emergency Shelter Basic Assessment Form

Basic Assessment with NBN ES

Basic assessment form for Night By Night Emergency Shelter.

(Updated 9/29/25 for the 2026 Data Standards)

Code Blue Emergency Shelter Assessment Form

Use this form if your shelter is open ONLY on Code Blue nights

Learn more about Code Blue here and here.

If your shelter is open every night, but increases in bed size on code blue nights, please continue using the Night-By-Night form or the Basic form.

Coordinated Entry Basic Assessment form 

(Updated 9/29/25 for the 2026 Data Standards)

Basic Assessment form with CE
  • The Basic Assessment form with Coordinated Entry questions and CE Events.
  • NEW: Updated on 8/27/24 to include barriers

Permanent Supportive Housing Basic Assessment Form 

(Updated 9/29/25 for the 2026 Data Standards)

PATH Basic Assessment Form  

(Updated 9/29/25 for the 2026 Data Standards)

PATH-funded projects

The Basic Assessment form is tailored for projects funded with PATH dollars (specifically services only and street outreach programs; please check data elements for other PATH-funded projects).

Street Outreach Basic Assessment Form

(Updated 9/29/25 for the 2026 Data Standards)

RHY Basic Assessment Form  

(Updated 9/29/25 for the 2026 Data Standards)

RHY Elements

Contains a list of all required RHY elements with the basic assessment form.

HOPWA Basic Assessment Form  

(Updated 9/29/25 for the 2026 Data Standards)

Homelessness Prevention Basic Assessment Form

(Updated 9/29/25 for the 2026 Data Standards)

HP Exit assessment

Contains the Housing Assessment at Exit assessment.