Agency Forms

  1. Agency Participation Agreement
  2. Agency Information Form
  3. Annual Housing Inventory data update form
  4. User Policy and Agreement
  5. Maine HMIS Procedures Manual
  6. Data Sharing Agreements for Inter-Agency Coordinated Services
  7. Qualified Organization Business Associate Agreement (HIPPA)

Agency Participation Agreement

If your agency would like to participate in the Maine HMIS, the Agency Participation Agreement is the first form you will need to complete.  The agreement covers the areas of:  terms of use, training and technical assistance, confidentiality, security, and access to data.  This agreement should be signed by an official who is authorized to enter into contractual agreements on your agency’s behalf.

Click here to download:  HMIS Agency Participation Agreement

Agency Information Form

After your agency has agreed to participate in Maine HMIS, please take some time to tell us about the types of housing and services that your agency provides.  This will assist the Maine HMIS administrators when configuring your agency in HMIS.

Click here to download:  Agency Information Form

Maine Annual Homeless Housing Inventory Form

Annual Housing Inventory data update form. It will be pre-filled with the information currently on record regarding projects who are already on the Housing Inventory. To add a project or projects, download and complete the form.

2018 Housing Inventory Count (HIC) Form

User Policy and Agreement

Once your agency is set up in HMIS, it would be helpful if users could login to enter data and run reports on behalf of the agency.  All users must read, acknowledge and sign the HMIS/ServicePoint User Policy, Responsibilities Statement, and Code of Ethics before they are allowed access to the HMIS system.

The User Policy and Agreement form was updated on 11/23/2009 to clarify the signature lines.  The form was updated again on 7/18/2018 to clarify which program type(s) the user needs to be trained for data entry and reporting.  This is the updated form.

Click here to download: HMIS ServicePoint User Policy Responsibilities Statement and Code of Ethics

Maine HMIS Procedures Manual

It is recommended that agencies retain a copy of the HMIS Procedures Manual for reference.  The Procedures Manual may be updated from time to time so that the information it contains remains timely and useful.  The most recent revision to the Maine HMIS Procedures Manual was on March 27, 2009.

Click here to download:  Maine HMIS Procedures Manual 03_27_2009

Data Sharing Agreements for Inter-Agency Coordinated Services

Most agencies are configured to use HMIS as a stand alone database, where client level data is recorded only for the use of the agency that records the data.  However there may be times when agencies would benefit from sharing certain data about clients that they mutually serve.

For example, all agencies that will administer funds as Homeless Prevention and Rapid Re-Housing (HPRP) subgrantees to serve clients under the American Recovery and Reinvestment Act (ARRA) will be required to share certain demographic and services data about clients they serve.  This will ensure maximum coordination of benefits and hopefully eliminate duplication of services for each client served with ARRA funds.

Agencies that wish to share client level data between or among multiple agencies must fill out and submit a Maine HMIS Coordinated Services Agreement.  Maine HMIS staff are available to assist in identifying and naming the data points in the agreement that the agencies wish to share.

Click here to download:  Maine HMIS Coordinated Services Agreement

Qualified Organization Business Associate Agreement (HIPPA)

Agreement to share information entered into Maine Statewide Homeless Management Information System (Maine HMIS) for the general purpose of managing the System. MaineHousing provides training, administration, coordination, and report generation to agencies, programs and Continuum of Care participating in Maine Statewide Homeless Management Information System. Acknowledges that in transmitting, receiving, storing, processing or otherwise dealing with any consumer protected information, they are fully bound by state and federal regulations governing confidentiality of patient records, including the Federal Law of Confidentiality for Alcohol and Drug Abuse Patients, (42 CFR, Part 2) and the Health Insurance Portability and Accountability Act of 1996 (‘HIPAA’, 45 CFR, Parts 160 & 164), and cannot use or disclose the information except as permitted or required by this agreement or by law.

Click here to download: Maine Qualified Service Organization Business Associate Agreement