17-Attachment J - HOPWA CAPER Report-Part 1 (24-25-Updated).xlsx

XLSX spreadsheet 58 KB Posted

Attached to
NOFA for Housing Opportunities for Persons with AIDS (HOPWA) Program
Solicitation number
OCC-2025-00028249
Issued by
Dallas County, Texas

About this file

Written by GovTribe AI ·

This document is a HOPWA (Housing Opportunities for Persons with AIDS) CAPER (Consolidated Annual Performance and Evaluation Report) Report Part 1 - Demographics, prepared for the City of Dallas Office of Community Care and Empowerment. The report is designed to collect demographic data for various HOPWA programs, including Tenant Based Rental Assistance (TBRA), Short-Term Rent/Mortgage/Utility Assistance (STRMU), Permanent Housing Placement (PHP), and Housing Information Services (HIS). The document provides a comprehensive template for tracking monthly and yearly data on program participants, including race, age, ethnicity, living situations, income levels, medical insurance, and housing stability outcomes.

The report is part of a broader NOFA (Notice of Funding Availability) process where the City of Dallas is seeking eligible organizations to serve as Subrecipients for providing housing assistance and supportive services to low-income persons living with HIV and their families. The HOPWA grant program is funded by the U.S. Department of Housing and Urban Development (HUD) and seeks to support multiple service categories including emergency rental assistance, facility-based housing, emergency vouchers, master leasing, housing information services, supportive services, and housing development. The report serves as a critical tool for tracking program performance, measuring outcomes, and demonstrating compliance with HUD reporting requirements for organizations receiving HOPWA funding.

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HOPWA CAPER (Part 1)

Attachment J
HOPWA CAPER Report (Part 1 - Demographics)
Contractor:
Month:
Purpose: The purpose of this report is to collect demographic data by type of program/project. This data is used by the City of Dallas to complete HUD Form 40110-D, Consolidated Annual Performance and Evaluation Report (CAPER) Measuring Performance Outcomes
Instructions: Submit a separate HOPWA CAPER Report for each HOPWA program/project. For facility-based housing, submit a separate report for each facility. Do not type in shaded areas - these represents formulas or links.
1. Indicate the type of HOPWA program/project.Facility Based Housing / Master LeasingList name of facility:
Tenant Based Rental Assistance (TBRA)
DO NOT INPUT NUMBERS IN SHADED AREAS
(Numbers in shaded areas are links or formulas - do not modify)Short-Term Rent/Mortage/Utility Assistance (STRMU)
Permanent Housing Placement (PHP)
Housing Information Services (HIS)
Supportive Service Only or Other ProgramsList name of program:
Facility Capital DevelopmentList name of facility:
2. Input the demographic data for the above program/project.
I. Continuing & Entry Data

(Data for Continuing & New Clients Added (Unduplicated))

Continuing & EntryContin-
uingOCTNOVDECJANFEBMARAPRMAYJUNJULAUGSEPTYTD
1. HMIS Persons Served Count (HMIS CAPER Q7a)
Clients Whose Data is Entered into HMIS0
Family Members Whose Data Entered into HMIS0
Subtotal00000000000000
2. HMIS Household Served Count (HMIS CAPER Q8a)
Households Whose Data is Entered into HMIS00000000000000
Subtotal00000000000000
The remainder of the report includes data for all persons served (clients and family members) (regardless of whether data is entered into HMIS).
Continuing & EntryContin-
uingOCTNOVDECJANFEBMARAPRMAYJUNJULAUGSEPTYTD
3. All Persons Served
Client (designate one client per household)0
Household Family Members (HIV+)0
Household Family Members (not HIV+ or Unknown HIV Status)0
Subtotal00000000000000
Continuing & EntryContin-
uingOCTNOVDECJANFEBMARAPRMAYJUNJULAUGSEPTYTD
4. Clients - Race/Age
Asian - Under 18 years0
Asian - 18 to 30 years0
Asian - 31 to 50 years0
Asian - 51 years and older0
Asian & White - Under 18 years0
Asian & White - 18 to 30 years0
Asian & White - 31 to 50 years0
Asian & White - 51 years and older0
Black/African American - Under 18 years0
Black/African American - 18 to 30 years0
Black/African American - 31 to 50 years0
Black/African American - 51 years and older0
Black/AA & White - Under 18 years0
Black/AA & White- 18 to 30 years0
Black/AA & White - 31 to 50 years0
Black/AA & White- 51 years and older0
American Indian/Alaskan Native - Under 18 years0
American Indian/Alaskan Native - 18 to 30 years0
American Indian/Alaskan Native - 31 to 50 years0
American Indian/Alaskan Native - 51 years and older0
Amer Ind/Alas Native & Black/AA- Under 18 years0
Amer Ind/Alas Native & Black/AA - 18 to 30 years0
Amer Ind/Alas Native & Black/AA - 31 to 50 years0
Amer Ind/Alas Native & Black/AA - 51 years and older0
Amer Ind/Alas Native & White - Under 18 years0
Amer Ind/Alas Native & White - 18 to 30 years0
Amer Ind/Alas Native & White - 31 to 50 years0
Amer Ind/Alas Native & White - 51 years and older0
Native Hawaiian/Other Pac Islander - Under 18 years0
Native Hawaiian/Other Pac Islander - 18 to 30 years0
Native Hawaiian/Other Pac Islander - 31 to 50 years0
Native Hawaiian/Other Pac Islander - 51 years and older0
Other Multi-Racial - Under 18 years0
Other Multi-Racial - 18 to 30 years0
Other Multi-Racial - 31 to 50 years0
Other Multi-Racial - 51 years and older0
White - Under 18 years0
White - 18 to 30 years0
White - 31 to 50 years0
White - 51 years and older0
Subtotal00000000000000MATCH
Continuing & EntryContin-
uingOCTNOVDECJANFEBMARAPRMAYJUNJULAUGSEPTYTD
5. Clients - Ethnicity
Non-Hispanic: All0
Hispanic: Asian0
Hispanic: Asian & White0
Hispanic: Black/African American0
Hispanic: Black/African American & White0
Hispanic: American Indian/Alaskan Native0
Hispanic: Am. Indian & Black/African American0
Hispanic: Am. Indian & White0
Hispanic: Native Hawaiian/Other Pac Islander0
Hispanic: Other Multi-Racial0
Hispanic: White0Data Match
Subtotal00000000000000MATCH
Continuing & EntryContin-
uingOCTNOVDECJANFEBMARAPRMAYJUNJULAUGSEPTYTD
6. Family Members - Race/Age
Asian - Under 18 years0
Asian - 18 to 30 years0
Asian - 31 to 50 years0
Asian - 51 years and older0
Asian & White - Under 18 years0
Asian & White - 18 to 30 years0
Asian & White - 31 to 50 years0
Asian & White - 51 years and older0
Black/African American - Under 18 years0
Black/African American - 18 to 30 years0
Black/African American - 31 to 50 years0
Black/African American - 51 years and older0
Black/AA & White - Under 18 years0
Black/AA & White- 18 to 30 years0
Black/AA & White - 31 to 50 years0
Black/AA & White- 51 years and older0
American Indian/Alaskan Native - Under 18 years0
American Indian/Alaskan Native - 18 to 30 years0
American Indian/Alaskan Native - 31 to 50 years0
American Indian/Alaskan Native - 51 years and older0
Amer Ind/Alas Native & Black/AA- Under 18 years0
Amer Ind/Alas Native & Black/AA - 18 to 30 years0
Amer Ind/Alas Native & Black/AA - 31 to 50 years0
Amer Ind/Alas Native & Black/AA - 51 years and older0
Amer Ind/Alas Native & White - Under 18 years0
Amer Ind/Alas Native & White - 18 to 30 years0
Amer Ind/Alas Native & White - 31 to 50 years0
Amer Ind/Alas Native & White - 51 years and older0
Native Hawaiian/Other Pac Islander - Under 18 years0
Native Hawaiian/Other Pac Islander - 18 to 30 years0
Native Hawaiian/Other Pac Islander - 31 to 50 years0
Native Hawaiian/Other Pac Islander - 51 years and older0
Other Multi-Racial - Under 18 years0
Other Multi-Racial - 18 to 30 years0
Other Multi-Racial - 31 to 50 years0
Other Multi-Racial - 51 years and older0
White - Under 18 years0
White - 18 to 30 years0
White - 31 to 50 years0
White - 51 years and older0
Subtotal00000000000000MATCH
Continuing & EntryContin-
uingOCTNOVDECJANFEBMARAPRMAYJUNJULAUGSEPTYTD
7. Family Member - Ethnicity
Non-Hispanic: All0
Hispanic: American Indian/Alaskan Native0
Hispanic: Asian0
Hispanic: Black/African American0
Hispanic: Nat. Hawaiian/Other Pac. Is.0
Hispanic: White0
Hispanic: Am. Indian & White0
Hispanic: Asian & White0
Hispanic: Black & White0
Hispanic: Am. Indian & Black0
Hispanic: Other Multi-Racial0Data Match
Subtotal00000000000000MATCH
Continuing & EntryContin-
uingOCTNOVDECJANFEBMARAPRMAYJUNJULAUGSEPTYTD
8. Prior Living Situation
Continuing from Prior Year00
Place not meant for human habitation (Homeless)0
Emergency shelter (incl. paid voucher) (Homeless)0
Transitional hsg for homeless persons (Homeless)0
Permanent housing for formerly homeless0
Psychiatric hospital or other psychiatric facility0
Substance abuse facility0
Non-psychiatric hospital0
Foster care home0
Jail, prison, or juvenile detention facility0
Rented home, apartment, or house0
House the individual owned0
Staying at someone else's house0
Hotel or motel paid for by the individual0
Any other living situation0
Did not report or refused to report prior living situation0Data Match
Subtotal00000000000000MATCH
Continuing & EntryContin-
uingOCTNOVDECJANFEBMARAPRMAYJUNJULAUGSEPTYTD
9. Homeless Status (based on Prior Living Situation in 8. above)
Continuing from Prior Year00
Place not meant for human habitation (from Item 8) - Chronically Homeless Only0
Place not meant for human habitation (from Item 8) - Veteran Only0
Place not meant for human habitation (from Item 8) - Both Chronically Homeless & Veteran0
Emergency Shelter (from Item 8) - Chronically Homeless Only0
Emergency Shelter (from Item 8) - Veteran Only0
Emergency Shelter (from Item 8) - Both Chronically Homeless & Veteran0
Transitional Housing (from Item 8) - Chronically Homeless Only0
Transitional Housing (from item 8) - Veteran Only0
Transitional Housing (from Item 8) - Both Chronically Homeless & Veteran0
Other Homeless0000000000000
Not Homeless (all reported in other prior living situations from Item 8)0000000000000Data Match
Subtotal0000000000000MATCH
Continuing & EntryContin-
uingOCTNOVDECJANFEBMARAPRMAYJUNJULAUGSEPTYTD
10. Household AMI Level
0-30% of Area Median Income (extremely low)0
31-50% of Area Median Income (very low)0
51-80% of Area Median Income (low)0Data Match
Subtotal00000000000000MATCH
The following items apply only to certain programs/projects.
TBRA & STRMU Projects OnlyContin-
uingOCTNOVDECJANFEBMARAPRMAYJUNJULAUGSEPTYTD
11. Unit Location
Collin County0
Dallas County0
Denton County0
Ellis County0
Hunt County0
Kaufman County0
Rockwall County0Data Match
Subtotal00000000000000MATCH
STRMU Projects OnlyOCTNOVDECJANFEBMARAPRMAYJUNJULAUGSEPTYTD
12. STRMU Households (by type)
STRMU Mortgage Asst Only (Households)0
STRMU Rent Asst Only (Households)0
STRMU Utility Only Asst (Households)0
More Than One Type of STRMU (Households)0Data Match
Subtotal0000000000000MATCH
Projects with Waiting ListOCTNOVDECJANFEBMARAPRMAYJUNJULAUGSEPT
13. Waitlng List
No. on Waiting List (as of Beginning of Month)00000000000
No. Added to Waiting List
No. Deleted from Waiting List
No. on Waiting List (as of End of Month)000000000000
Describe how waiting list is administered:
Violence Against Women Act (VAWA)OCTNOVDECJANFEBMARAPRMAYJUNJULAUGSEPT
14. Emergency Transfer Requests
Internal Emergency Transfers Requested (within agency)0
Internal Emergency Transfers Granted (within agency)0
External Emergency Transfers Requested (to another agency or program)0
External Emergency Transfers Granted (to another agency or program)0
Emergency Transfers Denied0

II. Exit & Year End Data (Data for Clients Who Exited During the Year or Year End Assessment)

Exit & Year EndContin-
uingOCTNOVDECJANFEBMARAPRMAYJUNJULAUGSEPTYear
EndYTD
No. of Households Continuing00
Add: No. of Households Added [equals (A) above]0000000000000
Total No. of Households Assisted0
Less: No. of Households Exited00000000000000
No. of Households Remaining in Program0
Stop: First Enter an Exit Destination (or Year End Assessment)
Exit & Year EndOCTNOVDECJANFEBMARAPRMAYJUNJULAUGSEPTYear
EndYTD
15. Exit Destination
Continuing to Next Year0
Other HOPWA Housing programs*0
Other Housing Subsidy Programs*0
Emergency Shelter0
Private Housing*0
Transitional Housing (time limited - up to 24 months)0
Institutional Arrangement (expected to last less than 6 months)0
Institutional Arrangement (expected to last more than 6 months)0
Jail/Prison (expected to last less than 6 months)0
Jail/Prison (expcted to last more than 6 months)0
Not Transitional - Expected to last ≤90 days and uncertain after 90 days0
Place Not Meant for Human Habitation0
Disconnected from Care0
Died0
(For use by STRMU Only) Able to maintain current housing without subsidy0
(For use by STRMU Only) Needs additional STRMU to maintain current housing0
Not Housing Client0
Subtotal00000000000000
*Important Note: PHP projects may only use Exit Destinations with * (Other HOPWA Programs, Other Housing Subsidy Programs, or Private Housing - This refers to the housing situation into which the household was placed using PHP assistance
Exit & Year EndYTDPercentGoal*
FacilityGoal*
FacilityGoal*
TBRAGoal*
STRMUGoal*

PHP

16. Housing Stability Outcomes(Perm)(Trans)
Stable Situations0ERROR:#DIV/0!98.0%68.0%97.0%52.0%100.0%
Temporary Situations0ERROR:#DIV/0!1.0%13.0%0.0%45.0%0.0%
Unstable Situations0ERROR:#DIV/0!1.0%19.0%3.0%3.0%0.0%
No. of Households Counted for Outcome0ERROR:#DIV/0!
Facility (Perm) - Permanent Housing
Remaining (Continuing to Next Year)0ERROR:#DIV/0!Facility (Trans) - Transitional Housing
Death0ERROR:#DIV/0!* Goal - based on 2020-21 National HOPWA Performance Profile - Formula Program
Not Housing Client0ERROR:#DIV/0!
Exit & Year EndOCTNOVDECJANFEBMARAPRMAYJUNJULAUGSEPTYear
EndYTD
17. Sources of Income (accessed or maintained access in past year)
Earned Income from Employment0
Retirement0
SSI (Supplemental Security Income)0
SSDI (SocialSecurity Disability Income)0
Other Welfare Assistance (SNAP, WIC, TANF, etc.)0
Private Disability Insurance0
Veteran's Disability Payment (service or non-service connected payment)0
Regular Contributions/Gifts from agencies or persons not residing in residence0
Worker's Compensation0
General Assistance (or local program)0
Unemployment Insurance0
Other Sources of Income0
NO SOURCE OF INCOME0Data Match
Subtotal - Sources of Income00000000000000MATCH OK
Less: Number with Multiple Sources of Income00000000000000Data Match
Total00000000000000MATCH
Exit & Year EndOCTNOVDECJANFEBMARAPRMAYJUNJULAUGSEPTYear
EndYTD
18. Medical Insurance (accessed or maintained access in past year)
Medicaid Health Program (or local program equivalent)0
Medicare Health Insurance (or local program equivalent)0
Veterans Affairs Medical Services0
AIDS Drug Assistance Program0
State Children's Health Insurance Program (CHIP) (or local prog0
Ryan White-funded Medical or Dental Assistance0
Other Private Insurance (e.g., employer-provided medical)0
Other Medical Insurance (not listed above)0
NO MEDICAL INSURANCE0Data Match
Subtotal - Medical Insurance00000000000000MATCH OK
Less: Number with Multiple Medical Insurance00000000000000Data Match
Total00000000000000MATCH
Exit & Year EndOCTNOVDECJANFEBMARAPRMAYJUNJULAUGSEPTYear
EndYTD
19. Health OutcomesData Match
Prescribed Anti-Retroviral Therapy (ART) (include those currently taking HIV medications)0MATCH OK
Improved Viral Load (in this program year) or Achieved Viral Suppression0MATCH OK
Exit & Year EndOCTNOVDECJANFEBMARAPRMAYJUNJULAUGSEPTYear
EndYTD
20. Longevity (except STRMU and PHP)
Less than 1 year0
1 year but less than 5 years0
More than 5 years but less than 10 years0
More than 10 years but less than 15 years0
More than 15 years0Data Match
Subtotal00000000000000MATCH
Exit & Year EndOCTNOVDECJANFEBMARAPRMAYJUNJULAUGSEPTYear
EndYTD
20A. Longevity (STRMU Only)
Served with STRMU first time this year0
Received STRMU also during the previous STRMU program year (this year & prior year)0
Received STRMU more than twice during the last 5 program years (in current & last 5 yrs)0
Received STRMU during the last 5 consecurtive program years (in current & last 5 yrs)0Data Match
Subtotal00000000000000MATCH
Exit & Year EndOCTNOVDECJANFEBMARAPRMAYJUNJULAUGSEPTYear
EndYTDPercentGoal*
21. Access OutcomesData Match
Contact with Case Manager0ERROR:#DIV/0!95.0%MATCH OK
Housing Plan0ERROR:#DIV/0!95.0%MATCH OK
Medical Insurance/Assistance (linked to 18. above)00000000000000ERROR:#DIV/0!91.0%MATCH OK
Contact with Primary Health Care Provider0ERROR:#DIV/0!91.0%MATCH OK
Sources of Income (linked to 17. above)00000000000000ERROR:#DIV/0!88.0%MATCH OK
Obtained Employment0ERROR:#DIV/0!5.0%MATCH OK
Exit & Year EndOCTNOVDECJANFEBMARAPRMAYJUNJULAUGSEPTYear
EndYTD
22. HOPWA-Funded Housing Assistance with HOPWA-Funded Supportive ServicesData Match
Received HOPWA-Funded Housing Assistance and HOPWA-Funded Case Management0MATCH OK
Received HOPWA-Funded Housing Assistance and HOPWA-Funded Supportive Services0MATCH OK
Exit & Year EndOCTNOVDECJANFEBMARAPRMAYJUNJULAUGSEPTYear
EndYTD
23. Type of HOPWA-Funded Supportive Services Received
Adult Day Care and Personal Assistance0
Alcohol-Drug Abuse Services0
Case Management0
Child Care0
Education0
Employment Assistance and Training0
Health/Medical Services0
Legal Services0
Life Skills Management0
Meals/Nutritional Services0
Mental Health Services0
Outreach0
Transportation0
NO HOPWA-FUNDED SUPPORTIVE SERVICES0Data Match
Subtotal - Households Receiving Supportive Services00000000000000MATCH OK
Less: Number Receiving More Than One Type of Supportive Service00000000000000Data Match
Total - Net Receiving Supportive Services00000000000000MATCH
Year End
24. REQUIRED - Brief Narratives (to be used for HUD reporting)[Please expand row to ensure narrative is visible in window]
Project's Accomplishments/Challenges in Spending Funds[Insert Narratives here at Year End]
Project's Accomplishments/Challenges in Meeting Household Goal
Project's Accomplishments/Challenges in Meeting Housing Stability Outcome Goal
Project's Accomplishments/Challenges in Meeting Each Access to Care Outcome Goal
Project's Accomplishments/Challenges in Meeting Other Goals (e.g., Nights of Housing)
How Project Coordinates with Mainstream Housing and Supportive Services
Other Achievements by Project or by Agency (if any)
Technical Assistance Needs (if any)
Barriers and How Barriers Were Addressed (if any)
Recommendations for HOPWA Program Improvement (if any)
Trends in Community Affecting Needs of Persons Living with HIV (if any)

III. Organization Data

25. Organization Information
Organization Name
Unique Entity Identifer (UEI):
Employer ID Number (EIN) or Tax ID Number (TIN)
HOPWA Contract Amount
Street Address
City
County
State
Zip Code
Parent Company, if applicable
Department Administering HOPWA Grant
Phone Number (including extension)
Fax Number
Website
Facebook Page
Twitter Handle
Faith-Based Organization? Yes or No
Nonprofit Organization? Yes or No
Grassroots Organization? Yes or No
Cities in Primary Service Area
Counties in Primary Service Area
Congressional District of Organization
Congressional District of Primary Service Area
Is there a Waiting List for HOPWA Housing in Service Area? Yes or No
26. Primary Program Contact
Name
Title
Department
Email
Phone Number (including extension)
Fax Number
27. Secondary Program Contact
Name
Title
Department
Email
Phone Number (including extension)
Fax Number
28. Contact For Individuals Seeking Services
Name
Title
Department
Email
Phone Number (including extension)
Fax Number
29. Facilities Only
Name of Housing Facility
Is facility a Medically Assisted Living Facility? Yes or No
Was the Housing Facility place into service during this program year? Yes or No
For housing facilities placed into service during this program year, how many units were placed into service? [Do not complete if facility was placed in service in prior years.]

IV. Capital Development Projects (received HOPWA development funding during the current program year)

30. Capital Development - Facility Information
Name of Housing Facility
For facilities being rehabilitated, what was the total amount of funding spent on rehabilitation?
What type of development was funded (new construction, rehabilitation, acquisition)?
For facilities being rehabilitated only, what is the final value of the building after rehabilitation was complete?
What type of housing (Permanent or Short-Term/Transitional) was developed?
For Capital Development facilities, what is the purchase or lease date of the property
For Capital Development facilities, what is the date the construction or rehabilitation started (if applicable)?
Was the facility placed into service during this program year? Yes or No
31. Complete for Capital Development Faicilities Opened This Year ONLY. If the facility was not opended this year, skip this section.
How many units were placed into service this year?
What date did supportive services begin?
What date was the constructionor rehabilitaiton completed?
What ate did residents begin to occupy the facility?
Is there a waitinglist maintained for the faiclity? Yes or NO.
If there is a waiting list, how many households are on the waiting list?
How many total units (HOPWA & non-HOPWA units) were developed in this faclity?
How many units in this facility were developed with HOPWA funds
32. For All Faclities DevelopedTotal Units Designated for Chronically HomelessTotal Uits Designated to Assist the HomelessTotal Units Energy-Star CompiantTotal Units 504 Accessible - Mobility Units - Senior Units
For units constructed (new) and/or acquired with or without rehab:
For rental units rehabbed:
For homeownership units constructed (if approved:

V. Stewardship Projects (reported during minimum use period) (received HOPWA development funding in prior program year but not receiving any HOPWA funding during current program year)

33. Stewardship Projects
Name of Housing Facility
What is the stewardship year (1-10) for this facility?
What date did the facility operations begin?
How many HOPWA units are supported in this stewardship facility?
What is the amount of non-HOPWA funds expended on the stewardship facilities?
What is the name of the authorized official that operates the facility?
What is the name of the primary program contact at the facility?
What is the email address of the primary program contact at the facility?
What is the phone number of the primary program contact at the facility?

&"Calibri,Bold"&9Exhibit G, HOPWA CAPER Report (Part 1 - Demographics) - Page &P of &N

This Report Form is subject to change based on HUD guidance.

File details come from the government source that posted it. Updated .