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EXHIBIT 1 <br />Exhibit TPS-2: HOMELESS PROVIDER'S CERTIFICATION <br />Attachment 3 of Notice PIH 2O21-15 Example of a Homeless Provider's Certification <br />Emergency Housing Voucher (EHV) <br />HOMELESS CERTIFICATION <br />EHV Applicant Name: <br />❑ Household without dependent children (complete one form for each adult in the household) <br />❑ Household with dependent children (complete one form for household) <br />Number of persons in the household: <br />This is to certify that the above named individual or household meets the following criteria <br />based on the check mark, other indicated information, and signature indicating their current <br />living situation - <br />Check only one box and complete only that section <br />Living Situation: place not meant for human habitation (e.g., cars, parks, abandoned buildings, <br />streets/sidewalks) <br />❑ The person(s) named above is/are currently living in (or, if currently in hospital or other <br />institution, was living in immediately prior to hospital/institution admission) a public or private place <br />not designed for, or ordinarily used as a regular sleeping accommodation for human beings, <br />including a car, park, abandoned building, bus station, airport, or camp ground. <br />Description of current living situation: <br />Homeless Street Outreach Program <br />Name: <br />This certifying agency must be recognized by the local Continuum of Care (CoC) as an agency that <br />has a program designed to serve persons living on the street or other places not meant for human <br />habitation. Examples may be street outreach workers, day shelters, soup kitchens, Health Care for <br />the Homeless sites, etc. <br />Authorized Agency Representative Signature: <br />Date: <br />Page TPS-34 Administrative Plan 7/l/2025 <br />City Council <br />5 - 934 7/15/2025 <br />