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OC HMIS Participating Agency Agreement
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Purpose
The HMIS (Homeless Management Information System) is a HUD -mandated information technology system
a that is designed to capture client -level information over time, on the characteristics and service needs of
homeless persons. Client data is maintained on a central server, which will contain all client information in an
encrypted state. HMIS integrates data from all homeless service providers and organizations in the community
and captures basic descriptive information on every person served. Participation in the OC HMIS allows
organizations to share information with other participating organizations to create a more coordinated and
effective service delivery system. The OC HMIS is the secured electronic database for Orange County and is a
valuable resource for local communities.
Agreement and Understanding
This Agreement authorizes this Participating Agency (Agency) to designate HMIS Users (User). A User is a staff
person entrusted to enter Protected Personal Information (PPI) into the OC HMIS, on behalf of this Agency. In
order to allow a User to access the OC HMIS, a User Agreement must be signed by the User and stored
electronically in the HMIS.
Confidentiality and Informed Consent
Confidentiality: This Agency must require all Users to abide by its organization's policies and procedures;
uphold all privacy protection standards established by the OC HMIS Policies and Procedures; and comply with
all relevant federal and State of California confidentiality laws and regulations that protect client records.
Except where otherwise provided for by law, this Agency shall ensure that confidential client records are
released with the client's written consent.
Written Consent: To obtain written consent, prior to each client's assessment, each client must be informed
that the client's information will be entered into an electronic database called HMIS. The terms of the Consent
to Share Protected Personal Information form must also be explained to each client. Clients who agree to have
their PPI entered into the OC HMIS must sign the Consent to Share Protected Personal Information form.
Verbal Consent: Verbal consent to enter PPI into the OC HMIS may be obtained during circumstances such as
phone screenings, street outreach, or community access center sign -ins. Each client must be informed that
their information will be entered into the HMIS database. The terms of the Consent to Share Protected
Personal Information form must also be explained to each client. The client's written consent must be
obtained once the client appears for their initial assessment.
Updated 8/24/18
Client's Rights
The client has a right to receive a copy of this Agency Agreement at the time of request.
Each client has the right to receive the following, no later than five (5) business days of a written request:
• A correction of inaccurate or incomplete PPI
• A copy of their consent form
• A copy of their HMIS records
• A current list of participating agencies that have access to HMIS data
Data Use
This Agency must protect HMIS data by ensuring that:
• A link to the Privacy Notice is accessed from the Organization's website.
• OC HMIS is not accessible to unauthorized users
• OC HMIS is only accessed by computers approved by the Organization
• HMIS Users are trained regarding user responsibilities and conduct
• HMIS Users sign and comply with the OC HMIS User Agreement
• HMIS Users forward a copy of a client's Revocation of Consent to the HMIS System Administrator, 2-1-
1 Orange County (2110C), within 24 hours of receipt
Responsibilities
This Agency is responsible to ensure that:
• The Notice Regarding Collection of Personal Information is posted at each intake desk or comparable
location
• HMIS Users do not misuse the system
• Clients are notified if a breach of their PPI is discovered
• Any HMIS User who finds a possible security lapse on the system is obligated to immediately report it
to 2110C
• A signed copy of the Consent to Share Protected Personal Information is retained for a period of seven
(7) years after the PPI was created or last changed.
Rights and Privileges
OC HMIS data is stored in one central database and is managed by 2110C. While each agency owns their own
data within the database, the Orange County Continuum of Care (CoC) may release aggregate data about its
own continuum at the program, sub -regional, and regional level. Aggregate data may be released without
organization permission at the discretion of the Continuum. Use of the OC HMIS is a privilege and is assigned
and managed by 2110C.
2
Updated 8/24/18
Copyright
The OC HMIS and other CoC-provided software are protected by copyright and are not to be copied, except as
permitted by law or by contract with the owner of the copyright. The number and distribution of copies of any
CoC provided software are at the sole discretion of 2110C.
Violations
Any violations or suspected violations of any of the terms and conditions of this agreement, the HMIS User
Agreement, and/or the HMIS Policies and Procedures, must be immediately and confidentially reported to
2110C and the Executive Director or other authorized representative of this Agency.
Term
This Participating Agency Agreement becomes effective on the date of final execution and shall remain in
effect unless terminated pursuant to paragraph XI. Termination, below.
Amendment and Termination
• The OC CoC reserves the right to amend this agreement by providing a 3-day notice to this Agency.
• Either party has the right to terminate this agreement, with or without cause, by providing a 3-day
written notice to the other party.
• If this agreement is terminated, this Agency shall no longer have access to HMIS or any information
therein. The CoC shall retain the right to use all client data previously entered by this Agency, subject
to any restrictions requested by the client.
All agencies that sign this agreement and are granted access to the OC HMIS agree to abide by OC HMIS'
Policies and Procedures. The signature of the Executive Director or other authorized representative of this
Agency indicates acceptance of all terms and conditions set forth in this agreement.
This Agreement is executed between the CoC and the Participating Organization. Upon final execution, this
Agency will be given access to the OC HMIS.
Agency Name SW qQ PM PO(tC ' R-'W f
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Executive Director/Authorized Representative Name
(Print)
Executive Director/Authorized Representative Signature
(Wet signature only)
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Date
DO NOT WRITE IN THIS SECTION — 2110C USE ONLY
HMIS System Administrator Name (Print)
HMISSystem Administrator Signature (Wet signature
only)
Date
Updated 8/24/18
3
Orange County CoC Inter -Agency Data Sharing
Memorandum of Agreement
The ?hk(_ , agency agrees to share client data among
participating agencies via the OC HMIS (Orange County Homeless Management Information System) for the
purposes outlined below. Each participating agency must complete and comply with the Agency Agreement.
Each individual HMIS user must complete and comply with the HMIS User Agreement. This document is
available on the OCHMIS website.
Uses of HMIS Data:
• Coordinate housing services for families and individuals experiencing homelessness or facing a housing
crisis in Orange County
• Understand the extent and the nature of homelessness in Orange County
• Evaluate performance and progress toward community benchmarks
• Improve the programs and services available to Orange County residents experiencing homelessness or
a housing crisis
• Improve access to services for all Orange County homeless and at -risk populations
• Reduce inefficiencies and duplication of services within our community
• Ensure that services are targeted to those most in need, including "hard to serve" populations
• Ensure that clients receive the amount and type of services that "best fits" their needs and preferences
• Pursue additional resources for ending homelessness
• Advocate for policies and legislation that will support efforts to end homelessness in Orange County
Client Protection:
• Informed consent must be given by clients in order for their identifying information to be shared
among agencies in the OC HMIS (see Orange County HMIS participating agencies on OCHMIS.org). If
the client does not give consent, their identifying information can still be entered into HMIS, but the
record should only be visible to the agency entering the data.
• All agencies participating in HMIS must sign this agreement. The client has the right to see a current list
of the OC HMIS participating agencies. As part of the informed consent process, clients must be
informed that additional agencies may join the OC HMIS at any time and will have access to their
information.
HMIS Users will maintain HMIS data in such a way as to protect against revealing the identity of clients
to unauthorized agencies, individuals, or entities.
Last Updated: 8/28/2018
• Clients may not be denied services based on their choice to withhold their consent.
Each party to this memorandum of agreement shall defend, indemnify, and hold all other parties harmless
from any and all claims arising out of that party's negligent performance of this agreement. Any loss or liability
to third parties resulting from negligent acts, errors, or omissions of an OC HMIS user while acting within the
scope of their authority under this Agreement shall be borne by that user exclusively.
Agreed to and signed by the following agency representative (Executive Director or equivalent only):
Printed Name: Da% iDU04-eVY+in
Last Updated: 8/28/2018
N-2020-215
ATTEST:
APPROVED AS TO FORM:
SONIA R. CARVALHO
City Attorney
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By:
TAMARA BOGOSIAN
Senior Assistant City Attorney
FOR APPROVAL:
.� • ! TI.
Chief of Police
CITY OF SANTA ANA
ST��
City Manager