Property Inspection and Management Review: 
Service Provider Questionnaire for Developments with LTH/HPH Units
Instructions: Service providers complete this form for developments that have long-term homeless (LTH) and high priority homeless (HPH) units. Retain the form for your files and submit a copy to your assigned asset manager or compliance officer.  
General Information	
Development Name	     	D#     	
Service Provider Organization	     	
Person Completing this Form	     	
Service Provider Contact Information	Phone:      	Email:      	
Service providers: Answer the following questions in PART I as they pertain to LTH/HPH units.
PART I: REFERRAL SYSTEM AND TENANT SCREENING
1.	Which form are you using for the required Minnesota Housing homeless verification? 
LTH Eligibility Form   	HPH Confirmation Form from HMIS 
2.	If using Coordinated Entry as a referral source, describe what is working well and/or any challenges with Coordinated Entry. Also include recommendations for improvement.      
3.	Describe any tenant screening issues you encountered in the last year, including households you worked with who decided not to apply due to screening criteria.      

SERVICES
4.	Is there a current memorandum of understanding (MOU) (or similar document) in place that defines the owner, property management, and service provider partnerships and clearly defines roles and responsibilities?
 Yes     	 No: Explain why not:      
If yes to the previous question, are all parties familiar with the MOU, and do they have access to it?
 Yes	 No: Explain why not:      
5.	How many FTE (full-time equivalent) service provider staff provide services at the property (Include breakdown of roles, if applicable)?      
6.	Do service provider staff maintain regular office hours and/or home visits at the property? 
 Yes 	 No
How many hours per week are they on site?      
7.	Does the site manager maintain regular office hours at the property?   Yes       No 
How many hours per week are they on site?      
8.	Are you an enrolled provider for Medicaid Housing Stabilization Services? 
 Yes	 No: Explain why not:      

PART II: If no changes in LTH/HPH households since the last Minnesota Housing inspection (all the same households still occupy the units), Part II of this form is optional. Answering the following questions will help Minnesota Housing better understand and respond to the work that service providers do to meet the needs of LTH/HPH households.
9.	Describe how property management and service staff work together to support households in maintaining housing.      
What changes or challenges, if any, have you experienced with providing services at the site?      
10.	If there is front desk staff on the property, what have been the benefits and/or challenges of operating the front desk?      
11.	Describe any ongoing concerns or challenges in serving LTH/HPH households.      
12.	Describe any training or services you think would be helpful in providing housing and services.      
13.	Describe any successes and/or effective ways to serve and meet the needs of the LTH/HPH households living at the property.      

PART III: WHAT ELSE?
14.	Please share any other information about LTH/HPH units you would like Minnesota Housing to know (challenges, successes, needs, etc.).