Veteraninformationsolution(VIS)Or Hospitalinquirysystem(HINQ) Fromlocalvamcsection

Revised October / 2016 /

Issue:

As per38 CFR62.2, enrollingparticipantsin SSVFrequiresthat granteesverify Veteranstatustodetermineprogrameligibility.Forsomefamilies who are unable toproduceVeteranstatusat initialscreening, thedocumentationcollectionprocesscantakeweeks, duringwhichtimeVeteranfamilies incrisisarewaitingforcriticallyneededservices.In additiontothe implicationsforextendedhomelessness,this delayinservicescanresultinpotentialparticipantsbecominglost to contact.Toproveaparticipant’sVeteranstatus,granteesshouldobtainat leastoneofthe following:

•VHAID Card

•VISTAPrintOuts

•VBAletterverifyingawardof a serviceconnecteddisabilitybenefit(anypercentage)

•VeteranInformationSolution(VIS)or HospitalInquirySystem(HINQ) fromlocalVAMCsection -VBAStatementof Service

•DD214

Resolution:

At thetimeof screening,SSVF granteesmaymake a determinationof PendingVerificationofVeteranStatus.Thisdeterminationwillallowthegrantee to immediately begindeliveringcasemanagement services totheVeteran familyuntilVeteranstatus isabletobe documented.

ProcessandRestrictions:

1.Temporaryfinancialassistance(TFA)cannot beofferedduringthe periodof PendingVerificationofVeteranStatus.TFAcanonly beginonceeligibilityisconfirmed.

2.PendingVerificationofVeteranStatus mustbe documentedbyanaffidavitof eligibilitysignedbytheparticipant.

3.Until eligibilityisconfirmed,PendingVerificationofVeteranStatus mustbere-certifiedevery 90days.Ifthe participant isultimatelyfoundnottobe eligiblefor SSVF,the participantmustbe dischargedwithappropriate communityreferrals.

4.UploadclientdatainHMIS, as requiredforallSSVFclients,andinclude inmonthlyreports.If nopersons inthehouseholdare Veterans, granteesmaydeletethoserecordsfromHMIS,if desired.

5.Service datawill counttowards outcomes andfinal servicenumbersregardlessoffinaldeterminationofVeteranstatus.

Revised October / 2016 /

Name:

DateofBirth: / Gender:
Phone: / Email:

IfKnown,AdditionalInformation(BranchofService,DateofService,CharacterofService,etc.):

Dateof Initialpendingverificationof Veteranstatus:
VeteranStatusDetermination isPending:
Request forthefollowingdocumentationhas beensubmitted –checkallthatapply
VHAID Card
VBAletter
VISTAPrintout
DD214
StatementofService
VIS/HINQ*
SSVFAgencyStaffNameand Signature:
II.DateofRecertification(mustbewithin90daysofInitialpendingverificationofVeteranstatusDate): / Status ofrequest for document:
SSVFAgencyStaffNameand Signature:

I ambeingacceptedasa clientofSupportive ServicesforVeteranFamiliesProgram(SSVF) onPendingVerificationof VeteranStatus.Whilemyincome andhousingstatushavebeendeterminedeligible,confirmation ofVeteranStatusispending.

I affirmthat Imeet the conditionsofan eligibleparticipantconsistingofa“Veteranfamily,”meaningthattheperson/family tobe servedis either (a) a Veteran;or(b) a memberof a familyinwhichtheheadof household,orthe spouseof the headofhousehold, isa VeteranandI ampendingdeterminationof Veteranstatus.

I further acknowledge thatthe followingrestrictionsto serviceshavebeenexplained tome:

1.Temporaryfinancialassistance(TFA)cannotbeofferedduringthe periodofPendingVerificationofVeteranStatus.TFAcanonly beginonceeligibilityisconfirmed. I canreceiveothertypesof assistancein the formofcasemanagementuntilmy Veteranstatus isverifiedand determined eligible for SSVF.

2.PendingVerificationof VeteranStatusmustbe documentedbythisaffidavitsigned by theVeteran.

3.TheperiodofPending Verificationof VeteranStatusmustbe re-certified every90 days fromthe dateofthisaffidavit. IfI amultimatelyfoundnot tobeeligiblefor SSVF,myfamilymembersandIwillbedischargedfromtheprogramandreferredto appropriatecommunityreferrals.

I havereceiveda copyofthis Affidavitformy records.

NameofVeteranorHeadofVeteranHousehold(Print)

VeteranorHeadofVeteranHouseholdSignatureDate

NameofSSVFAgencyRepresentative(Print)

SSVFAgencyRepresentativeSignatureDate

*Maintainthis documentation inclient file.

ReferralSource: