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r <br />Part Co Point in Time Housing and Participants Chart <br />(All Projects Except Dedicated BAGS Projects) N/A <br />1. Housing Type" <br />la Multi -family <br />lb. F1 Scattered Site <br />(Check all that apply) <br />❑ Single-family <br />❑ Project Based <br />Chronic Substance Abusers <br />❑ Con ate Facility <br />Veterans <br />a. Current <br />b. New Effort or <br />c. Projected <br />2, Units, Bedrooms, Beds <br />Level <br />Change in Effort <br />Level <br />(Point -in -Time) <br />(If Applicable) <br />(column a+ coL b) <br />Number of Units <br />Number of Bedrooms <br />Number of Beds <br />3. Participants <br />a. Number of Families with <br />Children(Family Households <br />i. Number of adults in families <br />ii. Number of children in families <br />iii. Number of disabled in families <br />b. Number of Single Individuals and <br />Other Households w/o children <br />i. Number of disabled individuals <br />ii. Number of chronically homeless <br />*Housing Types: Multi -family (apartments, duplexes, SROs, other buit(hngs with 2 or more units); Single-family, <br />Congregate Facihty Oonoito , banacks, shared -hvin ). <br />Part D: Targeted Subpopulations N/A <br />(All Projects Except Dedicated FMS Projects) <br />List the approximate percentages for each homeless subpopulation you expect to serve. If you expect to <br />serve subpopulations that fit more then one category (i.e. Severely Mentally Ill Persons with Chronic <br />Substance Abuse), you may place overlapping approximate percentages on the appropriate lines. If this <br />is a #1 priority project, it must serve 100% chronically homeless persons to receive the PH bonus. <br />1. Homeless Subpopulations <br />2. Approximate Percenta es <br />Chronically Homeless as defined by HUD <br />Severely Mentally nl <br />Chronic Substance Abusers <br />Veterans <br />Persons with HIV/AIDS <br />Victims of Domestic Violence <br />Unaccompanied Youth <br />(Under 18 years of age) <br />Part E. Discharge Policy (Only State & Local Government A licants <br />Are there policies and protocols developed or implemented for the discharge of <br />persons from publicly funded institutions or systems of care (e.g., health care <br />1. ® Yes ❑ No facilities, foster care or other youth facilities, or corrections programs and <br />institutions) in order to prevent such discharge from immediately resulting in <br />homelessness or requiring homeless assistance for such persons in your <br />