HMIS Custom Reporting & Data Requests

Name *

First Name

Last Name

Phone *

(###)

###

####

Does your agency currently use South Carolina's HMIS? *

Yes

No

Is the data request for a specific grant? *

Yes, ESG

Yes, CoC

Yes, this is for another grant

No, this is not for a grant

Grant Application due date (if applicable)

MM

DD

YYYY

Requested Delivery Date *

Please allow a minimum of 7-14 days for advanced reporting requests.

MM

DD

YYYY

What do you want the report to count? *

Individuals

Households

What do you want the report to list? *

Aggregate data

Client details (This will require additional paperwork)

Report Start Date *

MM

DD

YYYY

Report End Date *

MM

DD

YYYY

Report Scope *

Please specify the desired scope of your report.

Program Specific

Provider Wide

CoC Wide

State Wide

Other

Report Audience *

Select the intended audience for this report.

Internal

CoC

Funders

Public

Other

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