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Om p9 avdy,f <br />s _ 12 <br />GetConnttlM. GelMsreK <br />Certification for Domestic Violence Databases — 2014 Data Standards <br />Agency Name: Interval House <br />Database Name: <br />Address: 6615 Pacific Coast Highway, #170, Long Beach, CA 90803 <br />Agency Contact: Sharon Wie Job Title: <br />Phone Number: <br />Program Name: <br />2110C Reviewer <br />Name: <br />2110C Reviewer <br />Signature: <br />Rapid Reho <br />Rosa Durham <br />Email: sharon@intervalhouse.org <br />Date of Review: 9/17/2015 <br />HUD Requir•entents <br />Programs that serve domestic violence survivors are prohibited from entering data into HMIS; they <br />are required to enter their data in a separate database. However, this database should be <br />comparable to HMIS, and collect the same information. The purpose of this checklist is to determine <br />whether or not the database the domestic violence or legal services program is using is comparable to <br />HMIS. Each data element specifies which program types and clients are required to answer that data <br />element. All required data elements are based on regulations set forth by HUD, <br />HMIS Lead agency (211 QC) lnstructions <br />The database certification document should be updated on a yearly basis to accommodate changing <br />HUD regulations. Database certifications for domestic violence and legal services programs should <br />also be completed on a yearly basis to verify these regulations have been implemented. <br />Please check off each data element, including possible answer selections (if applicable), that are <br />available for data input in the database; then complete the Database Certification Results page. If <br />there are any required data elements that are not available for data input, the agency's database <br />should be considered out of compliance, and the reasons should be listed on the Database <br />Certification Results page. In this case, the reviewer will decide on a date for the database to be <br />reviewed again. The agency staff person will have to sign the Database Certification Results page <br />stating that they will bring the database into compliance by the date of the next review. <br />The database meets LA/OC HMIS Policies and Procedures, Section 2.4 Technical and Security <br />Standards, 2.5 Maintenance of Onsite Computer Equipment and 3.0 Security Policies and Procedures. <br />Revised 2/20/2015 <br />