Assessing	Housing	Needs and Risks:	

A	Screening	Questionnaire	

HOW TO USE	THIS QUESTIONNAIRE	

This	questionnaire	is	for	departments	of	correction,	reentry	service	providers,	service	

intake	coordinators,	case	managers,	law	enforcement	agencies,	courts,	and	others	to	better	

assess a	person’s unique	housing	needs	and	risk	of	homelessness	upon	arrest	or	return to	

the	community	from	jail	or	prison.	Effective	use	of	this	questionnaire	necessitates	close	

coordination	and	partnership	between	corrections,	courts,	law	enforcement	and	

community-based	reentry	service	providers.		

These	screening	questions	are	intended	to	reveal	personalized	housing	needs,	histories	of	

homelessness,	or	risk	of	homelessness.	Adequately	assessing	these	needs	and	coordinating	

service	delivery	between	partner	organizations	closes	service	gaps,	reduces	the	likelihood	

of	a	client	falling	through	the	cracks,	and	allows	organizations	to	catch	clients	who	may	

have	elevated	housing	risks	at	an	earlier	stage	of	the	intake	process.		

After	completing	the	questionnaire,	a	client’s	housing	assessment	can	be	linked to	his	or	

her	case	file.	Partner	organizations	with	comprehensive	data	sharing	agreements	can	share	

a	nuanced	understanding	of a	client’s	housing	needs.	The	evolution	of a	client’s	housing	

needs	can	also	be	traced	over	time,	as	risk	for	homelessness	is	reduced	and	housing	

stability	improves.		

Used	in	conjunction	with	other	housing	tools	and	services,	this	questionnaire	can	help	

corrections,	courts,	law	enforcement	and reentry	service	providers	improve	individuals’	

housing	success	and	other benefits	associated	with	stable	housing,	such as	employment,	

continuity	of	care,	and	pro-social connections.	Better	housing	stability	creates a	foundation	

for	improved	reentry	success	and	reduced	likelihood	of	recidivism.		

ABOUT	THIS	QUESTIONNAIRE	

This	questionnaire	is	intended	to	be	a	simple	and	easy-to-use	starting	point	for	better	

assessing	the	housing	needs	of	people upon	entering	or exiting	jail,	prison,	or	supervision.	

It	is	intended	to	provide	useful	supplemental	information	that	may	not	be	covered	

elsewhere in	the	intake	or	case	planning	process.	Use	these	questions	to	guide	a	productive	

conversation	with	a	client.		

Every	person	has	unique	housing	needs,	and	every	community	has	a	unique	housing	

landscape.	We	encourage	customization	to	your	unique	community	and	existing	intake	

processes,	and	support organizations	and	professionals	making	additions	and	adaptations	

to	better	fit	their	community,	available	resources,	and	existing	organizational	partnerships.	

This project was supported by Grant No. 2012-CZ-BX-K071 and 2016-MU-BX-K011, awarded by the Bureau of Justice 

Assistance. The Bureau of Justice Assistance is a component of the Department of Justice's Office of Justice Programs, which 

also includes the Bureau of Justice Statistics, the National Institute of Justice, the Office of Juvenile Justice and Delinquency 

Prevention, the Office for Victims of Crime, and the SMART Office. Points of view or opinions in this document are those of the 

author and do not necessarily represent the official position or policies of the U.S. Department of Justice.
Housing history/risk of homelessness:

These questions should guide a conversation with a client and be used to assess his or her housing 

stability and appropriate program eligibility. If the content of a question is covered elsewhere in the 

intake or case planning process, skip it. Please note, some questions may be of a sensitive nature or a 

client may be reluctant to answer. Responses should always be voluntary and kept confidential. They 

should never be used to discriminate or deny services to someone. 

Can you afford housing? Describe your housing plan post-release.

Yes No 

Describe: 

Where did you live immediately before being arrested, entering a diversion program, or 

entering jail/prison?

Describe: 

Were you homeless before arrest/diversion/entering jail/prison?

Yes No 

Describe: 

At any point in time, have you ever lived: outside, in a car, in a tent, in an overnight shelter, 

or in someone else’s home (i.e. couch-surfing)?

Yes No 

Describe: 

Do you have a spouse/significant other/parent/dependent children/grown children/ or other 

relatives with whom you’d like to live upon release? If so, does that person have stable housing? 

Yes No 

Describe: 

Is there anyone or any place you are legally not allowed to reside? 

Yes No 

Describe: 
Have you ever lived in public housing? 

Yes No 

Describe: 

Have you ever been charged/convicted of: arson, stalking, manufacture/sale of drugs, sex offense, 

violent crime/assault? 

Yes No 

Describe: 

Specialized population status/qualifies for specialized housing services: 

These questions should guide a conversation with a client and be used to assess his or her eligibility for 

certain specialized housing services. If the content of a question is covered elsewhere in the intake or case 

planning process, skip it. Other questions are intended to determine if there are any barriers to that 

person’s comfort level or stability when seeking various types of housing arrangements. Please note, 

some questions may be of a sensitive nature or an individual may be reluctant to answer. Responses 

should always be voluntary and kept confidential. They should never be used to discriminate or deny 

services to someone. 

Are you a veteran?

Yes No 

Describe: 

Do you have a physical or mental disability? 

Yes No 

Describe: 

Have you been diagnosed with a mental illness, substance use disorder, PTSD, cognitive 

disability, Traumatic Brain Injury, or HIV/AIDS? 

Yes No 

Describe: 

Do you have any dependents, such as children or elderly parents? 

Yes No 

Describe: 
Do you identify as LGBTQ? If so, do you feel that this affects the services you can get or the 

types of places you can go for help? 

Yes No 

Describe: 

Are you a citizen/legal resident? 

Yes No 

Describe: 

Are you a member of a federally or state recognized American Indian tribe? 

Yes No 

Describe: 

Do you plan to reside in a rural community post-release? 

Yes No 

Describe: 

Wraparound services: 

These questions should guide a conversation with a client and be used to assess any relevant 

wraparound needs that may impact his or her housing stability, or are not otherwise covered in the 

intake process. If the content of a question is covered elsewhere in the intake or case planning process, 

skip it. Please note, some questions may be of a sensitive nature or an individual may be reluctant to 

answer. Responses should always be voluntary and kept confidential. They should never be used to 

discriminate or deny services to someone. 

Did you work before being arrested/while incarcerated? Describe your employment plan?

Yes No 

Describe: 

Did you go to school before being arrested/while incarcerated (GED course, etc.)? Do you 

want to pursue additional education? 

Yes No 

Describe: 
Do you have children? What is your current child support/custody situation? 

Yes No 

Describe: 

Are you enrolled in Medicaid/Medicare/SSDI/other? What do you do if you get sick or need to 

see a doctor? 

Yes No 

Describe: 

How do you plan to travel to your appointments? To see your case manager? Your parole/

probation officer? Do you drive/take the bus/ride-share?

Describe: 

Do you have a driver’s license? What about another form of photo ID?

Yes No 

Describe: 

Have you or your family ever been on SNAP (food stamps)? Or gone to a food pantry? What do 

you do if you can’t afford food?

Yes No 

Describe: 

Are there any other services you’ve received or want to see a social worker/case worker for? 

Such as TANF or help with utilities (electricity, gas, heat, etc.)? 

Yes No 

Describe: