HUD and VA established HUD-VASH in 1992 to target veterans with severe psychiatric or substance use disorders. From fiscal years 1992 through 1994, the program provided approximately 1,753 housing After the initial voucher distributions, no vouchers to homeless veterans.new vouchers were made available to homeless veterans until fiscal year 2008. From fiscal years 2008 through 2011, the program received funding for about 37,000 new HUD-VASH vouchers. As of fiscal year 2008, program participants are no longer required to have chronic mental illnesses or chronic substance use disorders with required treatment. However, a significant number of veterans with those issues are expected to be helped within the program’s target population of veterans experiencing chronic homelessness. Obligations for new HUD-VASH vouchers and supportive services increased from $78 million in fiscal year 2008 to $172 million in fiscal year 2011 (see fig. 1). As of April 2012, more than 140 VA facilities were participating in HUD- VASH. In addition, according to HUD, more than 360 PHAs had partnered with VA facilities to administer HUD-VASH nationwide since fiscal year 2008. The allocation process for HUD-VASH vouchers is a collaborative approach that relies on three sets of data to determine geographic need: HUD point-in-time data on homeless veterans needing services in the area, VAMC data on the number of contacts with homeless veterans, and performance data from PHAs and VAMCs. Based on this analysis of geographic need (adjusted by the number of vouchers received in previous years’ allocations), HUD and VA identify communities that should receive VASH vouchers. The agencies then determine the exact number to allocate in proportion with each community’s level of need. VA then identifies VAMCs from these communities to participate in HUD-VASH, taking into account VA’s case management resources. HUD considers a PHA’s administrative performance and in consultation with VA identifies PHAs located in the jurisdiction of the VAMCs and invites them to apply for HUD-VASH vouchers. The selected VAMCs and PHAs in a given community must partner to administer the program. Under certain terms, HUD allows PHAs to make a portion of their HUD-VASH vouchers project-based (that is, tied to a specific housing unit and not to a tenant). PHAs can request that a portion of their allocation of HUD-VASH vouchers be project-based as long as funding for those vouchers, when added to the funding for vouchers from the PHA’s regular voucher program that have been project-based, does not exceed 20 percent of the PHA’s overall voucher budget authority and the partnering VAMC supports the project. The Veterans Health Administration within VA issues a HUD-VASH handbook, which establishes procedures and responsibilities for administering HUD-VASH. VA also has released a HUD-VASH Resource Guide that was developed in conjunction with other federal and community partners. It includes additional HUD-VASH guidance and provides technical assistance on clinical issues pertaining to individuals in permanent supportive housing programs. HUD’s policies and procedures for HUD-VASH, including PHA responsibilities, are defined in a Federal Register notice, the most recent of which dates to March 2012. Figure 2 illustrates the processes and activities for which VA and HUD (through PHAs in compliance with HUD regulations) are responsible when providing HUD-VASH assistance. For example, VA screens veterans to help ensure the following. That they are homeless based on the McKinney-Vento Homeless Assistance Act definition; that is generally, a person who lacks regular, adequate housing or will imminently lose housing and lacks resources to obtain other permanent housing. That they are eligible for VA health care. That they are willing to participate in case management services that are intended to promote housing stability and link the veteran to needed clinical services. According to VA, many veterans experiencing homelessness have physical, emotional, or other problems that make the goal of living independently challenging. VAMCs refer veterans who meet VA requirements to PHAs, which determine eligibility based on HUD’s income requirements for section 8. To be eligible for assistance, households generally must have very low incomes—not exceeding 50 percent of the area median income, as determined by HUD.offers several waivers to the regular section 8 voucher requirements. Specifically, under HUD-VASH, PHAs cannot deny assistance to potentially eligible households for past section 8 violations, such as previous nonpayment, or for criminal history. However, no members of Except for a sex offender provision, HUD-VASH the veteran household can be subject to a lifetime registration requirement under a state registration program for sex offenders. Once the veteran meets HUD’s requirements for the program, the PHA can issue the voucher for participation in HUD-VASH. According to VA, the agency has assumed primary responsibility for collecting and reporting HUD-VASH data, which it does for internal performance purposes, monthly congressional reporting, and compliance with Office of Management and Budget (OMB) reporting. VA and HUD officials told us that VA also provides HUD with program data, which HUD uses for internal performance purposes and for OMB reporting. More than one VA office shares responsibilities for HUD-VASH data collection and analysis. VA’s National Center for Homelessness among Veterans (national center), which falls under the National Homeless Program Office, undertakes development and evaluation of care options and research and methodology related to VA’s homeless programs. Additionally, VA’s Northeast Program Evaluation Center supports and oversees data collection for VA’s mental health programs. According to a VA official, this center provides sites with day-to-day support on technical aspects of data collection, and the national center provides specific feedback on the data collection process and analysis, among other activities. VA currently uses two systems to collect HUD-VASH program information. According to VA, in 2008, it implemented a HUD-VASH database, referred to as the Dashboard, to collect monthly program status updates from HUD-VASH sites. VAMC staff submit Dashboard reports to their respective Veterans Integrated Service Networks (VISN), which in VA officials told turn submit facility-level reports to the national center.us that VA implemented a new data collection system, the Homeless Operations Management and Evaluation System (HOMES), in April 2011, and VA is in the process of fully implementing reporting mechanisms required to generate reports based on HOMES data.information for several of VA’s homeless programs, including HUD-VASH. It is designed to track and maintain data on individual veterans as they move through VA’s system of care, including HUD-VASH participation. For example, VA’s HOMES user manual states that a HUD-VASH clinician who is familiar with the veteran should complete and submit a HUD-VASH monthly status report form for veterans currently enrolled in the program. The report is intended to capture various information on the veteran for the past 30-day period, including the number of contacts the veteran had for case management, the veteran’s housing arrangement, amount and source of any income, visits to the emergency room or other hospitalizations (including those for mental health conditions), use of alcohol or illegal drugs, and satisfaction (including with their current accommodations, safety of living, and leisure activities). According to HUD officials, as part of its section 8 program, HUD collects voucher utilization and household information using two information systems, the Voucher Management System (VMS) and Public and Indian Housing Information Center (PIC). PHAs are responsible for submitting VMS and PIC data to HUD. HUD uses VMS as a centralized system to monitor and manage PHAs’ use of vouchers. VMS data include PHAs’ monthly leasing and expenses for HUD-VASH vouchers, which HUD uses to obligate and disburse PHA funding. PHAs enter voucher totals in VMS rather than individual records of HUD-VASH voucher activity. HUD uses PIC as a centralized system to track information on households assisted and lease activity. PIC data fields include PHA identification, assistance program type (such as HUD-VASH), and household demographic information. PIC data fields also include information on income sources and amounts, assets, rent, housing type, and whether the subsidy is tenant-based or project-based. According to VA and HUD, the departments rely on VAMCs and PHAs to make determinations on veteran eligibility for the HUD-VASH program. Based on our meetings with staff at 10 VAMCs and 10 PHAs nationwide, VAMCs and PHAs generally followed the same procedures to determine that veterans met statutory requirements. VAMC staff that we contacted described how they screened veterans to determine whether they met requirements for HUD-VASH. Homeless status: To verify that a veteran met the McKinney-Vento definition of “homeless,” VAMC staff told us that they interviewed the veteran. This included, for example, discussing the veteran’s current housing situation (homeless, precariously housed, doubled up, in own housing but facing housing loss/eviction, or stably housed), and history or pattern of housing stability/instability. Some VAMC staff also told us that community organizations referring veterans into the HUD- VASH program may provide documentation supporting the veteran’s homeless status. VA health care: To verify that a veteran is eligible for VA health care, VAMC staff in several locations told us that they determined if the individual had an existing record in VA’s electronic patient record system.