APPLICATION CERTIFICATION & CONSENT
This agency may enter the personal information I have given them into the MAACLink, Caseworthy and/or Service Point computer systems that operate inside secure and confidential networks of agencies by trained representatives. The information I have provided is true and correct. I understand that my information is electronically tracked in order to assess my household needs and provide better services such as housing, utility assistance, food and other services. My information may be shared among the agencies from which I have requested emergency assistance or case management. If I am applying for utility assistance, my identifying information may be shared with my utility provider by phone, email, or in written form in order to secure payment to the correct account. If I am applying for rental assistance, my identifying information may be shared with my landlord or property management company by phone, email, or in written form in order to secure payment to correct account.
MAACLink, Caseworthy and Service Point are computer systems used locally as Homeless Management Information Systems (HMIS). Use of an HMIS is required by the US Department of Housing and Urban Development (HUD) for agencies that receive HUD funding. MAACLink, Caseworthy and Service Point are not electronically connected to HUD and are only used by authorized agencies. All users have received confidentiality training and have signed strict agreements to protect clients’ personal information and limit its use appropriately.
A Privacy Notice is available at participating agencies. It provides details on how member agencies and their employees handle client information and data sharing.
I give permission to Metro Lutheran Ministry to collect and enter my personal and household information into the MAACLink, Caseworthy, and/or Service Point data systems.
I understand that the MAACLink, Caseworthy, and Service Point systems are shared with and used by authorized agencies in my community for the purposes of:
1. Assessing the needs of low-income, homeless or other people with special needs in order to give better assistance and to improve their current or future situations.
2. Improving the quality of care and service for people in need.
3. Tracking the effectiveness of community efforts to meet the needs of people who have received assistance.
4. Reporting data on an aggregate level that does not identify specific people or their personal information.
I understand that:
• All agencies that use MAACLink, Caseworthy, and/or Service Point will treat my information in a professional and confidential manner.
• Signing this release form does not guarantee that I will receive assistance.
• My information may be shared with a third party (utility provider, landlord, etc) in order to process the service I have requested.
• I have the right to a printed copy of my client file.