Homeless Management Information System (HMIS) Notice of Privacy Practices and Consent Last updated: 10/01/2026 This notice explains how your information is entered into and shared through the Kansas City Homeless Management Information System (HMIS). It is separate from your dWell-KC Release of Information. The dWell-KC Release covers sharing with the case workers helping you. This consent covers entering your information into HMIS, a community-wide database used by agencies outside your case worker's network. 1. Why we collect this information Kansas City participates in HMIS, a local database used to record information about people experiencing homelessness. HMIS is required by the U.S. Department of Housing and Urban Development (HUD). It is used to improve the quality and coordination of housing and services across our community. 2. What information we collect [a] Name, date of birth, and Social Security Number (for identification) [b] Contact information (address, phone, email) [c] Household composition and family members [d] Housing history and current living situation [e] Income, benefits, and employment information [f] Health and disability status (as relevant to services) [g] Services you have received and their outcomes You do not have to give your Social Security Number to receive services. If you choose not to, staff will record that you declined. 3. How your information is used [a] Coordinate housing and supportive services across participating agencies [b] Generate reports required by HUD and other federal, state, or local funders [c] Improve planning and resource allocation for homeless services in our community 4. Who can see your information [a] Staff at agencies participating in the [Your CoC Name] HMIS who are providing you services [b] HUD and authorized federal oversight agencies, in de-identified or aggregate form only [c] Researchers and evaluators, in de-identified form only, that does not identify you personally All participating agency staff must sign a user agreement and follow the [Your CoC Name] HMIS privacy and security policies. 5. What will not be shared Your information will not be shared with immigration authorities, law enforcement, or any party not authorized under this notice without your separate written consent, unless the law requires it. If the law requires a disclosure, only the minimum information needed will be shared. 6. Specially protected information [a] Survivors of domestic violence, dating violence, sexual assault, or stalking: Victim service providers do not enter your identifying information into HMIS, as required by the Violence Against Women Act (VAWA). If you are receiving services from another agency and sharing your information could put you at risk, you may ask that your record be entered without identifying information or not be shared with other agencies. [b] Substance use treatment records: Records from substance use disorder treatment programs protected by 42 CFR Part 2 are not entered into or shared through HMIS without your separate Part 2 consent. [c] HIV status: Information about your HIV status is protected by Missouri law and will not be shared through HMIS without your separate written consent. 7. Your rights [a] Refuse to provide information. Refusing will not by itself stop you from receiving services, though some programs may require certain information to determine eligibility. [b] Refuse to have your information shared. You may ask that your HMIS record be visible only to the agency entering it. [c] Review your record. You may request to see the information stored about you in HMIS. [d] Request corrections. If you believe information in your record is inaccurate, you may request a correction. [e] Withdraw consent. You may withdraw this consent at any time by notifying your case manager in writing. Future sharing will stop, but information already shared or reported to funders cannot be taken back. [f] Receive a copy of this notice. You will automatically receive a copy when you accept it. [g] File a complaint. You will not be denied services or treated differently for asking questions or filing a complaint. 8. How long we keep your information Your information will be kept for [X] years after your last contact with a participating agency, following [Your CoC Name] HMIS policies and HUD requirements. After that, it will be deleted or have identifying details removed. 9. Signing for your household If you are the head of household, you may accept this consent on behalf of anyone in your household. By doing so, you confirm that you have the legal authority to act for them. 10. Questions or complaints Contact your case manager, or the HMIS Lead Agency: The Greater Kansas City Coalition to End Homelessness [Address] · [Phone] · [Email] This notice is provided in accordance with HUD's HMIS Data Standards and applicable privacy regulations. Acceptance By signing below or selecting "I Agree," I confirm that I have read and understand this notice, and I consent to having my information, and the information of any household members I am signing for, entered into and shared through HMIS as described above.

Client Release of Information Consent to Release and Exchange of Information Last updated: 01/01/2026 This Release of Information ("Release") applies to your dWell-KC account. By accepting it, you allow Housing Access Network to share and receive your personal information with the agency representatives working with you, so they can help you get stabilized housing faster. 1. Who may share and receive your information You authorize Housing Access Network, including its staff and volunteers, to release your information to, and receive your information from: [a] Agency representatives connected to your Housing Access Network account [b] Other organizations Housing Access Network determines are needed to help you get or keep housing, such as housing providers, landlords, property managers, shelters, public housing authorities, benefits offices, and health or social service providers These parties may also share your information with each other for the same purpose. 2. What information may be shared [a] Identifying information, such as your name, date of birth, contact details, and identification documents [b] Housing history, including past addresses, rental history, and evictions [c] Income, employment, and benefits information [d] Household and family information [e] Case notes, service plans, and progress updates [f] Medical information, including diagnoses, disabilities, medications, and providers [g] Mental health and substance use information [h] Criminal history and legal status [i] Veteran status and military records 3. Why your information is shared Your information is shared to speed up and coordinate the services and help you receive. This includes finding and applying for housing, confirming eligibility for programs and benefits, requesting disability accommodations, and connecting you with support services. You agree that Housing Access Network may decide what information to share, and with whom, as it determines is related to these purposes. 4. This is a basic consent; additional releases may be required This Release is a base consent to share information related to your services and your search for housing assistance. It is not a HIPAA authorization, and it is not a consent under 42 CFR Part 2 (the federal rule that protects records from substance use disorder treatment programs that is required for HIPAA covered entities). If Housing Access Network needs to disclose specific health information, or substance use treatment records protected by 42 CFR Part 2, it will give you a separate HIPAA authorization or 42 CFR Part 2 consent form as required. A doctor, hospital, clinic, or treatment program may also require its own release before giving out your records. 5. Your consent is voluntary You do not have to accept this Release. Declining will not affect your eligibility for services. Some referrals may require you to share information directly with that provider. 6. Information shared with others Once your information is shared, the receiving party may share it again, and it may no longer be protected by this Release. Records protected by 42 CFR Part 2 are not shared under this Release and keep their federal protections against re-disclosure. 7. Your safety If sharing any of your information could put you or your household at risk, such as your address, location, or contact details, you may ask to limit or stop that sharing at any time. Tell your Housing Access Network case manager, and they will update what is shared. If you receive services from a domestic violence, dating violence, sexual assault, or stalking victim service provider, that provider's records are kept separate and are not shared under this Release, consistent with the Violence Against Women Act (VAWA). 8. How long this lasts and how to cancel This Release stays in effect while your dWell-KC user account is set to 'active', unless you cancel it sooner. You may cancel at any time by notifying your Housing Access Network case manager in writing. Canceling stops future sharing but does not undo information already shared. 9. Your rights You may ask your Housing Access Network case manager what information has been shared and with whom. You will automatically receive a copy of this Release when you accept it, and you may request another copy at any time. 10. Signing for your household If you are the head of household, you may accept this Release on behalf of anyone in your household. By doing so, you confirm that you have the legal authority to act for them. Acceptance By signing below or selecting "I Agree," I confirm that I have read and understand this Release, and I authorize Housing Access Network to share and receive my information, and the information of any household members I am signing for, as described above.