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Written verification from the institution's staff that the participant has been residing <br /> in the institution for less than 90 days; and information on the previous living <br /> situation as being homeless in shelter or streets. <br /> Written verification if available. Self-report is acceptable. Utilize the area on the <br /> form for person to self-declare and then sign and date. <br /> Qualifying under the definition in Paragraph 4: <br /> > Acceptable Evidence for Individuals Fleeing Domestic Violence: <br /> Oral statement by the individual or head of household seeking assistance that <br /> indicates that they are fleeing that situation, <br /> o that no subsequent residence has been identified and that they lack the <br /> resources or support networks, e.g., family, friends, faith-based or other <br /> social networks, needed to obtain other housing, that is certified by the <br /> individual or head of household that the oral statement is true and complete; <br /> AND where the safety of the individual or family would NOT be jeopardized: <br /> Written observation by intake worker;or <br /> Written referral by a housing or service provider, social worker, or other <br /> organization from whom the household has sought assistance for domestic violence. <br /> If the individual or family is being admitted to a domestic violence shelter or is receiving <br /> services from a victim services provider,the oral statement need only be documented by a <br /> certification by the individual or head of household,or by the intake worker. <br /> 4.2 — ESG Homelessness Prevention Eligibility <br /> Criteria <br /> ESG funds may be used to provide housing relocation and stabilization services and short- <br /> and/or medium-term rental assistance necessary to prevent an individual or family from <br /> moving into an emergency shelter or another place described in paragraph (1) of the <br /> "homeless"definition in 24 CFR 576.2. <br /> This assistance,referred to as homelessness prevention,may be provided to individuals and <br /> families who meet the criteria under the"at risk of homelessness" definition,or who meet <br /> the criteria in paragraph(2),(3),or(4)of the"homeless"definition in 24 CFR 576.2 and have <br /> an annual income below 30 percent of median family income for the area, as determined <br /> by HUD. The costs of homelessness prevention are only eligible to the extent that the <br /> City of South Bend - ESG Policies and Procedures Manual 27 <br />