Appendix 2 | Municipality Cost Questionnaire

Orange County United Way, Jamboree & UCI Study of the Costs of Homelessness

We are soliciting your cooperation in our efforts to conduct a cost study of homelessness in Orange County. By homelessness, we refer, in accordance with HUD, to individuals or families who reside in places not meant for human habitation, or in emergency, transitional or supportive housing when they came from the streets, or who have been evicted from private dwellings, discharged from an institution, or are fleeing domestic violence without the resources or networks needed to obtain housing. Please contact Dr. David A. Snow with any questions or concerns (dsnow@uci.edu). Thank you for your cooperation and support.

Municipality:

Address:

Name of Municipal Respondent:

Respondent Email: Respondent Phone #:

Date:

1. What is the population of the municipality?

2. What was the total budget of the municipality for FY2014/15?

3. Approximately what percent of the total budget was spent on homelessness?

4. Please complete the following table to the best of your ability. Some of the department designations may not apply in your case, so please ignore or modify as appropriate:

City Department:

Mayor/Council City Attorney City Manager Community Development Economic Development Fire Department Emergency Medical Services (EMS) Parks and Recreation Police Department Other: (specify) Other: (specify) Other: (specify) FY2014/2015 Budget Approximate % of Department Budget Spent on Homelessness

5. List 3 to 4 non-government agencies that are key service providers for the homeless in your municipality: 6. List key health service providers in your municipality: 7. List major locations in your municipality where the street homeless congregate: