Form Pas 106H PDF Details

Every business is required to submit a form 106H if they want to make any changes to their company's bylaws. This can include anything from electing new board members to changing the name of the company. The form must be filed with the state secretary, and there is a small fee associated with it. Not filing this form can result in significant penalties, so it's important to understand what needs to be included on it. In this blog post, we'll walk you through everything you need to know about Form 106H. We'll explain what information is required, and we'll give you some tips on how to complete it correctly. Let's get started!

QuestionAnswer
Form NameForm Pas 106H
Form Length3 pages
Fillable?No
Fillable fields0
Avg. time to fill out45 sec
Other nameshomeless shelter intake forms, emergency shelter intake form, homeless shelter intake process, shelter intake form

Form Preview Example

Continuum of Care Program

Rental Assistance Intake Form

Name:

 

Date:

 

Date of Birth:

 

SS #:

 

Referring Agency:

 

Referral Person:

 

Case Manager:

 

Telephone Number:

 

Current Residence if Any:

 

 

 

 

 

Telephone Number or Other Means of Contact:

 

 

 

 

 

Alternate Means of Contact:

 

 

 

 

 

Current Living Situation (Note: Must Meet HUD Definition of Homelessness)

Please check one:

Non-housing (street, car, park, etc.)

Emergency shelter

Transitional housing after having been homeless

Fleeing/attempting to flee domestic violence

Note: If the participant came from an institution (such as a mental health/substance abuse treatment facility) but was there less than 90 days and was living on the street or in emergency shelter before entering the treatment facility, he/ she should be counted in either the street or shelter category, as appropriate.

Certificate of Homelessness is completed and attached

Can the person be considered chronically homeless (homeless continuously for one year or more or have experienced four episodes of homelessness in the past three years)?

Yes (documentation is attached) No

What is the qualifying disability?

Is documentation from a professional qualified to make a disability determination attached?

Yes

No

Other Household Members: Please list all family members who will be living in the household

Relationship

Name

Date of Birth

Age

Social Security Number

PAS-106H (Revised 10/14)

Demographics:

Please place the total number of household members in each box.

Ethnicity:

Hispanic or Latino

Non-Hispanic or Latino

Race:

American Indian

Asian

Black/African American

Native Hawaiian/ Other Pacific Islander

White

American Indian/Alaskan Native & White

Asian & White

Black/African American & White

American Indian/ Alaskan Native & Black/African American

Other Multi-Racial

Special Needs Program Qualifications: (For primary program participant only, please check all that apply): Must have a diagnosed Axis I substance use disorder to be eligible for the program)

Mental Illness

Alcohol Abuse

Drug Abuse

HIV/AIDS and related diseases

Other: (please check all that apply)

Developmental Disability

Physical Disability

Domestic Violence

Other (please specify)

Total Household Monthly Income from EACH of the following sources:

Supplemental Security Income (SSI)

Social Security Disability Income (SSDI)

Social Security

General Public Assistance

Temporary Aid to Needy Families (TANF)

Child Support

Veteran’s Benefits

Employment Income

Unemployment Income

Medicare

Medicaid

Food Stamps

Other (please specify)

No Financial Resources

Bank Accounts

Type of Account

Bank Name and Address

Amount

Checking

Savings

Other Assets:

Asset Declaration: I certify that the above listed assets are the only assets of which I am either full or partial owner, that my name does not appear on any other bank accounts, checking accounts, saving certificates, stocks, bonds, or any other kind of asset. I further certified that I have not disposed of any property worth more than $2,000 in the last two year period.

I certify that all of the information included in this application is true and correct.

Applicant Name

Signature

 

Date

The following documentation should be included with this form:

ｸSigned Release of Information form

ｸBirth certificate (or verification of birthplace/date from Social Security, proof of application from HSA/DSS for copy of birth certificate, or driver’s license)

ｸAward letter for SSI/SSDI from Social Security Administration, budget from HSA/DSS, or other documentation of income (pay stubs, etc.)

ｸDocumentation of disability (letter from treatment provider, primary care provider, signed by professional qualified to make the diagnosis)

ｸCertification of Homelessness

How to Edit Form Pas 106H Online for Free

With the help of the online tool for PDF editing by FormsPal, you may fill in or edit shelter intake form here and now. To maintain our editor on the leading edge of efficiency, we aim to implement user-oriented capabilities and enhancements on a regular basis. We are at all times pleased to get suggestions - join us in revampimg how we work with PDF docs. Getting underway is effortless! Everything you need to do is adhere to the next easy steps below:

Step 1: Click on the "Get Form" button at the top of this webpage to get into our editor.

Step 2: With our state-of-the-art PDF editing tool, it is possible to accomplish more than simply complete forms. Edit away and make your documents look sublime with custom text added in, or modify the file's original input to excellence - all comes with the capability to incorporate just about any pictures and sign the PDF off.

Concentrate when filling out this form. Ensure every single blank is filled out properly.

1. Fill out your shelter intake form with a group of major blanks. Consider all of the required information and make certain absolutely nothing is omitted!

Ways to prepare homeless shelter intake document step 1

2. Once the last section is completed, you're ready to add the necessary particulars in Note If the participant came from, Certificate of Homelessness is, Can the person be considered, Yes documentation is attached No, What is the qualifying disability, Is documentation from a, Yes No, Other Household Members Please, Relationship, Name, Date of Birth, Age, and Social Security Number so that you can progress to the third stage.

Completing segment 2 of homeless shelter intake document

As to Yes No and Certificate of Homelessness is, make certain you don't make any errors in this current part. Both of these are the most significant fields in the file.

3. This 3rd step is usually rather simple, PASH Revised - each one of these blanks will need to be filled out here.

Step number 3 in filling in homeless shelter intake document

4. All set to start working on the next portion! Here you've got all of these Please place the total number of, Hispanic or Latino NonHispanic or, Demographics Ethnicity Race, Mental Illness Alcohol Abuse Drug, and Developmental Disability Physical blanks to complete.

Filling out segment 4 in homeless shelter intake document

5. As a final point, the following final part is precisely what you should wrap up prior to using the form. The blanks in this instance are the following: Total Household Monthly Income, Supplemental Security Income SSI, Social Security Disability Income, Temporary Aid to Needy Families, Child Support, Veterans Benefits, Employment Income, Unemployment Income, Medicare, Medicaid Food Stamps, Other please specify, and No Financial Resources.

Filling out segment 5 in homeless shelter intake document

Step 3: Check all the information you've inserted in the blank fields and click the "Done" button. Create a free trial subscription with us and get immediate access to shelter intake form - downloadable, emailable, and editable inside your personal account page. FormsPal guarantees protected document editing without data recording or sharing. Feel comfortable knowing that your details are secure with us!

Form Pas 106H isn’t the one you’re looking for?

Related Documents