The Colorado Interagency Council on Homelessness

This page contains information you will need to conduct the winter homeless count.

Please click below for a PDF of the Statewide Homeless Count survey instrument and tracking document.

Survey Instrument - Please note, agencies can enter information into the top box before printing copies of their surveys.

Survey Instrument - Spanish Language

Tracking Document

Cover Sheet

Cover Sheet – One cover sheet will be used PER LOCATION - the cover sheet will be attached to completed surveys submitted for each location.  If agency staff/volunteers are conducting surveys in several locations during the count period, please complete one cover sheet per location.  If several volunteers are conducting surveys at the same location, for example a congregate meal site, one individual needs to collect all surveys and complete the cover sheet.

Tracking Form

Tracking Form for Counts/Estimates of Unsheltered Homeless Persons

This form is only to be used in situations where it is impossible to conduct surveys (due to safety concerns or remoteness of location). The Tracking Form for Counts/Estimates should be completed by someone qualified to count or make an estimate.  Please be sure to complete only one Tracking Form for Counts/Estimates of Unsheltered Homeless Persons per location.

Coordinators - Make sure you aren't forgetting anything!

County Coordinator Check List

Count Day Packet

The following items are in the packet: The official Statewide Homeless Count definition, an interviewer questionnaire, explanation of questions, contact information, an agency referral sheet and a HIPPA release document.

Day of Homeless Count Packet (PDF)
Day of Homeless Count Packet (Word)

HIPAA RELEASE OF INFORMATION AND DISCLOSURE FORM (if required by your organization)

HIPAA (Health Insurance Portability and Accountability Act) protects the confidentiality and integrity of patient health information. Most organizations and agencies will not need to use a HIPAA release to administer a survey.  The decision of whether or not to use the HIPAA release will be made by the organization or agency administering the surveys.

Click here for the HIPAA release.

Many of these items are in PDF format. You can download Adobe Acrobat Reader here.

Note: After you download the Adobe Acrobat Reader to your computer, double-click the newly downloaded file and follow the installation instructions.  Once the reader is installed, click the name of the PDF file you wish to view.