The Federal Privacy Act of 1974 requires that you be notified that disclosure of your Social Security number is voluntary under this record-keeping system. This system was authorized pursuant to directives from Congress and the Department of Housing and Urban Development (HUD). The Social Security number is used to verify identity, assure timely delivery of services, prevent duplication of services, and generate accurate required reports to HUD. The PromisSE is a shared, computerized record-keeping system that captures information about people experiencing homelessness or near homelessness, including their service needs. Opening Doors Northwest Florida, as the Continuum of Care (CoC) for Escambia and Santa Rosa counties, is participating in PromisSE, which collects information on clients served by its member agencies and the services they provide.
By submitting your application, you are agreeing to the following:
I understand that all information gathered about me is personal and private and that I do not have to share information collected in PromisSE. It has been explained to me that all information collected will serve for reporting purposes and as a precaution to prevent duplication of services to ineligible individuals and families. I have had an opportunity to ask questions about PromisSE and to review the identifying information, which is authorized by this release for the PromisSE Member Agencies to share. I also understand that information about non-confidential services provided to me by human service agencies in the Continuum of Care may be shared with other participating PromisSE agencies. This Release of Information will remain in effect for 5 (five) years from the date of digital signature and will expire at that time, unless I make a formal request to this Agency that I no longer wish to participate in PromisSE. Based on the above information, I authorize CoC FL-511, as a PromisSE Member Agency, to share my information with all participating PromisSE agencies. I authorize the use of a copy of this original to serve as an original for the purposes stated above. By digitally signing my name below, I certify that I have read and understood the above.
Further, I give permission for United Ministries of Pensacola, Inc. to share my records with other local agencies in order to provide assistance to my household, to store my records electronically or in a paper file that is retained by United Ministries of Pensacola, Inc. I understand that this authorization shall remain in effect from the date of my signature until United Ministries of Pensacola, Inc. ceases to operate.