<?xml version="1.0" encoding="utf-8"?>
<systemform>
  <formid>{ab9619ab-1a0f-490e-9380-d81b4366421a}</formid>
  <IntroducedVersion>1.1.0.2</IntroducedVersion>
  <FormPresentation>1</FormPresentation>
  <FormActivationState>1</FormActivationState>
  <form maxWidth="400">
    <tabs>
      <tab id="{f52739f2-8532-454f-a952-bef7a69113d2}" name="tab_1" showlabel="false">
        <labels>
          <label description="Tab" languagecode="1033" />
        </labels>
        <columns>
          <column width="100%">
            <sections>
              <section id="{68c65466-ddb8-4001-bd6f-37d600561120}" name="tab_1_column_1_section_1" columns="1" showlabel="true" showbar="false" IsUserDefined="0" locklevel="0" labelwidth="250" celllabelalignment="Left" celllabelposition="Left">
                <labels>
                  <label description="If Veteran is NOT currently homeless, does he/she feel at risk of becoming so?" languagecode="1033" />
                </labels>
                <rows>
                  <row>
                    <cell id="{1c782923-585c-824b-40a8-bb3b09dcd572}" showlabel="false" locklevel="0">
                      <labels>
                        <label description="If Veteran is NOT currently homeless" languagecode="1033" />
                      </labels>
                      <control id="vhacrm_isathomelessrisk_code" classid="{3EF39988-22BB-4f0b-BBBE-64B5A3748AEE}" datafieldname="vhacrm_isathomelessrisk_code" disabled="false" />
                    </cell>
                  </row>
                  <row>
                    <cell id="{417108ad-b3e0-3d13-6a26-bead33dccc03}" showlabel="false" userspacer="true">
                      <labels>
                        <label description="" languagecode="1033" />
                      </labels>
                    </cell>
                  </row>
                  <row>
                    <cell id="{2ba0930a-1b2b-a947-ccd6-ddbebde0d2e7}" showlabel="true" locklevel="0">
                      <labels>
                        <label description="If not homeless, where is Veteran staying:" languagecode="1033" />
                      </labels>
                      <control id="vhacrm_ifnothomelessstaying_code" classid="{3EF39988-22BB-4f0b-BBBE-64B5A3748AEE}" datafieldname="vhacrm_ifnothomelessstaying_code" disabled="false" />
                    </cell>
                  </row>
                </rows>
              </section>
              <section name="tab_1_section_2" showlabel="true" showbar="false" locklevel="0" id="{65b0dda6-9310-d730-3322-339928741c88}" IsUserDefined="0" layout="varwidth" columns="1" labelwidth="250" celllabelalignment="Left" celllabelposition="Left">
                <labels>
                  <label description="Specify Veteran's other sources of funds, if any:" languagecode="1033" />
                </labels>
                <rows>
                  <row>
                    <cell id="{13d441bb-8b1c-64cc-1ad5-4e475203c3ea}" showlabel="true" locklevel="0">
                      <labels>
                        <label description="Social Security" languagecode="1033" />
                      </labels>
                      <control id="vhacrm_fundssocialsecurity_bool" classid="{67FAC785-CD58-4f9f-ABB3-4B7DDC6ED5ED}" datafieldname="vhacrm_fundssocialsecurity_bool" disabled="false" />
                    </cell>
                  </row>
                  <row>
                    <cell id="{9c69a607-13b1-9c71-c7ea-2052de7c5e2e}" showlabel="true" locklevel="0">
                      <labels>
                        <label description="SSI" languagecode="1033" />
                      </labels>
                      <control id="vhacrm_fundsssi_bool" classid="{67FAC785-CD58-4f9f-ABB3-4B7DDC6ED5ED}" datafieldname="vhacrm_fundsssi_bool" disabled="false" />
                    </cell>
                  </row>
                  <row>
                    <cell id="{1c73ab8e-7466-78db-0a78-4e1e710ed03e}" showlabel="true" locklevel="0">
                      <labels>
                        <label description="VA Disability" languagecode="1033" />
                      </labels>
                      <control id="vhacrm_fundsvadisability_bool" classid="{67FAC785-CD58-4f9f-ABB3-4B7DDC6ED5ED}" datafieldname="vhacrm_fundsvadisability_bool" disabled="false" />
                    </cell>
                  </row>
                  <row>
                    <cell id="{153a73b8-e756-00e8-25b1-ce135ed4da3e}" showlabel="true" locklevel="0">
                      <labels>
                        <label description="VA Pension" languagecode="1033" />
                      </labels>
                      <control id="vhacrm_fundsvapension_bool" classid="{67FAC785-CD58-4f9f-ABB3-4B7DDC6ED5ED}" datafieldname="vhacrm_fundsvapension_bool" disabled="false" />
                    </cell>
                  </row>
                  <row>
                    <cell id="{97696a8e-ebc5-278e-e12d-7b1125576d8e}" showlabel="true" locklevel="0">
                      <labels>
                        <label description="Family Sources" languagecode="1033" />
                      </labels>
                      <control id="vhacrm_fundsfamily_bool" classid="{67FAC785-CD58-4f9f-ABB3-4B7DDC6ED5ED}" datafieldname="vhacrm_fundsfamily_bool" disabled="false" />
                    </cell>
                  </row>
                  <row>
                    <cell id="{174b4dde-de3b-044e-5921-242b012e6120}" showlabel="true" locklevel="0">
                      <labels>
                        <label description="Other sources of support" languagecode="1033" />
                      </labels>
                      <control id="vhacrm_fundsother_bool" classid="{67FAC785-CD58-4f9f-ABB3-4B7DDC6ED5ED}" datafieldname="vhacrm_fundsother_bool" disabled="false" />
                    </cell>
                  </row>
                </rows>
              </section>
              <section name="tab_1_section_3" showlabel="false" showbar="false" locklevel="0" id="{141921ca-6638-a79b-b803-e2c48a37a7bc}" IsUserDefined="0" layout="varwidth" columns="1" labelwidth="250" celllabelalignment="Left" celllabelposition="Left">
                <labels>
                  <label description="Section" languagecode="1033" />
                </labels>
                <rows>
                  <row>
                    <cell id="{6c03dce4-28c8-5e29-11aa-5d38de3d3ddc}" showlabel="true" locklevel="0">
                      <labels>
                        <label description="Is veteran's income sufficient to provide adequate housing?" languagecode="1033" />
                      </labels>
                      <control id="vhacrm_isvetincomesufficient_code" classid="{3EF39988-22BB-4f0b-BBBE-64B5A3748AEE}" datafieldname="vhacrm_isvetincomesufficient_code" disabled="false" />
                    </cell>
                  </row>
                </rows>
              </section>
              <section name="tab_1_section_4" showlabel="true" showbar="false" locklevel="0" id="{47ac8bcc-1117-5b76-7682-51d769a11a29}" IsUserDefined="0" layout="varwidth" columns="1" labelwidth="250" celllabelalignment="Left" celllabelposition="Left">
                <labels>
                  <label description="Other Federal or community resources used:" languagecode="1033" />
                </labels>
                <rows>
                  <row>
                    <cell id="{627772a1-3ea3-62ed-6c68-d1b16bd4b667}" showlabel="true" locklevel="0">
                      <labels>
                        <label description="Received community health care" languagecode="1033" />
                      </labels>
                      <control id="vhacrm_resourcehealthcare_bool" classid="{67FAC785-CD58-4f9f-ABB3-4B7DDC6ED5ED}" datafieldname="vhacrm_resourcehealthcare_bool" disabled="false" />
                    </cell>
                  </row>
                  <row>
                    <cell id="{b0a565b2-d76e-5a78-b553-33116762d990}" showlabel="true" locklevel="0">
                      <labels>
                        <label description="Received community substance abuse treatment" languagecode="1033" />
                      </labels>
                      <control id="vhacrm_resourceabusetreatment_bool" classid="{67FAC785-CD58-4f9f-ABB3-4B7DDC6ED5ED}" datafieldname="vhacrm_resourceabusetreatment_bool" disabled="false" />
                    </cell>
                  </row>
                  <row>
                    <cell id="{ad6b9c63-616d-6261-98e3-01953a2366a1}" showlabel="true" locklevel="0">
                      <labels>
                        <label description="Received community mental health services" languagecode="1033" />
                      </labels>
                      <control id="vhacrm_resourcementalhealth_bool" classid="{67FAC785-CD58-4f9f-ABB3-4B7DDC6ED5ED}" datafieldname="vhacrm_resourcementalhealth_bool" disabled="false" />
                    </cell>
                  </row>
                  <row>
                    <cell id="{2c7ecb95-ca6d-ecbb-648d-ebbd70025219}" showlabel="true" locklevel="0">
                      <labels>
                        <label description="Health and Human Services" languagecode="1033" />
                      </labels>
                      <control id="vhacrm_resourcehumanservices_bool" classid="{67FAC785-CD58-4f9f-ABB3-4B7DDC6ED5ED}" datafieldname="vhacrm_resourcehumanservices_bool" disabled="false" />
                    </cell>
                  </row>
                  <row>
                    <cell id="{e35b8915-953d-8b3a-15a2-447910e57b18}" showlabel="true" locklevel="0">
                      <labels>
                        <label description="Housing and Urban Development" languagecode="1033" />
                      </labels>
                      <control id="vhacrm_resourcehousingdev_bool" classid="{67FAC785-CD58-4f9f-ABB3-4B7DDC6ED5ED}" datafieldname="vhacrm_resourcehousingdev_bool" disabled="false" />
                    </cell>
                  </row>
                  <row>
                    <cell id="{a88ae369-a34a-d677-b221-68b53a9bc3da}" showlabel="true" locklevel="0">
                      <labels>
                        <label description="Community-based supportive services" languagecode="1033" />
                      </labels>
                      <control id="vhacrm_resourcesupportive_bool" classid="{67FAC785-CD58-4f9f-ABB3-4B7DDC6ED5ED}" datafieldname="vhacrm_resourcesupportive_bool" disabled="false" />
                    </cell>
                  </row>
                  <row>
                    <cell id="{26690d34-0c65-b39e-bc7a-7a4ea71e93b9}" showlabel="false" userspacer="true">
                      <labels>
                        <label description="" languagecode="1033" />
                      </labels>
                    </cell>
                  </row>
                </rows>
              </section>
            </sections>
          </column>
        </columns>
      </tab>
    </tabs>
    <DisplayConditions Order="2">
      <Role Id="{627090ff-40a3-4053-8790-584edc5be201}" />
      <Role Id="{119f245c-3cc8-4b62-b31c-d1a046ced15d}" />
    </DisplayConditions>
  </form>
  <IsCustomizable>1</IsCustomizable>
  <CanBeDeleted>1</CanBeDeleted>
  <LocalizedNames>
    <LocalizedName description="NCCHV Assessment Quick View Homelessness Questions Part 2" languagecode="1033" />
  </LocalizedNames>
</systemform>