Homelessness Prevention Screening Form

Operation Sacred Trust logo
Supportive Services for Veteran Families
Program Enrollment
Thank you for your service and sacrifices on behalf of the United States of America and our nation's families. We are grateful for your life and appreciate the opportunity to assist you.

The Operation Sacred Trust ("OST") Program is a U.S. Department of Veteran Affairs-funded Supportive Services for Veteran Families ("SSVF") initiative assisting Veteran families located in south Florida's Broward and Miami-Dade counties who are homeless or facing imminent homelessness. Federal funding requirements under which OST operates requires that Veteran families receiving services meet certain eligibility requirements, including: (1) service in the active military, naval, or other service, other than training, from which the Veteran received a discharge other than dishonorable; (2) combined household income not exceeding 50% of the Area Median Income in the county in which the Veteran is located; and (3) experiencing literal homelessness or the imminent threat of homelessness if not for SSVF assistance. 

For more information on the legislation and guidelines within which each SSVF provider must operate, see the SSVF Program Guide at http://www.va.gov/HOMELESS/ssvf/docs/SSVF_Program_Guide_March_2015_Edition.pdf.

If you believe you may be eligible for SSVF services, please carefully complete the following information. Your application will be reviewed promptly and you will receive follow-up from a member of our team no later than one business day from submission of your complete application. If you do not believe you are eligible for services, please know you can still reach out to us for help identifying other resources and supports that could potentially be helpful to you and your family.

If you do not hear from a member of our team within one business day after submitting your application or prefer to apply for services by phone or in-person, please call OST toll-free at (855) 778-3411 x830 or email intake@411Veterans.com.
Broward County, Florida Household Income AMI (2016)
Based on combined gross income from all sources for all household members. 
Household Size Extremely Low (30%) Very Low (50%)
A
B
C
D
E
Miami-Dade County, Florida Household Income AMI (2016)
Based on combined gross income from all sources for all household members. 
Household Size Extremely Low (30%) Very Low (50%)
A
B
C
D
E
About Veteran Head of Household
For program purposes, a Veteran family is a family of one or more persons of which at least one is an eligible Veteran.












Most Recent Home Address








Veteran Status


Bad Conduct discharges are not the same as dishonorable. For Veterans with multiple discharges, the best discharge may be used.
Income Status
Current Housing
We need to know about your current housing situation. To start with, where are you currently staying and what's happening with your housing?








Personal Circumstances
Alternative Resources
Housing Stability Challenges




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