This government document is issued by Los Angeles Homeless Services Authority for use in Los Angeles, CA
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https://www.google.com/url?client=internal-element-cse&cx=005754506516827097515:jwrv4k4j_1g&q=https://www.lahsa.org/documents%3Fid%3D2969-form-2969-shallow-subsidy-participant-eligibility-screening-tool.pdf&sa=U&ved=2ahUKEwiJmKTAz-78AhVnUKQEHX82Bl84PBAWegQIAxAC&usg=AOvVaw3iIUj2O750x4cHXZhFg5B9