first_name_of_the_individual_or (type: esriFieldTypeString, alias: First Name of the Individual or Head of Household Seeking Assistance., SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
last_name_of_the_individual_or_ (type: esriFieldTypeString, alias: Last Name of the Individual or Head of Household Seeking Assistance., SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
last_four_digits_of_the_social_ (type: esriFieldTypeDouble, alias: Last Four Digits of the Social Security Number of the Individual or Head of Household Seeking Assistance., SQL Type: sqlTypeOther, nullable: true, editable: true)
date_of_birth_of_the_individual (type: esriFieldTypeDate, alias: Date of Birth of the Individual or Head of Household Seeking Assistance., SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
number_of_people_in_the_househo (type: esriFieldTypeDouble, alias: Total Number of People in the Household., SQL Type: sqlTypeOther, nullable: true, editable: true)
number_of_children_under_18_yea (type: esriFieldTypeDouble, alias: Number of Children in the Household under 18 years of age., SQL Type: sqlTypeOther, nullable: true, editable: true)
street_address_of_property (type: esriFieldTypeString, alias: Street Address of Property., SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
city_of_property (type: esriFieldTypeString, alias: City of Property., SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
zip_code_of_property (type: esriFieldTypeDouble, alias: Zip Code of Property., SQL Type: sqlTypeOther, nullable: true, editable: true)
do_you_rent_or_own (type: esriFieldTypeString, alias: Do you rent or own?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [rent: Rent], [own: Own], [unsheltered: Unsheltered])
do_you_have_a_current_lease (type: esriFieldTypeString, alias: Do you have a current lease?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [yes: Yes], [no: No], [unsheltered: Unsheltered])
how_many_months_have_you_been_a (type: esriFieldTypeDouble, alias: How many months have you been at your current address?, SQL Type: sqlTypeOther, nullable: true, editable: true)
number_of_bedrooms (type: esriFieldTypeDouble, alias: Number of Bedrooms., SQL Type: sqlTypeOther, nullable: true, editable: true)
which_utilities_are_the_househo (type: esriFieldTypeString, alias: Which Utilities are the Household responsible for?, SQL Type: sqlTypeOther, length: 1000, nullable: true, editable: true)
what_assistance_will_you_requir (type: esriFieldTypeString, alias: What assistance will you require?, SQL Type: sqlTypeOther, length: 1000, nullable: true, editable: true)
what_is_the_households_monthly_ (type: esriFieldTypeDouble, alias: What is the Household's Monthly Income?, SQL Type: sqlTypeOther, nullable: true, editable: true)
is_your_income_loss_due_to_covi (type: esriFieldTypeString, alias: Is your income loss due to COVID-19?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [yes: Yes], [no: No])
have_you_applied_for_unemployme (type: esriFieldTypeString, alias: Have you applied for Unemployment?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [yes: Yes], [no: No])
are_you_a_veteran (type: esriFieldTypeString, alias: Are you a Veteran?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [yes: Yes], [no: No])
is_anyone_in_the_household_a_ve (type: esriFieldTypeString, alias: Is anyone in the Household a Veteran?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [yes: Yes], [no: No])
have_you_received_any_financial (type: esriFieldTypeString, alias: Have you received any other financial assistance from any agencies in Pasco County in 2020?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [yes: Yes], [no: No])
after_this_screening_a_service_ (type: esriFieldTypeString, alias: After this screening, a service provider will contact you for all documentation that is required for approval of assistance. The following documentation may be asked for. Please have it ready or available upon contact from the agency. A delay in providing documentation may delay or deny assistance., SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [i_understand: I Understand])
by_checking_this_box_you_affirm (type: esriFieldTypeString, alias: By checking this box, you affirm that all information submitted is accurate and honest. If the information has been found to be false, a delay or denial of assistance could occur., SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [i_understand: I Understand])
is_your_landlord_pursuing_or_th (type: esriFieldTypeString, alias: Is your landlord pursuing or threatening an eviction?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [yes: Yes], [no: No], [unsheltered: Unsheltered])
which_months_are_you_behind_in_ (type: esriFieldTypeString, alias: Which months are you behind in rent?, SQL Type: sqlTypeOther, length: 1000, nullable: true, editable: true)
which_of_these_best_describes_y (type: esriFieldTypeString, alias: Which of these best describes your current situation?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [i_am_housed_but_behind_on_rent_: I am housed but behind on rent/mortgage or utilities.], [i_am_unsheltered_and_need_assis: I am unsheltered and need assistance finding housing.])
have_you_received_any_assistanc (type: esriFieldTypeString, alias: Have you received any assistance through the Pasco County Government CARES Funding?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [yes: Yes], [no: No], [i_am_not_sure_: I am not sure.])
if_you_are_working_with_another (type: esriFieldTypeString, alias: If you are working with another agency for this assistance, please enter the name of that agency here., SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
do_you_have_health_insurance_th (type: esriFieldTypeString, alias: Do you have health insurance through medicaid? If yes, which health plan provides the insurance?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [yes_through_magellan_complete_c: Yes, through Magellan Complete Care of Florida.], [yes_through_simply_healthcare_: Yes, through Simply Healthcare.], [yes_through_staywell_: Yes, through StayWell.], ... 3 more ...)
Templates:
Name: New Feature
Description:
Drawing Tool: esriFeatureEditToolPoint
Prototype: