[Optional: submit on contracting county or Tribal human services organization letterhead]
Housing Support Funding Commitment Form
Last Updated: March 2025
Instructions: Counties or Tribes that have or intend to approve a Housing Support agreement with a housing provider are required to complete this form to inform Minnesota Housing of the contract details. Applicants must submit this form in Minnesota Housing’s Multifamily Customer Portal as part of the Multifamily Consolidated Request for Proposals (RFP) application process to receive rental assistance points or document secured service resources and as part of the due diligence closing checklist.
General Information
This section is to be completed by the applicant.
Development Name:      
Development Street Address:      
Development City, State ZIP Code:      
Owner/Administrator Name:      
Service Provider Name:      
Housing Support Room and Board Contracted Provider Name:      
Housing Support Services Contracted Provider Name:      
Housing Support is a state funded income supplement program that pays for room and board costs for adults with low incomes who have a disabling condition or are age 65 or older. Recipients live in a licensed facility or authorized community-based setting (settings where all residents have a signed lease agreement and have the option to prepare their own meals). Some community-based settings may be required to serve people who have experienced long-term homelessness in addition to meeting the other Housing Support eligibility criteria.
Housing Support payments are made directly to the contracted housing provider. In order to receive Housing Support payments, the housing provider must meet certain statutorily defined criteria and sign the appropriate standardized Housing Support agreement with the county or Tribal jurisdiction in which the housing is located. The formal agreement determines the maximum number of Housing Support units and their payment rates. The maximum monthly housing rate payment will be $1,192 effective July 1, 2025. Providers of Housing Support in community-based settings (excluding Metro Demonstration Project) will receive an additional $50 for a total monthly room and board payment of $1,242 starting July 1, 2025.
Some service providers may also be eligible to receive the Housing Support Supplemental Service Rate of $494.91. The supplemental service rate for long-term homeless supportive housing and the Metro Demonstration Project is reduced by half for people who have been determined eligible for Medicaid Housing Stabilization Services (HSS). Some locations have been legislatively authorized to receive service rates higher than $494.91. 
Additional Housing Support information is available on the Minnesota Department of Human Services Housing Support webpage and the Housing Benefits 101 website.
Supportive Housing Unit Information
This section is to be completed by the county or Tribal human services staff. Minnesota Housing, at its sole discretion, may contact the county or Tribal official(s) for additional information regarding this proposal.
Complete the following table. Keep in mind the following items as you are filling out this section:
•	High Priority Homeless (HPH) are defined as units set aside for households who are prioritized for permanent supportive housing by the Coordinated Entry System.
•	People with Disabilities (PWD) units are defined as units that will be set aside and rented to people with disabilities.
•	Setting type options include Long-Term Homeless Supportive Housing, General Supportive Housing, Board and Lodge with Special Services, or Metro Demonstration Project.
Table 1: Supportive Housing Unit Information
Number of HPH, PWD, and Other Units	Number of Housing Support Units/Beds	Setting Type	Payment Rate per Bed	Supplementary Service Rate
(if applicable)	Anticipated Agreement
Start Date	
      HPH	     	     	     	     	     	
      PWD	     	     	     	     	     	
      Other	     	     	     	     	     	
Supplemental Service Rate
If authorized for a Supplemental Service Rate, the authority to receive it comes from (check one):
	 Long-term homeless supportive housing eligibility.
	 Metro Demonstration Project eligibility.
	 The county or Tribe assigned available “banked beds” to allow supplemental services in this project.
	 Minnesota statute specifically authorizes supplemental service rates in this project.
Contingent Commitment
The Housing Support commitment for the HPH units is contingent upon Minnesota Housing determining the market need for the units as proposed in consultation with the Continuum of Care (CoC) or Tribe during the application feasibility review. If Minnesota Housing determines there is not a market need for the HPH units, the associated rental assistance points will be removed from the applicant’s score.
Additional Comments and/or Restrictions
     

Signature
This section is to be completed by the county or Tribal human services staff.
     	     
Name of County or Tribe	Department
     	     
Signatory Printed Name	Title
     	     
Signatory Telephone Number	Signatory Email Address
     	     
Signature	Date