Information Collection

Supportive Services for Veteran Families Program

IC 194740 under ICR 201611-2900-008 · OMB 2900-0757.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0757 can be found here:

Documents and Forms

Document Name Document Type
Form VA Form 10-10072c Supportive Services for Veteran Families Program Form and Instruction
Copy of NOFA_Budget_Template_10.26.16.xlsx Other-worksheet
Copy of Blank_SSVF FY16 Financial Report Template_UNLOCKED.xlsm Other-Worksheet
Grantee certification template_11-4-16.docx Other-Worksheet
VA Form 10-10072 Supportive Services for Veterans Families Progrm Applica New Application 10-31-16b_VA Form 10-10072.pdf Form and Instruction
VA Form 10-10072a SSVF Participant Satisfaction Survey Participant Satisfaction Survey v11-4-16.docx Form
VA Form 10-10072b Quarterly Grantee Performance Report Quarterly Grantee Performance Report 10-10072b 11-4-16.doc Form and Instruction
VA Form 10-10072c Renewal Application for Supportive Services Grant SSVF_2015_Renewal_Application_Form_Electronic 10-10072c v10-31-16b.pdf vaww.va.gov/vaforms/medical/pdf/vha-10-10072C-fill.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Supportive Services for Veteran Families Program	Agency IC Tracking Number:	2900-0757

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 38 CFR Part 62 (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	VA Form 10-10072c	Renewal Application for Supportive Services Grant	SSVF_2015_Renewal_Application_Form_Electronic 10-10072c v10-31-16b.pdf	http://vaww.va.gov/vaforms/medical/pdf/vha-10-10072C-fill.pdf	Yes	No	Fillable Printable
Other-Worksheet			Grantee certification template_11-4-16.docx		Yes	No	Fillable Printable
Form and Instruction	VA Form 10-10072	Supportive Services for Veterans Families Progrm Application	New Application 10-31-16b_VA Form 10-10072.pdf		Yes	No	Fillable Printable
Other-worksheet			Copy of NOFA_Budget_Template_10.26.16.xlsx		Yes	No	Fillable Fileable
Form	VA Form 10-10072a	SSVF Participant Satisfaction Survey	Participant Satisfaction Survey v11-4-16.docx		Yes	No	Fillable Printable
Form and Instruction	VA Form 10-10072b	Quarterly Grantee Performance Report	Quarterly Grantee Performance Report 10-10072b 11-4-16.doc		Yes	No	Fillable Printable
Other-Worksheet			Copy of Blank_SSVF FY16 Financial Report Template_UNLOCKED.xlsm		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 12,270	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	24,480	24,480
Annual IC Time Burden (Hours)	25,505	25,505
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.