Supportive Services for Veteran Families (SSVF) Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form VA Form 10-0508c Renewal Application for Supportive Services Grant	Form and Instruction	Modified	Available
Form VA Form 10-0508b Quarterly Grantee Performance Report	Form and Instruction	Modified	Available
Form VA Form 10-0508a SSVF Participant Satisfaction Survey	Form	Modified	Available
Form VA Form 10-0508 Supportive Services for Veterans Families Progrm Application	Form and Instruction	Modified	Available
White Paper revisions to 10-0508 SSVF Application (2).docx	Justification for No Material/Nonsubstantive Change	Uploaded 2012-10-04	Available
SSVF Program Participant Survey Justification B 4_11_2011.doc	Supporting Statement B	Uploaded 2011-07-20	Available
SSVF Program Justification.doc	Supporting Statement A	Uploaded 2010-12-02	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
194740	Supportive Services for Veteran Families Program	Form and Instruction	Modified	Renewal Application for Supportive Services Grant
194740	Supportive Services for Veteran Families Program	Form and Instruction	Modified	Quarterly Grantee Performance Report
194740	Supportive Services for Veteran Families Program	Form	Modified	SSVF Participant Satisfaction Survey
194740	Supportive Services for Veteran Families Program	Form and Instruction	Modified	Supportive Services for Veterans Families Progrm Application
194740	Supportive Services for Veteran Families Program	Other-worksheet	Modified

ICR Details

OMB Control No: 2900-0757	ICR Reference No: 201210-2900-001
Status: Historical Active	Previous ICR Reference No: 201110-2900-001
Agency/Subagency: VA	Agency Tracking No: 2900-0757
Title: Supportive Services for Veteran Families (SSVF) Program
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/04/2012
Retrieve Notice of Action (NOA)	Date Received in OIRA: 10/04/2012
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2013	12/31/2013	12/31/2013
Responses	100	0	100
Time Burden (Hours)	3,500	0	3,500
Cost Burden (Dollars)	0	0	0

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Abstract: This data collection is in association with Rulemaking (RIN 2900-AN53). The purpose of the SSVF Program is to provide supportive services grants to private non-profit organizations and consumer cooperatives who will coordinate or provide supportive services to very low-income veteran families who are residing in permanent housing, are homeless and scheduled to become residents of permanent housing within a specified time period, or after exiting permanent housing, are seeking other housing that is responsive to such very low-income veteran family’s needs and preferences. The new SSVF Program is within the continuum of VA’s homeless services programs.

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Authorizing Statute(s): PL: Pub.L. 110 - 387 604 Name of Law: Veterans’ Mental Health and Other Care Improvements Act
   US Code: 38 USC 2044 Name of Law: Financial Assistance for Supportive Services
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
2900-AN53	Final or interim final rulemaking	75 FR 217	11/10/2010

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Supportive Services for Veteran Families Program	VA Form 10-0508c, VA Form 10-0508a, VA Form 10-0508, VA Form 10-0508b	Supportive Services for Veterans Families Progrm Application ,   SSVF Participant Satisfaction Survey ,   Quarterly Grantee Performance Report ,   Renewal Application for Supportive Services Grant

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	100	100	0	0	0	0
Annual Time Burden (Hours)	3,500	3,500	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $4,364

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 10/04/2012

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