Information Collection

Supportive Services for Veteran Families Program

IC 194740 under ICR 201511-2900-005 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form VA Form 10-10072 Supportive Services for Veteran Families Program	Form and Instruction
SSVF_Applicant Budget Template xls Worksheet_8-13.xls	Other-worksheet
SSVF Quarterly Financial Report Template_8-13.xlsx	Other-Worksheet
VA Form 10-10072 Supportive Services for Veterans Families Progrm Applica 2014 SSVF Application 10-10072 NEW APPLICANTS.docx	Form and Instruction
VA Form 10-10072a SSVF Participant Satisfaction Survey SSVF Participant Satisfaction Survey 10-10072a 12-18.pdf	Form
VA Form 10-10072b Quarterly Grantee Performance Report Quarterly Grantee Performance Report 10-10072b_8-13.doc	Form and Instruction
VA Form 10-10072c Renewal Application for Supportive Services Grant SSVF_2015_Renewal_Application_Form_Electronic 10-10072c.pdf vaww.va.gov/vaforms/medical/pdf/vha-10-10072C-fill.pdf	Form and Instruction

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	VA Form 10-10072	Supportive Services for Veterans Families Progrm Application	2014 SSVF Application 10-10072 NEW APPLICANTS.docx		Yes	No	Fillable Printable
Other-worksheet			SSVF_Applicant Budget Template xls Worksheet_8-13.xls		Yes	No	Fillable Fileable
Form	VA Form 10-10072a	SSVF Participant Satisfaction Survey	SSVF Participant Satisfaction Survey 10-10072a 12-18.pdf		Yes	No	Fillable Printable
Form and Instruction	VA Form 10-10072b	Quarterly Grantee Performance Report	Quarterly Grantee Performance Report 10-10072b_8-13.doc		Yes	No	Fillable Printable
Other-Worksheet			SSVF Quarterly Financial Report Template_8-13.xlsx		Yes	No	Fillable Printable
Form and Instruction	VA Form 10-10072c	Renewal Application for Supportive Services Grant	SSVF_2015_Renewal_Application_Form_Electronic 10-10072c.pdf	http://vaww.va.gov/vaforms/medical/pdf/vha-10-10072C-fill.pdf	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 %

table that charts list of burden
	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

table that charts IC Documents
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.