VA Form 10-10072b Quarterly Grantee Performance Report

U.S. Department of Veterans Affairs

Supportive Services for Veteran Families (SSVF) Program

Quarterly Grantee Performance Certification

Instructions: Please complete the following form and email, along with your Quarterly Financial Report (Attachment 1), to the VA SSVF Program Office at [email protected]. Please clearly mark any information that is confidential to individual participants.

Grantee Name:

SSVF Grant Amount:

Grant Award Number:

Name and Title of Contact Completing Form: ________________________________________

Contact Email: ___________________________________________________________________

FINAL RULE

1. I certify that this SSVF program is in compliance with the Final Rule (38 CFR part 62).

Yes/No

2. I certify that I am operating in compliance with my signed grant agreement.

Yes/No

DATA QUALITY

3. I certify that our program is participating in the SSVF Client Participant Satisfaction survey to maintain compliance with our grant agreement.

Yes/No

4. I certify that I am reviewing the monthly data quality/upload summary reports.

Yes/No

5. I certify that data received by the VA via our monthly HMIS uploads accurately represents our program performance.

Yes/No

5a. If the answer to the previous question was no, please outline your plan to improve upload quality including timelines/dates.

6. I certify that our program is actively working to improve data quality for all “zero tolerance” data elements identified by the VA. These data elements are expected to have 100% data quality. Note: Zero tolerance data elements are: Veteran SSN, Head of Household (note only 1 per household), VAMC Station Code, Client CoC Code, AMI, and Residential Move-In Date.

Yes/No

7. I certify that our program is actively working to improve data quality for all non-zero tolerance data elements with a score below 95%.

Yes/No

8. I certify that full SSN information is entered for all Veterans served in our SSVF program.

Yes/No

9. I certify that accurate CoC codes are entered for all clients served in our SSVF Program.

Note: CoC codes should be linked to the client/head of household

Yes/No

10. I certify that accurate 3 or 5-digit VA Medical Center (VAMC) codes are entered for all clients served in our SSVF Program. Please refer to station codes provided by the SSVF Program Office.

Yes/No

11. I certify that Residential Move-In Dates are entered as soon as Rapid Re-Housing clients move in to a permanent residence.

Yes/No

12. I certify that Housing Prevention Threshold Scores are entered for all prevention clients served in our SSVF Program.

Yes/No

13. I certify that accurate Destination information is entered at program entry and exit for all clients served in our SSVF Program. The use of "Other" as a destination option is used sparingly and only in instances where no other destination code is a viable option.

Yes/No

14. I certify that our program is addressing all erroneous records indicated in our monthly Data Quality/Data Summary Reports.

Yes/No

15. I certify that I have reviewed and resolved all enrollment duplication issues identified in the monthly Data Quality/Upload Summary report. Please refer to the section of the report listing records with duplicate enrollments in one or more SSVF program.

Yes/No

16. I certify that all duplicate enrollments have been reviewed and our program has made all efforts to ensure that individual TFA payments have not exceeded the limitations in the Final Rule/NOFA.

Yes/No

17. Were any incidents identified in which the Veteran and/or Landlord knowingly received duplicate TFA payments from multiple SSVF providers?

Yes/No/NA

17a. If the answer to the previous question was "yes", please provide an explanation of the situation.

SUPPORTIVE SERVICES

Type of Benefit/Service (See 38 CFR 62.33 for definitions of these services)*	Grantee/program provided benefit directly (Yes/No)	Grantee/program assisted participants in obtaining benefit through referrals to other organizations (Yes/No)
Health care services	Yes No	Yes No
Daily living services	Yes No	Yes No
Personal financial planning services	Yes No	Yes No
Transportation services	Yes No	Yes No
Income support services	Yes No	Yes No
Fiduciary and representative payee services	Yes No	Yes No
Legal services	Yes No	Yes No
Child care	Yes No	Yes No
Housing counseling, housing search	Yes No	Yes No
Other: __________________	Yes No	Yes No
Other: __________________	Yes No	Yes No
Other: __________________	Yes No	Yes No

TRAININGS AND WEBINARS

18. I certify that all new employees have completed the webinars listed in the New Staff Training Guide available on www.va.gov/homeless/ssvf/index.asp.

Yes/No

19. I certify that SSVF staff (new and existing) review all trainings/webinars provided by the SSVF Program Office.

Yes/No

HHS SUBACCOUNTS AND DRAWDOWNS

20. Required

I certify that payment requests from HHS Payment Management System reflect actual spending.

Yes/No

21. I certify that all expenditures are for costs approved on the SSVF Budget.

Yes/No

22. I certify that I have received approval from the SSVF Program Office for any modifications made to my approved SSVF budget.

Yes/No

23. I certify that all spending is in compliance with all OMB regulations.

Yes/No

Additional feedback for SSVF Compliance Office:

CERTIFICATION AND SUBMISSION

I certify that I am authorized to submit this response on behalf of this SSVF program. Please note: Documentation supporting all certifications must be maintained by the grantee and made available for monitoring visits and audits.

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10-10072b

VA Form

July 2011