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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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 10-10072c	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 %

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.