Homeless Providers Grant and Per Diem Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 10-0361-PDO Homeless Provider Grant and Per Diem Program - Per Diem Only Application	Form	Modified	Available
Form 10-0361-SN Homeless Providers Grant and Per Diem Program Special Needs Application	Form and Instruction	Modified	Available
Form 10-0361-CG Homeless Providers Grant and Per Diem Program Captial Grant Application	Form and Instruction	Modified	Available
Form 10-0361-TA Homeless Providers Grant and Per Diem Program Technical Assistance Application	Form and Instruction	Modified	Available
2900-0554-Justification Statement Revised for AP54(P) (6-16-17).docx	Supporting Statement A	Uploaded 2017-06-28	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
28735	Homeless Providers Grant and Per Diem Program	Form	Modified	Homeless Provider Grant and Per Diem Program - Per Diem Only Application
28735	Homeless Providers Grant and Per Diem Program	Form and Instruction	Modified	Homeless Providers Grant and Per Diem Program Special Needs Application
28735	Homeless Providers Grant and Per Diem Program	Form and Instruction	Modified	Homeless Providers Grant and Per Diem Program Captial Grant Application
28735	Homeless Providers Grant and Per Diem Program	Form and Instruction	Modified	Homeless Providers Grant and Per Diem Program Technical Assistance Application
28735	Homeless Providers Grant and Per Diem Program	Instruction	Modified

ICR Details

OMB Control No: 2900-0554	ICR Reference No: 201706-2900-011
Status: Historical Active	Previous ICR Reference No: 201609-2900-002
Agency/Subagency: VA	Agency Tracking No: 2900-0554
Title: Homeless Providers Grant and Per Diem Program
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/19/2017
Retrieve Notice of Action (NOA)	Date Received in OIRA: 06/28/2017
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2020	36 Months From Approved	06/30/2020
Responses	1,450	0	650
Time Burden (Hours)	19,090	0	12,340
Cost Burden (Dollars)	0	0	0

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Abstract: To determine which applicants are eligible to receive grants and per diem programs that provide supportive housing/services to assist homeless veterans transition to independent living, to prioritize applicants and assure compliance with VA rules.

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Authorizing Statute(s): PL: Pub.L. 107 - 95 2001 through 2066 Name of Law: Homeless Veterans Comprehensive Assistance Act of 2001
   PL: Pub.L. 109 - 461 502 through 503 Name of Law: Goals for Participation by small business owned and Controlled by Veterans in Procurement Contracts
   PL: Pub.L. 106 - 107 1 through 9 Name of Law: Federal Financial Assistance Management Improvement Act of 1999
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 69903	10/07/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 89574	12/12/2016
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
Homeless Providers Grant and Per Diem Program	10-0361-SN, 10-0361-CG, 10-0361-TA, 10-0361-PDO	Homeless Providers Grant and Per Diem Program Technical Assistance Application ,   Homeless Providers Grant and Per Diem Program Captial Grant Application ,   Homeless Providers Grant and Per Diem Program Special Needs Application ,   Homeless Provider Grant and Per Diem Program - Per Diem Only Application

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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	1,450	650	0	800	0	0
Annual Time Burden (Hours)	19,090	12,340	0	6,750	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Changing Regulations

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

Burden Reduction Due to:

Short Statement: The is not a change in burden hours despite the deletion of the VA Form 10-0361-Series, as the collection of information has not changed only the instrument of collection was changed and we anticipate burden to remain the same. Use of a standard business format has allowed VA to modify the specific collection of information questions to reflect the requirements of current regulatory/statutory changes to those requirements as they relate to each specific grant or per diem application without having to have the cost of modifying a new form each time a change is made. In addition, the standard business format allows applicants to use existing business resources to complete the collection.

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Annual Cost to Federal Government: $265,046

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

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

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: 06/28/2017

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