Information Collection

Supportive Services for Veteran Families Program

IC 194740 under ICR 202107-2900-001 · OMB 2900-0757.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0757 can be found here:

2025-01-22 - Revision of a currently approved collection

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_NOFO Budget Template_2021.xlsx	Other-worksheet
SSVF_NOFO Budget Template_2021.xlsx	Other-worksheet
SSVF_FY21 Financial Report Template_2021.xlsm	Other-Worksheet
SSVF_FY21 Financial Report Template_2021.xlsm	Other-Worksheet
SSVF_Grantee Certification Template_2021.docx	Other-Worksheet
SSVF_Grantee Certification Template_2021.docx	Other-Worksheet
VA Form 10-10072 Supportive Services for Veterans Families Program Applic SSVF Application_VA Form 10-10072_updated Nov 2021.docx	Form and Instruction
VA Form 10-10072 Supportive Services for Veterans Families Program Applic SSVF Application_VA Form 10-10072_updated Nov 2021.docx	Form and Instruction
VA Form 10-10072a SSVF Program Participant Satisfaction Survey SSVF Program_Participant Satisfaction Survey_10-10072a_updated Nov 2021.docx	Form
VA Form 10-10072a SSVF Program Participant Satisfaction Survey SSVF Program_Participant Satisfaction Survey_10-10072a_updated Nov 2021.docx	Form
VA Form 10-10072b SSVF Quarterly Grantee Performance Report SSVF_Quarterly Grantee Performance Report_10-10072b_updated Nov 2021.docx	Form and Instruction
VA Form 10-10072b SSVF Quarterly Grantee Performance Report SSVF_Quarterly Grantee Performance Report_10-10072b_updated Nov 2021.docx	Form and Instruction
VA Form 10-10072c Renewal Application for Supportive Services Grant SSVF_Renewal Application for Grant_10-10072c_updated Nov 2021.docx vaww.va.gov/vaforms/medical/pdf/vha-10-10072C-fill.pdf	Form and Instruction
VA Form 10-10072c Renewal Application for Supportive Services Grant SSVF_Renewal Application for Grant_10-10072c_updated Nov 2021.docx vaww.va.gov/vaforms/medical/pdf/vha-10-10072C-fill.pdf	Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

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 Program Application	SSVF Application_VA Form 10-10072_updated Nov 2021.docx		Yes	No	Fillable Printable
Other-worksheet			SSVF_NOFO Budget Template_2021.xlsx		Yes	No	Fillable Fileable
Form	VA Form 10-10072a	SSVF Program Participant Satisfaction Survey	SSVF Program_Participant Satisfaction Survey_10-10072a_updated Nov 2021.docx		Yes	No	Fillable Printable
Form and Instruction	VA Form 10-10072b	SSVF Quarterly Grantee Performance Report	SSVF_Quarterly Grantee Performance Report_10-10072b_updated Nov 2021.docx		Yes	No	Fillable Printable
Other-Worksheet			SSVF_FY21 Financial Report Template_2021.xlsm		Yes	No	Fillable Printable
Form and Instruction	VA Form 10-10072c	Renewal Application for Supportive Services Grant	SSVF_Renewal Application for Grant_10-10072c_updated Nov 2021.docx	http://vaww.va.gov/vaforms/medical/pdf/vha-10-10072C-fill.pdf	Yes	No	Fillable Printable
Other-Worksheet			SSVF_Grantee Certification Template_2021.docx		Yes	No	Fillable Printable

Federal Enterprise Architecture Business Reference Module

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	Change Due to Potential Violation of the PRA
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.