Information Collection

Supportive Services for Veteran Families Program

IC 194740 under ICR 202410-2900-003 · OMB 2900-0757.

Documents and Forms

Document Name Document Type
Form VA Form 10-10072 Supportive Services for Veteran Families Program Form and Instruction
VA Form 10-10072 Supportive Services for Veterans Families Program Applic SSVF Application_VA Form 10-10072_Oct 2024.docx Form and Instruction
VA Form 10-10072a SSVF Program Participant Satisfaction Survey SSVF Program_Participant Satisfaction Survey_10-10072a_updated Oct 2024.docx Form
VA Form 10-10072b SSVF Quarterly Grantee Performance Report SSVF_Quarterly Grantee Performance Report_10-10072b_Oct 2024.docx Form and Instruction
VA Form 10-10072c Renewal Application for Supportive Services Grant SSVF_Renewal Application for Grant_10-10072c_Oct2024.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:

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_Oct 2024.docx		Yes	No	Fillable Printable
Form	VA Form 10-10072a	SSVF Program Participant Satisfaction Survey	SSVF Program_Participant Satisfaction Survey_10-10072a_updated Oct 2024.docx		Yes	No	Fillable Printable
Form and Instruction	VA Form 10-10072b	SSVF Quarterly Grantee Performance Report	SSVF_Quarterly Grantee Performance Report_10-10072b_Oct 2024.docx		Yes	No	Fillable Printable
Form and Instruction	VA Form 10-10072c	Renewal Application for Supportive Services Grant	SSVF_Renewal Application for Grant_10-10072c_Oct2024.docx	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 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	13,230	-11,250	24,480
Annual IC Time Burden (Hours)	22,693	-2,812	25,505
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.