10-10072
Supportive Services for Veteran Families (SSVF) Program—Application for Supportive Services Grant
VA Form 10-10072 is the U.S. Department of Veterans Affairs Supportive Services for Veteran Families (SSVF) Program Application for Supportive Services Grant. The form says it is to be completed by eligible applicants for supportive services grants under VA's SSVF Program, and that VA will use the information to evaluate and select grant recipients. It is an organization's grant application, not a form Veterans use to ask for services.
The form is ten pages: background and submission rules, an application checklist, an Executive Summary with threshold questions, summary grant information, the narrative questions for Sections A to E, the Section F certifications and signature, and instructions for the Exhibit III budget template. The form points to the regulations in 38 CFR Part 62 and the Notice of Fund Availability (NOFA) for definitions and submission details.
You can fill out the PDF free in your browser on this page and download the result without an account.
The applicant's legal name, other business names, EIN, DUNS number, business and mailing addresses and contact person, the grant funds requested, the number of participant households to be served, and the geographic region, Continuums of Care and VISN served.
Checkboxes under 38 CFR 62.21 for eligible entity, eligible activities, eligible participants, compliance with the Final Rule, outstanding obligations and default, then yes or no questions covering the past 10 years.
Which public benefits the applicant will provide directly or through referrals, from health care and daily living services to legal services and housing counseling, and which other supportive services, such as rental assistance and moving costs, will be offered.
Background and past performance (up to 35 points), program concept (25), quality assurance and evaluation (15), financial capability (15) and community linkages (10). The form says the narrative cannot exceed 8 pages.
Compliance, accuracy, non-delinquency, debarment, reports and record retention, fiscal control, civil rights and lobbying, followed by the signature.
Key personnel resumes and hiring criteria, the eligibility and screening tool, the program budget in the Excel template, optional letters of support and agreements, and articles of incorporation or similar documents.
The form says definitions and program information are in 38 CFR Part 62 and the NOFA, and that the NOFA sets the number of copies and the format.
Fill in the administrative information, grant request, region served, threshold checkboxes and summary grant information.
The form says responses are typed in 12 point Times New Roman with 1 inch margins and begin with the question number and heading.
Attach Exhibits I to V. For the budget, the template instructions say the applicant fills in yellow cells only.
An authorized representative signs the Section F certification and adds name, title and date.
The form says all items arrive as a single application package, at the address and by the time and date specified in the NOFA.
You get the real form, filled in a browser tab, with nothing standing between you and the finished PDF.
The form does not print a submission address. It says the application is submitted in accordance with the NOFA, and that applications received after the NOFA's time and date will not be accepted even if postmarked by the deadline date.
The form says only timely and complete applications will be considered, and materials arriving separately will not be considered.
The form lists the SSVF Program Office at [email protected] or 1-877-737-0111, a toll-free number, and the SSVF page at http://www.va.gov/homeless/SSVF.asp for application workshops.
The form says application material will be made available for public inspection for a five-year period beginning not less than 30 days after the grant award, under the Freedom of Information Act.
The footer reads VA FORM AUG 2013 10-10072. It carries OMB Number 2900-0757, with an estimated burden of 35 hours per response.
10-10072C
53 fields, 14 pages
10-10072B
54 fields, 3 pages
10-10072A
191 fields, 3 pages
The form describes who completes it and who reviews it.
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The form says the applicant must be either a private nonprofit organization or a consumer cooperative to be eligible for a grant under the SSVF Program.
No. The form says it is completed by applicants for supportive services grants. It describes Veteran families as the participants an applicant's program would serve.
The form says VA will award up to 35 points for Section A, 25 for Section B, 15 for Section C, 15 for Section D and 10 for Section E.
The form says the total narrative for Sections A to F cannot exceed 8 pages, typed in 12 point Times New Roman with 1 inch margins.
In the Microsoft Excel template. The instructions say supportive services must total a minimum of 90% of the grant amount and administrative expenses cannot exceed 10%.
The form says the NOFA specifies the address, the number of copies, the format and the deadline time and date.