Header
Grantee name, SSVF grant amount, date of report, and the SSVF program number on each page.
10-10072B
Supportive Services for Veteran Families (SSVF) Program—Quarterly Grantee Performance Report
- Agency
- VA
- Revision
- July 2011
- Fillable fields
- 54
- Pages
- 3
- Official source
- VA form page
- Checked
- October 20, 2026
VA Form 10-10072B: SSVF Program Quarterly Grantee Performance Report
VA Form 10-10072B is the U.S. Department of Veterans Affairs Supportive Services for Veteran Families (SSVF) Program Quarterly Grantee Performance Report. It is completed by organizations that hold an SSVF grant, not by Veterans. The instructions say to complete the form and email it, along with the Quarterly Financial Report (Attachment 1), to the VA SSVF Program Office at [email protected].
The form is three pages and asks 13 questions about the quarter, grouped as General, Outreach and Screening, Supportive Services, Participants, Program Goals and Outcomes, and SSVF Grant Agreement Compliance. Each page has a line for the SSVF program number. The Quarterly Financial Report it mentions is not part of this PDF.
You can fill out the PDF free in your browser on this page and download the result without an account.
What's on VA Form 10-10072B
Questions 1 and 2: General
Significant positive and negative events during the quarter and their impact on performance, and any assistance needed from the SSVF Program Office.
Questions 3 to 6: Outreach and screening
Where outreach took place, a copy of the screening form if it changed, referral sources above an estimated 5% of referrals, and how many ineligible individuals were screened and where they were referred.
Questions 7 to 9: Supportive services
A table of services provided directly or by referral, the three services participants requested most, and other supportive services such as rental assistance, utility-fee payment, deposits, moving costs and emergency supplies.
Questions 10 to 12: Participants and outcomes
Participant safety issues such as domestic violence or suicide risk, a notable participant case, and confirmation that data for 100% of participants was exported from HMIS to the SSVF Data Repository not less than monthly.
Question 13: Grant agreement compliance
Whether the grantee complied with all terms of its supportive services grant agreement during the quarter, with an explanation if not.
How VA Form 10-10072B is completed
- 1
Fill in the header
Enter the grantee name, grant amount and report date, and the SSVF program number on each page.
- 2
Answer questions 1 to 13
Describe the quarter's events, outreach, screening, services, participant issues, outcomes and compliance.
- 3
Mark confidential details
The instructions say to clearly mark any information that is confidential to individual participants.
- 4
Add the attachments
Attach the participant screening form if it changed since the previous quarter, and the Quarterly Financial Report (Attachment 1).
- 5
Email it
Send the completed form to the VA SSVF Program Office at [email protected].
Why fill Form 10-10072B on indox
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Where to send it
By email
The instructions say to email the form, along with the Quarterly Financial Report (Attachment 1), to the VA SSVF Program Office at [email protected].
Not in this PDF
The Quarterly Financial Report (Attachment 1) is named in the instructions but is not part of this three-page PDF.
Edition
The footer reads VA FORM JUL 2011 10-10072B. It carries OMB Number 2900-0757, with an estimated burden of 2 hours 25 minutes.
Related forms
10-10072
Supportive Services for Veteran Families (SSVF) Program—Application for Supportive Services Grant
125 fields, 10 pages
10-10072C
Supportive Services for Veteran Families (SSVF) Program—Renewal Application for Supportive Services Grant
53 fields, 14 pages
10-10072A
Supportive Services for Veteran Families (SSVF) Program—Participant Satisfaction Survey
191 fields, 3 pages
Who uses VA Form 10-10072B?
The instructions and questions describe who fills it in and who receives it.
Official sources and the blank
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Questions about Form 10-10072B
Who files VA Form 10-10072B?
SSVF grantees. The form asks for the grantee name and SSVF grant amount and reports on the grantee's program during the quarter.
Where is the report sent?
The instructions say to email it, along with the Quarterly Financial Report (Attachment 1), to the VA SSVF Program Office at [email protected].
Does the report include participant information?
It can, for example in the notable participant case in question 11. The instructions say to clearly mark any information that is confidential to individual participants.
What does question 12 ask about data?
It asks the grantee to confirm that data for 100% of participants has been exported from HMIS and uploaded to the SSVF Data Repository not less than on a monthly basis, or to explain why not.
How long does the report take?
The form estimates a burden of 2 hours 25 minutes.