10-10072C
Supportive Services for Veteran Families (SSVF) Program—Renewal Application for Supportive Services Grant
VA Form 10-10072C is the U.S. Department of Veterans Affairs Supportive Services for Veteran Families (SSVF) Program Renewal Application for Supportive Services Grant. The form says it is to be completed by grantees applying for renewal of a supportive services grant, and that VA uses the information to evaluate and select recipients to renew their grants. It is a grantee organization form, not a Veterans benefit application.
The form is 14 pages: background and submission notes, a renewal application checklist, an Executive Summary, Section A on SSVF Program Outcomes, Section B on Cost-Effectiveness, Section C on Compliance with Program Goals and Requirements, and instructions for the budget template. It points to the regulations at 38 CFR Part 62 and the Notice of Fund Availability (NOFA) for definitions and program information.
You can fill out the PDF free in your browser on this page and download the result without an account.
Page 2 lists what an application includes: the Executive Summary, Sections A to C and the exhibits, among them a Certificate of Good Standing, an eligibility or screening tool, a monthly program budget in the Excel template and a budget narrative.
The organization's legal name, VA program number, EIN, DUNS number, addresses and contact person, questions on subcontractors and CARF or COA accreditation, the threshold requirements under 38 CFR 62.21, the grant amount requested, program changes, the budget, participants and the certification.
Narrative answers on housing stability, participant satisfaction, the program timeline, homelessness prevention and ending homelessness, including coordination with the Continuum(s) of Care. The form says VA awards up to 55 points for this section.
The average total grant cost per participant household for the previous grant award period, with an explanation, and whether the program was carried out consistent with last year's approved budget. Up to 30 points.
How the program was implemented in line with VA's goals for the SSVF Program, and certifications that it was administered under applicable laws, regulations, guidance and the grant agreement. Up to 15 points.
Page 14 explains the Microsoft Excel budget template. The applicant fills in yellow cells only. The form says supportive services costs total a minimum of 90% of the grant amount and administrative expenses cannot exceed 10%.
The form says definitions and program information are in 38 CFR Part 62 and the NOFA under which the application is submitted, both posted on the SSVF Program web page.
Type the administrative details and answer each threshold question. The form says the grant request cannot be greater than the current grant award amount, and points to the NOFA for the maximum allowable grant size.
Type each answer into the box after its question. The form asks applicants to limit responses to the space provided.
Fill in the Excel monthly budget template and attach a budget narrative describing each line item and its assumptions. The form says administrative costs are broken down into multiple line items by category.
An authorized representative of the applicant signs and dates item G, with the applicant's name and the signer's name and title.
The form says the NOFA sets the number of copies, the format, the address and the deadline, and that all items arrive together as a single application package.
You get the real form, filled in a browser tab, with nothing standing between you and the finished PDF.
The form says the application is submitted in accordance with the NOFA, which specifies the number of copies, the format, the address and the time and date. Applications received after that time and date will not be accepted even if postmarked by the deadline date.
The form says only timely and complete renewal applications are considered for funding. Materials arriving separately will not be considered and may result in the application being rejected or not funded.
The form says application documentation is made available for public inspection for a five-year period beginning not less than 30 days after the grant award, in accordance with the Freedom of Information Act.
The form lists the SSVF Program Office by e-mail at [email protected] or by phone at 1-877-737-0111, which it says is a toll-free number.
The PDF footer reads VA FORM AUG 2012 10-10072C, matching the August 2012 revision date on VA's page. It carries OMB Number 2900-0757 and an estimated burden of 10 hours.
10-10072
125 fields, 10 pages
10-10072A
191 fields, 3 pages
10-10072B
54 fields, 3 pages
The form describes who completes it, who signs it and who reviews it.
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The form says it is to be completed by grantees applying for renewal of a supportive services grant under the SSVF Program. It is an organization's grant application, not a form Veterans file for benefits.
The form says that to be eligible for a renewal grant under the SSVF Program, the applicant must have received a supportive services grant award in the previous fiscal year.
The form says VA awards up to 55 points for Section A, SSVF Program Outcomes, up to 30 points for Section B, Cost-Effectiveness, and up to 15 points for Section C, Compliance with Program Goals and Requirements.
The form does not print one. It says the NOFA specifies the address, time and date, and that applications received after that time and date will not be accepted even if postmarked by the deadline date.
The form says the request cannot be greater than the current grant award amount in order to submit a renewal application, and points to the NOFA for the maximum allowable grant size.
The form lists the SSVF Program Office by e-mail at [email protected] or by phone at 1-877-737-0111.
