10-0361-PDO Homeless Providers Grant and PerDiem Program Per Diem On

Department of Veterans Affairs

OMB Number 2900-0554
Estimated Burden: 20 hours

The Paperwork Reduction Act of 1995 requires us to notify you that this information collection is in
accordance with the clearance requirements of section 3507 of the Paperwork Reduction Act of 1995.
The public reporting burden for this collection of information is estimated to average 20 hours per
response, including the time for reviewing instructions, searching existing data sources, gathering and
maintaining the data needed, and completing and reviewing the collection of information. Respondents
should be aware that notwithstanding any other provision of law, no person will be subject to any penalty
for failing to comply with a collection of information if it does not display a currently valid OMB control
number. This collection of information is intended to assist VA Mental Health Strategic Health Care Group
officials determine eligibility to receive grant and/or per diem payments and to rate and rank these
applications. Response to this survey is voluntary and failure to participate will have no adverse effect on
benefits to which you might otherwise be entitled.

Homeless Provider Grant
and Per Diem Program
Per Diem Only
Application
Section A - Instructions
VA Form
JAN 2006

10-0361 PDO

Department of Veterans Affairs Homeless Providers Grant & Per Diem Program

SECTION A – GENERAL INFORMATION AND INSTRUCTIONS
Paperwork Reduction Act (PRA) Notice: This application has been approved by OMB (Office of
Management and Budget) under PRA, 44 USC 3507, and assigned an OMB approval number. The
requested information is needed and will be used by VA to determine eligibility for and award of
grants/per diem under the VA Homeless Providers Grant/Per Diem Program (PL 107-95). Submission
of the requested information is required to obtain a benefit.
Respondent burden: Public reporting burden for this collection of information is estimated to
average 35 hours per response, including the time for reviewing instructions, searching existing data
source, gathering and maintaining the data needed, and completing and reviewing the collection of
information. Send comments regarding this burden estimated or any other aspect of this collection of
information, including suggestions for reducing this burden, to the Department of Veterans Affairs.
Purpose and goals: The purpose of the VA Homeless Providers Grant and Per Diem Program is to
promote the development and provision of supportive housing and/or appropriated supportive services,
including innovative approaches to assist homeless Veterans in the transition from homelessness and
to enable them to live as independently as possible. The goal of this program is to help homeless
Veterans, primarily those living in places not ordinarily meant for human habitation or in emergency
shelters, to (1) achieve residential stability; (2) increase their levels and/or income; and (3) obtain
greater self-determination. These goals are reflected in the application package and selection criteria
for the program.
Residential stability refers to access to, and length of stay in, stable affordable housing. Achieving
residential stability involves not only the availability of affordable, permanent housing, but also the
success of the program in addressing the problems that led to the Veteran becoming homeless. Those
problems may involve mental illness, substance abuse, physical disabilities, unemployment, or other
factors.
Increased skill level and/or income refers to the resources needed to enable persons to live as selfsufficiently as possible. For many homeless persons this involves actions to bridge the gap between
current income and the cost of living. The gap could be closed through employment, a higher-paying
job, or access to entitlement benefits. The likelihood of obtaining a job, or a higher-paying job, could
be enhanced through job or skills training, or enrolling in General Equivalency Diploma (GED) or
higher education courses. For homeless persons with mental or physical disabilities that are so severe
as to rule out outside employment, the goal of increased skill level and/or income may involve actions
to increase self-sufficiency in other ways (e.g., life skills training, increased income through
employment within a project, or increased income through access to entitlement benefits).
Greater self-determination refers to increases in the influence that participants have on decisionsthat affect their lives. Those increases may result from such actions as involvement in the
development of his or her individual housing and supportive services plan (including developing
personal goals), participating in resident advisory council meetings or other involvement in the
development of program rules and procedures, involvement in program implementation through such
activities as employment and volunteer services, and choice in selecting service providers.
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Department of Veterans Affairs Homeless Providers Grant & Per Diem Program

Measurable objectives: To apply these goals to their proposed program, applicants must establish
and include in their applications measurable objectives for each of the three goals. Applicants must
also describe how their proposed programs will help them achieve these goals.
The measurable objectives established by each applicant are expected to vary based on the specific
needs and characteristics of the homeless Veterans proposed to be served as well as the specific
program chosen. Where the population proposed to be selected has multiple or particularly difficult
problems that need to be addressed, objectives should reflect realistic expectations.
The highest ratings under the quality of project plan criterion of the application will be awarded to
applications containing project plans that describe specific measurable objectives for each of the
common goals specified above, how the proposed housing and services will help residents reach these
goals, how the program's success will be evaluated, and how program modifications will be made, if
necessary, as a result of this evaluation.
VA will not consider the level of expectations described in the objective in rating applications. That
is, an application that contains realistic objectives that reflect the very dysfunctional nature of the
population to be served will be treated the same as an application that contains more optimistic
objectives that reflect a less dysfunctional population. VA specifically does not want the process of
establishing measurable objectives to lead applicants away from serving homeless persons with the
most serious problems. VA does want applicants for each program to adopt the three goals, carefully
consider how they can achieve them through their proposed projects, establish measurable objectives
to gauge whether they are achieving the goals and, if funded, periodically measure project results and,
as necessary make program adjustments.
Eligible activities: Funds may be used to provide operational costs as outlined in governing
regulations for programs that furnish supportive services and supportive housing for homeless
Veterans, including:
1. Transitional housing (up to 24 months) with supportive services designed to enable homeless
Veterans to become as independent as possible;
2. Supportive services in a service center facility for homeless Veterans not in conjunction with
supportive housing.
Life Safety Code Compliance: All entities receiving grants and or per diem under PL 107-95 must
meet the fire and safety requirements applicable under the Life Safety Code of the National Fire
Protection Association as well as any local or state codes as required.
Eligible applicants: Public or nonprofit private entities are eligible to apply for per diem payments,
including states, metropolitan cities, urban counties, or other governmental entities, Indian tribal
governments, and private nonprofit organizations.
Per diem award process: VA will notify applicants within grouped categories according to the
funding priorities set forth in the NOFA, if any. Applicants will then be ranked, within their respective
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funding category if applicable. The highest-ranked applications for which funding is available, within
highest priority funding category if applicable, will be selected to receive a special needs grant in
accordance with their ranked order. If funding priorities have been established and funds are still
available after selection of those applicants in the highest priority group VA will continue to
conditionally select applicants in lower priority categories in accordance with the selection method set
forth in the regulations subject to available funding.
VA expects to announce these selections within 120 days of the application submission deadline. Such
applicants will be subsequently notified of any additional project information necessary for grant
award and the date of the deadline for submission of such information. If an applicant is unable to
meet any conditions for grant award within the specified timeframe, VA reserves the right to not award
funds and to use the funds available for other components of the Grant and Per Diem Program.
Technical deficiencies: VA will notify an applicant in of any curable technical deficiencies in the
application and the date by which these deficiencies must be corrected. VA must receive corrections
in accordance with the information specified in the letter. If the applicant fails to submit the
corrections with in this period, VA will disqualify the application.
Curable technical deficiencies are items that are not necessary for VA review under the selection
criteria (e.g., failure to submit a required certification). Applicants may not submit items that would
improve the substantive quality of the application after the application deadline.
Documentation and public access requirements: VA will ensure that documentation and other
information regarding each application submitted are sufficient to indicate the basis upon which
assistance was provided or denied. This material, including any letters of support, will be made
available for public inspection for a five-year period beginning not less than 30 days after the award of
the assistance. Material will be made available in accordance with the Freedom of Information Act (5
U.S.C. 552) and VA’s implementing regulation at 38 CFR § 1.553.

GENERAL INSTRUCTIONS FOR APPLICATION COMPLETION
Components: Funds are available for assistance in the form of per diem to:
Provide operational costs as outlined in governing regulations for programs that furnish supportive
services and supportive housing for homeless Veterans.
A more detailed description of these components, including program requirements, is contained in the
rule published in the Federal Register, 38 CFR part 61.0. A copy of these regulations is provided in
the appendix of this application. Applicants must review the regulations before completing this
application.
Application deadline: Only complete and timely applications will be considered for funding. To be
considered timely, the application must be received at the address and by the time and date specified in
the Notice of Fund Availability (NOFA) published in the Federal Register. Applications received after
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the date and time published in the NOFA will not be accepted even if postmarked by the deadline date.
Following the application deadline, applicants will be notified that their application has been received.
To be considered complete all items requested in the grant application must arrive as a single
application package. Materials arriving separately will not be included in the application package for
consideration and may result in the application being rejected or not funded.
Organization of the Application: The application is composed of sequentially numbered single, print
on one-side pages. This allows for easy removal of each individual page for copying and insertion into
typewriters or printers. Not all pages are to be completed by all applicants. Applicants should pay
close attention to the specific instructions in each section.
The application is divided into the following sections: (A) General Instructions, (B) Per Diem Only
Submission, (C) Not Applicable for this award, (D) Forms, and (E) Appendices. The majority of the
application has been formatted in a manner allowing all information and responses to be placed
directly on the form. There will be a wide variety of response types.
Generally, a combination of “Fill in the Blank” and “Narrative or Essay” have been used. Many
questions have specific text box spaces for responses. Responses should be typed, by using a
typewriter, computer, or word processor in the appropriate space provided unless otherwise indicated.
Font size should be 10 point or larger. Do not use the backs of the pages. Applicants may
duplicate on white paper and distribute these materials as needed.
Specific instructions: Specific Instructions are located at the beginning of each area with most areas
being self-explanatory.
Responses to questions: Please do not read “into” the questions. Simply, answer the questions in a
direct manner. Be sure to answer all parts of the question. The questions are designed to provide an
accurate view of the proposal to a review panel. The space that is provided is sufficient to complete an
accurate response. If applicants find they are having trouble answering a question in the space
provided, they should look at the response and eliminate what may be unnecessary information.
Chances are that a following question will provide an opportunity to use the eliminated information.
Information other than requested: The application is designed to provide VA with sufficient
information to determine eligibility and to assign rating points for each section criterion. Applicants
must not include information other than that requested. Moreover, applicants are asked to be
concise in presenting requested information and must not exceed the designated spaces provided for
response or add additional pages unless the application specifically instructs the applicant to respond
on additional pages.
Definitions and References: Definitions and references can be found in the Rules and Regulations
provided in the appendices. Generally, subjects are self-explanatory or a reference is given as to where
to obtain a specific topic explanation.
Final application assembly: An assembly checklist has been provided. The application must be
assembled in the order shown on the assembly checklist. After the entire application is assembled:
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Department of Veterans Affairs Homeless Providers Grant & Per Diem Program

1. Attach the cover sheet;
2. Number every page of the application sequentially using the applicant page number
box;
3. Enter the appropriate page number of each form on the checklist;
4. If a form is not applicable, enter “NA” in the page column of the checklist;
5. Submit the original plus four (3) copies (on white paper);
6. Do not punch holes in the application;
7. Do not submit the application in a loose-leaf binder;
8. The same authorized representative of the organization who signed the assurances must sign
the Standard Form 424.
For further information: If you have any questions regarding the VA Homeless Providers Grant and
Per Diem Program, contact the Program Office at:
Mail Address:

Telephone (toll free):
FAX (toll free):

VA FORM
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VA Homeless Providers Grant and Per Diem Program
Department of Veterans Affairs
10770 North 46th Street, Suite C-100
Tampa, FL 33617
1-877-332-0334
1-877-332-0335

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Department of Veterans Affairs Homeless Providers Grant and Per Diem
Program
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