Homeless Providers Grant and Per Diem Program

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
Second Submission – Instructions
VA Form
JAN 2006

10-0361-PDO

SECOND SUBMISSION 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
20 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.
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 decisions-that
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.
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.
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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 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.
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
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assistance was provided or denied. 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. 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
your Conditional Selection letter. Applications received after the date and time in your Conditional
Selection letter will not be accepted even if postmarked by the deadline date. To be considered complete
all items requested in the grant application must be submitted 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. Applicants should pay close attention to the specific instructions in each section.
The majority of the Second Submission 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.
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Definitions and References: Definitions and references can be found in the Rules and Regulations, 38
CFR part 61.0. 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:
1. Number every page of the application sequentially using the applicant page number
box;
2. Enter the appropriate page number of each form on the checklist;
3. If a form is not applicable, enter “NA” in the page column of the checklist;
4. Submit the original plus three (3) copies (on white paper);
5. Use binder clips or rubber bands to separate each of the application copies;
6. Do not punch holes in the application or submit the application in a loose-leaf binder;
7. The same authorized representative of the organization who signed the Standard Form 424 in the
First Submission must sign the General Assurances in the Second Submission.
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: VA Homeless Providers Grant and Per Diem Program
Department of Veterans Affairs
10770 North 46th Street, Suite C-200
Tampa, FL 33617
Telephone (toll free):
FAX (toll free):

VA FORM
JAN 2006

1-877-332-0334
1-877-332-0335

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