VA Form 10-10072A: SSVF Participant Satisfaction Survey

VA Form 10-10072A: SSVF Participant Satisfaction Survey – The VA Form 10-10072A, officially titled Supportive Services for Veteran Families (SSVF) Program—Participant Satisfaction Survey, is a key tool used by the U.S. Department of Veterans Affairs to gather feedback from veterans and their families who receive supportive services. This voluntary survey helps the VA evaluate program effectiveness, identify areas for improvement, and ensure high-quality support for those experiencing or at risk of homelessness.

Whether you are a veteran who has participated in the SSVF program, a family member, a case manager, or a service provider, understanding this form is important. Below is a clear, up-to-date guide based on official VA sources.

What Is VA Form 10-10072A?

VA Form 10-10072A is a short participant satisfaction survey (OMB Control Number 2900-0757) with an estimated completion time of 15 minutes. The current version is dated April 2011 and remains in active use. It is designed specifically for individuals who have received services through the Supportive Services for Veteran Families (SSVF) program.

The form collects confidential feedback on service quality, specific types of assistance received, housing stability, and overall experience. Responses help the VA and grantee organizations improve support for other veteran families.

Purpose of the SSVF Participant Satisfaction Survey

The primary goal of VA Form 10-10072A is to measure participant satisfaction and program outcomes. Your feedback helps the VA:

  • Assess the quality of services provided by SSVF grantees
  • Identify strengths and areas needing improvement
  • Support data-driven decisions for the national SSVF program
  • Ensure services remain veteran-centered and effective at promoting housing stability

Federal regulations require SSVF grantees to offer this satisfaction survey to participants, typically near the time of program exit.

Who Should Complete VA Form 10-10072A?

This form is intended for veterans and their families (including spouses, children, and other dependents) who have received supportive services through an SSVF grantee organization.

It is most commonly completed:

  • Near the end of SSVF participation (within approximately 30 days of pending exit)
  • By the participant directly (responses are confidential and can often be submitted directly to VA)

Participation is completely voluntary. Choosing not to complete the survey will have no negative impact on any VA benefits or future services you may be entitled to receive.

Key Sections and Questions on the Survey

While the exact layout is best viewed by downloading the official form, VA Form 10-10072A generally includes:

  • Provider/organization name field
  • Basic household information and VA healthcare enrollment status
  • Overall quality rating of services received (Poor / Average / Good / Excellent)
  • Likelihood to recommend the provider to another veteran or friend
  • Likelihood to return to the same provider if help is needed again
  • Questions about involvement in creating an individualized housing stabilization plan
  • A detailed table covering specific services received and their quality, such as:
    • Case management
    • Assistance obtaining VA benefits
    • Help with other public benefits (health care, daily living skills, financial planning, transportation, income support)
    • Other supportive services (rental assistance, utility payments, security deposits, moving costs, emergency supplies)
  • Open-ended space for additional feedback
  • Conditional questions about housing history and employment changes (for new vs. exiting participants)

The form uses simple checkboxes and rating scales for ease of completion.

When and How Is the Survey Administered?

According to 38 CFR § 62.36, SSVF grantees must provide each participant with a satisfaction survey within 30 days of the participant’s pending exit from the program. The participant may submit the survey directly to the VA.

In practice, the survey may be offered:

  • On paper (using the fillable PDF)
  • Electronically
  • Over the phone (sometimes administered by a VA contractor)

Recent program updates have removed the requirement for a pre-service survey while continuing the exit satisfaction survey.

How to Download VA Form 10-10072A?

You can download the official fillable PDF version directly from the VA:

Download VA Form 10-10072A (PDF) – Official Fillable Version

You can also access the form through the official VA forms page:
VA Form 10-10072A – Official Page

The form is fillable, so you can complete it digitally or print and fill it by hand.

Where to Submit the Completed Survey

Completed surveys are typically returned to your SSVF service provider, who forwards them to the VA. In some cases, you may be given instructions to submit directly to the VA (electronically or by mail). Contact your provider or the SSVF Program Office for specific submission instructions.

SSVF Program Office Contact:
Phone: 1-877-737-0111
Email: [email protected]

How Your Feedback Improves the SSVF Program?

The SSVF program has helped hundreds of thousands of veteran families achieve housing stability since 2012. Participant satisfaction data plays a direct role in:

  • Evaluating grantee performance
  • Identifying successful service models
  • Making national program improvements
  • Ensuring resources are used effectively

Your honest input helps other veterans and families receive even better support in the future.

Your Rights and Privacy

  • Voluntary — You are not required to participate.
  • Confidential — Survey responses do not include names and are used only for program evaluation.
  • No penalty — Declining to complete the survey will not affect your benefits or eligibility for future VA services.
  • The form includes standard Paperwork Reduction Act and privacy notices.

Related Resources for Veteran Families

Here are trusted, current resources to help you or a veteran family member:

Frequently Asked Questions

Is VA Form 10-10072A still current?
Yes. Although revised in April 2011, it remains the official Participant Satisfaction Survey used by the SSVF program as of 2025–2026.

Do I have to complete it?
No. It is voluntary and will not affect your benefits.

Can I get help filling it out?
Yes. Your SSVF case manager or provider can assist. The form is designed to be straightforward.

What if I have concerns about the services I received?
The survey includes space for open feedback. You can also contact the SSVF Program Office or the National Call Center for Homeless Veterans.

Where can I find an SSVF provider near me?
Start by calling the National Call Center at 877-424-3838. They can connect you to local resources and SSVF grantees.

Need Help Right Now?

If you or a veteran family member is facing housing instability, call the National Call Center for Homeless Veterans at 877-424-3838 (24/7, free, confidential). Trained counselors are ready to help connect you to the right support.

This guide is for informational purposes and is based on official VA sources. For personalized assistance with VA Form 10-10072A or SSVF services, contact your local provider or the VA directly.

Official Download Link:
Download VA Form 10-10072A (PDF)

For the most current information, always refer to va.gov/forms/10-10072a/ and your SSVF service provider.