United States Department of Veterans Affairs

Grant and Per Diem Program

Procedure for Annual

Per Diem Rate Reporting

[Table of Contents]{.underline}

[Part I: General Instructions (Read First)]{.underline}

[Part II: Complete OMB Standard Form 269 -- Financial Status Report
(Long Form)]{.underline}

[Part III -- Transmit Form]{.underline}

[Part I: General Instructions]{.underline}

1\. Organizations are required to submit OMB Standard Form 269 --
Financial Status Report (long Form) within 90 days from the end of their
financial reporting fiscal year. Extensions can be requested via written
notification to the address specified in Step 2.

2\. If deemed necessary, the VA GPD Office may require any organization
that is receiving funding under this program to submit the SF 269 on a
more frequent basis. However, not more than quarterly.

2\. Reports must be based on the accrual basis of accounting and
generally accepted accounting principles (GAAP).

> 3\.

5\. For links to applicable Federal Regulations and OMB Circulars, refer
to the VA GPD website <http://www1.va.gov/homeless/page.cfm?pg=3> .

To obtain the necessary forms, refer to the VA GPD Provider's website
<http://www1.va.gov/homeless/page.cfm?pg=35> .

6\. Direct any questions via e-mail to <robert.gegan@va.gov>. If you
would like to discuss via telephone, request a day and time via the same
e-mail address or by calling the VA GPD Program Office at
1-877-332-0334.

7\. Based on questions received a Frequently Asked questions web page
will be posted on the VA GPD Provider's website listed above.

***[Non-Compliance]{.underline}***

***Organizations that fail to submit the SF 269 by the required due date
will not be eligible for any per diem rate increases. Additionally, per
diem payments may be withheld or suspended, which could lead to
termination of the grant.***

[Part II: Complete OMB Standard Form 269 -- Financial Status Report
(Long Form)]{.underline}

Page 2 of the SF 269 includes instructions for completing the form.
Additional guidance is provided below for some of the items.

-   [Item 1]{.underline} --Enter the VA Project No. (e.g. 99-045-FL)

-   [Item 5]{.underline} -- Enter the account code/number or other
    identifier used in the Provider\'s accounting system to segregate VA
    GPD Project costs. This should be the same as what was entered on
    the Per Diem Rate Request Form. Under Item 2.

-   [Item 6]{.underline} -- Check the Yes box.

-   [Item 7]{.underline} -- Check the Accrual box.

-   [Items 8]{.underline} -- Enter the financial reporting fiscal year.

-   [Item 10]{.underline} -- Do not use columns I or II; only enter data
    in column III Cumulative.

    a.  Enter the total direct costs of veteran care plus allocable
        indirect costs.

    b.  Enter any applicable credits incurred during the fiscal year.

    c.  Enter all program income earned; typically rent and program fees
        charged to veterans. Exclude any program income used to meet any
        Federal match requirements; enter that amount in Item 10g. The
        sum of Items 10c and 10g must equal total program income earned.

> Items 10e thru 10i must represent the total other sources of income
> that funded the costs specified in Item 10d. [**DO NOT** enter any VA
> GPD Per Diem funding]{.underline}.

f.  Enter portion of \$ amount from Item 10d that was charged to another
    Federal award.

g.  Enter any program income used to fund the match requirements, if
    any, of the Federal awards included in Item 10f.

h.  Enter all remaining other sources of income.

    j.  This \$ amount VA GPD Costs reported on the SF 269 must be based
        on the ***[allowable]{.underline}*** direct costs of veteran
        care plus allocable indirect costs less any applicable credits,
        charged to the VA GPD award, as specified in the 38 CFR Part 61
        and one of the following OMB Circulars:

> A-87 -- Applicable to State, Local and Indian Tribal governments.
>
> A-122 -- Applicable to non-profit organizations.
>
> Items 10k thru 10m, 10r, and 10s must equal zero.

n.  This must equal 10j.

o.  This should represent the amount billed to the VA for bed days
    provided during the fiscal year, under the specified VA Project No.

p.  If this amount is less than zero, the value in 10i is understated.
    If it is greater than zero, the value in 10p represents the amount
    that was overbilled.

    -   [Item 11]{.underline} -- Indirect expenses must be based on a
        current Indirect Rate Agreement. If an organization does not
        have one, indirect charges to the VA GPD project are
        unallowable.

        b.  Rate: Enter the rate per the negotiated Indirect Rate
            Agreement.

        c.  Base: Enter the portion of the \$ amount from 10a, that is
            included in the indirect allocation base.

        d.  Total Amount: This must equal the product of Item 11b times
            Item 11c; i.e. the rate times the base.

        e.  This must equal the product of Item 11b times the portion of
            the \$ amount in Item 11c charged to the VA GPD project.

    -   [Item 12]{.underline} -- Enter the number of bed days provided
        during the fiscal year and the effective date of the Indirect
        Rate Agreement that supports Item 11. Any other information the
        agency deems necessary may also be entered in this section.

[Part III: Transmit Forms]{.underline}

The SF 269 must be signed by the Executive Director or the Chief
Financial Officer, and then mailed to the following address:

> VA GPD Field Office
>
> 10770 N. 46^th^ Street, Suite C-200
>
> Tampa, FL 33617
>
> ATTN: Bob Gegan

***The VA GPD Office must receive the original SF 269.***