Miscellaneous Forms

• VA Benefits in Brief
  This form summarizes benefits that the Veteran's Administration offers. (21-0760)
• R&D Program - Investigator's Biographical Sketch
  Submit this biographical form if you are a scientific investigator in a proposed Veteran's Administration research grant program. (10-1313-5)
• Financial Status Report (blank copy)
  If you owe a debt to the Veteran's Administration you may be allowed to create a payment plan to pay it off. Submit this form if you are requesting either a waiver of the debt or a payment plan. (5655)
• Shop Data Sheet (Artificial Limbs)
  Submit this form if you are a business owner who wants to enter into a contract with the Veteran's Administration to provide services to VA patients with artificial limbs. (VA2793)
• Statement of Assurance of Compliance with Equal Opportunity Laws
  For an organization to receive federal funding the organization must submit this form which assures the Veteran's Administration that they will follow equal opportunity employment laws. (20-8206)
• R&D Program - Investigator's Biography
  Submit this biographical form if you are a scientific investigator in a Veteran's Administration research grant program. (10-1313-6)
• Application for Furnishing Nursing Home Care to Beneficiaries of VA
  Use this form to apply to the Veteran's Administration to become eligible to provide Nursing Home care to VA patients. (10-1170)
• Application for Residents
  Submit this form to apply for a medical residency with a Veteran's Administration Hospital. (10-2850b)
• Application of Service Representative for Placement on Mailing List
  This form is to be used by recognized Veteran's Service Organizations to be placed on the mailing list of Veteran's Administration publications. (VA3215)
• State Home Construction Grant Program Space Program Analysis-Nursing Home & Domiciliary
  State run Veteran's retirement homes may use this form to apply for a grant from the Veteran's Administration. (10-0388-3)