VAFORMS.NET – VA Form 10-10SH – State Home Program Application for Veteran Care Medical Certification – VA Form 10-10SH is a State Home Program application. It must be completed in order to receive benefits from the VA. The form asks for information about the veteran’s home, income, and medical history. Then, it asks for contact information, such as a home or mobile phone number. If available, the veteran must also provide their email address.
Download VA Form 10-10SH – State Home Program Application for Veteran Care Medical Certification
| Form Number | VA Form 10-10SH |
| Form Title | State Home Program Application for Veteran Care Medical Certification |
| Edition Date | June 2022 |
| File Size | 1 MB |
What is a VA Form 10-10SH?
The VA Form 10-10SH is required by the VA when a veteran receives a per diem payment. The form includes sections for general information, service, dependents, income, and more. In addition, the form asks for signatures from a doctor, an RN, and a physical therapist.
The purpose of the form is to provide VA with sufficient medical information about the veteran’s medical condition. A failure to complete or submit the form properly can result in denial or delay in receiving a VA per diem payment. The form is used in conjunction with other VA forms, such as the 10-10EZ or 10-10EZR.
VA Form 10-10SH – State Home Program Application for Veteran Care Medical Certification
VA Form 10-10SH – State Home Program Application for Veteran Care Medical Certification requires six signatures from the applicant’s medical providers. Failure to complete this form will not affect other benefits. The information on the form is collected under the authority of Title 38 CFR Parts 51 and 52, and Title 38 U.S.C. Sections 1741-1743, and will be used to determine eligibility for medical benefits in the State Home Program.
State veteran homes provide an affordable, quality, and compassionate alternative to a Veterans Administration facility. These facilities are reimbursed by VA Medical Centers to provide quality care to eligible veterans. These facilities offer a range of services, from assisted living to domiciliary care.
The VA pays the State homes an annual adjusted rate for each veteran living in a state veteran home. This rate is known as the “per diem,” and it applies to both in-home and out-of-home care. The per diem does not apply to veterans on disability compensation.
VA Form 10-10SH Example
