PART 58—FORMS
- 58.10—VA Form 10-3567—State Home Inspection Staffing Profile.
- 58.11—VA Form 10-5588—State Home Report and Statement of Federal Aid Claimed.
- 58.12—VA Forms 10-10EZ and 10-10EZR—Application for Health Benefits and Renewal Form.
- 58.13—VA Form 10-10SH—State Home Program Application for Veteran Care Medical Certification.
- 58.14—VA Form 10-0143A—Statement of Assurance of Compliance with Section 504 of The Rehabilitation Act of 1973.
- 58.15—VA Form 10-0143—Department of Veterans Affairs Certification Regarding Drug-Free Workplace Requirements for Grantees Other Than Individuals.
- 58.16—VA Form 10-0144—Certification Regarding Lobbying.
- 58.17—VA Form 10-0144A—Statement of Assurance of Compliance with Equal Opportunity Laws.
- 58.18—VA Form 10-0460—Request for Prescription Drugs from an Eligible Veteran in a State Home.