Previous application
A no or yes question on whether you have applied for HISA before, with the date as MM/DD/YYYY and the time if yes.
10-0103
Veterans Application for Assistance in Acquiring Home Improvements and Structural Alterations
- Agency
- VA
- Revision
- March 2025
- Fillable fields
- 12
- Pages
- 1
- Official source
- VA form page
- Checked
- October 20, 2026
VA Form 10-0103: Application for Home Improvements and Structural Alterations (HISA)
VA Form 10-0103 is the U.S. Department of Veterans Affairs Veterans Application for Assistance in Acquiring Home Improvements and Structural Alterations, the benefit the form calls HISA. The instructions at the top of the form say to submit the application to the VA health care facility where the Veteran receives care. VA's page lists it under Housing assistance.
The PDF is one page. Section I, Veteran's Information, is marked to be completed by the Veteran: whether a previous HISA application was made, name, Social Security number, VA file number, address and phone, and the person or firm with whom the Veteran bid for labor and materials. A certification follows, then a question about an advance payment and the Veteran's signature in ink.
You can fill out the PDF free in your browser on this page and download the result without an account.
What's on VA Form 10-0103
Items 1 to 5: Veteran's details
Name and Social Security number, both marked as mandatory fields, VA file number, address and the Veteran's telephone number.
Item 6: bid for labor and materials
The person or firm with whom you satisfactorily bid for necessary labor and materials. The form says to attach a signed copy of the bid and include plans and specifications for the work.
Certification
Five statements: medical and economic features are yet to be considered, cost limits apply in the aggregate as a one lifetime benefit, the Veteran pays any cost above the remaining balance, VA assumes no maintenance or product liability, and the benefit is used only within the States, Territories and Possessions, the District of Columbia and Puerto Rico.
Item 7: advance payment
Whether you are requesting an advance payment if approved. The form says VA may make an advance payment to the beneficiary equal to 50 percent of the total benefit authorized for the HISA project (38 CFR 17.3130(a)).
Items 8 and 9: signature
The Veteran signs full name in ink and enters the date signed. The form notes the severe penalties the law provides for willful submission of any false statement.
How to apply with VA Form 10-0103
- 1
Answer the previous application question
Check no or yes. If yes, give the date and time of the earlier HISA application.
- 2
Fill in Items 1 to 5
Enter your name, Social Security number, VA file number, address and phone. The form marks name and Social Security number as mandatory fields.
- 3
Attach the bid
Name the person or firm in Item 6 and attach a signed copy of the bid with plans and specifications for the work to be done.
- 4
Read the certification and answer Item 7
Read the five certification statements, then check yes or no for an advance payment.
- 5
Sign and date it
Sign your full name in ink in Item 8 and enter the date signed in Item 9 as MM/DD/YYYY.
- 6
Submit it to your VA facility
Give the application to the VA health care facility where you receive care, as the instructions on the form say.
Why fill Form 10-0103 on indox
You get the real form, filled in a browser tab, with nothing standing between you and the finished PDF.
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Where to submit it
Where it goes
The instructions say to submit the application to the VA health care facility where the Veteran receives care.
What goes with it
A signed copy of the bid from the person or firm in Item 6, with plans and specifications for the work to be done.
Not the burden email
The form gives [email protected] for comments on the burden estimate and says not to send your completed VA Form 10-0103 to this email address.
Edition
The PDF footer reads VA FORM MAR 2025 10-0103, while VA's page lists a revision date of February 2025. It carries OMB Control No. 2900-0188, which expires 06/30/2027, and an estimated burden of 5 minutes.
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Questions about Form 10-0103
What is VA Form 10-0103 used for?
It is the Veteran's application for assistance in acquiring home improvements and structural alterations, which the form calls HISA.
Where do I submit VA Form 10-0103?
The instructions say to submit the application to the VA health care facility where the Veteran receives care.
What do I attach to the application?
Item 6 says to attach a signed copy of the bid from the person or firm for the labor and materials, and to include plans and specifications for the work to be done.
Is HISA a one-time benefit?
The certification says cost limitations apply in the aggregate as a one lifetime benefit, and that entitlement ends when the cost limit is reached. The form does not print the limit.
Can VA pay part of the cost in advance?
Item 7 says VA may make an advance payment to the beneficiary equal to 50 percent of the total benefit authorized for the HISA project, citing 38 CFR 17.3130(a).
What if the work costs more than my remaining benefit?
The certification says that when the anticipated total cost exceeds the remaining balance of the allowable benefit, the Veteran agrees to pay the difference or the benefit will not be authorized.