Paperwork notice
OMB Control No. 2900-0883, an estimated burden of 5 minutes and an expiration date of 12/31/2026. The form says it is required to obtain the grant.
10-0143
Certification Regarding Drug-Free Workplace Requirements for Grantees Other Than Individuals
- Agency
- VA
- Revision
- December 2023
- Fillable fields
- 8
- Pages
- 2
- Official source
- VA form page
- Checked
- October 20, 2026
VA Form 10-0143: Certification Regarding Drug-Free Workplace Requirements for Grantees
VA Form 10-0143 is the U.S. Department of Veterans Affairs Certification Regarding Drug-Free Workplace Requirements for Grantees Other Than Individuals. It is a grant document for organizations, not a benefit application for Veterans. VA's form page lists it under VHA and gives no public use description.
The form says the certification is required by the regulations implementing the Drug-Free Workplace Act of 1988, 38 CFR 44, Subpart F, which require certification by grantees, prior to award, that they will maintain a drug-free workplace. It calls the certification a material representation of fact upon which reliance will be placed when the agency determines to award the grant.
The PDF has two pages: the seven numbered commitments on page 1, then places of performance and the signature block on page 2. 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 10-0143
Legal basis and consequences
The Drug-Free Workplace Act of 1988 and 38 CFR 44, Subpart F. The form says false certification or violation shall be grounds for suspension of payments, suspension or termination of grants, or government-wide suspension or debarment.
Items (1) to (3): Statement and awareness
Publishing a statement that prohibits the unlawful manufacture, distribution, dispensing, possession or use of a controlled substance in the workplace, setting up a drug-free awareness program, and giving the statement to each employee on the grant.
Items (4) to (7): Notice and follow-up
Employees notify the employer of a workplace drug conviction no later than five days after it. The grantee notifies the agency within ten days and takes one of two listed actions within 30 days.
Places of performance
Space for the site or sites of work done in connection with the grant: street address, city, county, state and zip code.
Signature block
Organization name, grant number or name, name and title of the authorized representative, signature and date.
How to complete VA Form 10-0143
- 1
Read the seven items
Page 1 lists what the grantee certifies it will do to provide a drug-free workplace.
- 2
List the places of performance
The form says the grantee inserts the site or sites for performance of work done in connection with the specific grant.
- 3
Name the organization and grant
Enter the organization name and the grant number or name.
- 4
Sign as the authorized representative
The authorized representative enters a name and title, then signs and dates the form.
Why fill Form 10-0143 on indox
You get the real form, filled in a browser tab, with nothing standing between you and the finished PDF.
- Fill the form right in your browser, no software to install
- Free to fill and free to download, with no account
- The official blank straight from the VA, not a copy someone retyped
- Works on a phone, tablet or computer
Where it goes
No mailing address
The form and VA's page print no mailing address or submission method. The form says the certification is made by grantees prior to award.
Edition
The PDF is dated DEC 2023 and carries OMB Control No. 2900-0883, which expires 12/31/2026. VA's page lists a form revision date of May 2014.
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Who uses VA Form 10-0143?
The form is completed by a grantee organization, not by a Veteran or other individual.
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Questions about Form 10-0143
What is VA Form 10-0143?
It is a certification that a grantee other than an individual will maintain a drug-free workplace. The form says grantees make it prior to award.
Is VA Form 10-0143 for Veterans?
No. The title limits it to grantees other than individuals, and VA's page lists it under VHA with no public use description.
Who signs VA Form 10-0143?
The grantee's authorized representative, who also enters a name and title on page 2.
What happens if the certification is false?
The form says false certification or violation of the certification shall be grounds for suspension of payments, suspension or termination of grants, or government-wide suspension or debarment.
What time limits does the form mention?
Employees notify the employer of a workplace drug conviction no later than five days after it. The grantee notifies the agency within ten days of that notice and takes one of the listed actions within 30 days.