Paperwork notice
OMB Control No. 2900-0883, an estimated burden of 5 minutes and an expiration date of 11/30/2026.
10-0143a
Statement of Assurance of Compliance with Section 504 of the Rehabilitation Act of 1973
- Agency
- VA
- Revision
- December 2023
- Fillable fields
- 8
- Pages
- 1
- Official source
- VA form page
- Checked
- October 20, 2026
VA Form 10-0143a: Assurance of Compliance with Section 504 of the Rehabilitation Act
VA Form 10-0143a is the U.S. Department of Veterans Affairs Statement of Assurance of Compliance with Section 504 of the Rehabilitation Act of 1973. The form is signed for a State Veterans Home, which it calls the Signatory. It is not a benefit application for Veterans, and VA's form page lists it under VHA with no public use description.
In it, the Signatory agrees to comply with section 504 of the Rehabilitation Act of 1973 (Pub. L. No. 93-112) and its regulations, such as VA Regulations 7800 Series (38 CFR Section 18), so that no person is excluded from, denied the benefits of, or subjected to discrimination under its VA-assisted programs on the ground of handicap. The form says completing it is required to obtain and retain this Federal grant.
The PDF is one page. 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 10-0143a
Signatory
The name and location of the State Veterans Home, followed by the words HEREBY AGREES THAT.
The agreement
Compliance with section 504 and its regulations, and an assurance that the Signatory will immediately take any measures necessary to effectuate the agreement.
Real property
If real property or a structure is provided or improved with VA aid, the assurance covers the period it is used for the aided purpose or similar services.
Consideration and enforcement
The assurance is given to obtain Federal financial assistance, including facilities furnished or payments made under Section 1741 of Title 38 USC. The form says the United States shall have the right to seek judicial enforcement.
Signature block
Signature of authorized official, title, date and mailing address.
How to complete VA Form 10-0143a
- 1
Name the State Veterans Home
Enter the name and location of the State Veterans Home on the Signatory line.
- 2
Read the assurance
The paragraphs set out the section 504 agreement, the real property terms and how VA can enforce the assurance.
- 3
Sign as the authorized official
An official authorized to sign the assurance signs it.
- 4
Add title, date and address
Enter the official's title, the date and a mailing address.
Why fill Form 10-0143a on indox
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Where it goes
No mailing address
The form and VA's page print no mailing address or submission method. The form says completing it is required to obtain and retain this Federal grant.
Edition
The PDF is dated DEC 2023 and carries OMB Control No. 2900-0883, which expires 11/30/2026. VA's page lists a form revision date of September 2006.
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Who uses VA Form 10-0143a?
The form is signed on behalf of a State Veterans Home, not by an individual Veteran.
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Questions about Form 10-0143a
What is VA Form 10-0143a?
It is a statement in which a State Veterans Home agrees to comply with section 504 of the Rehabilitation Act of 1973 and its regulations, given to obtain Federal financial assistance from VA.
Is VA Form 10-0143a for Veterans?
No. It is signed on behalf of a State Veterans Home, and VA's page lists it under VHA with no public use description.
Who signs VA Form 10-0143a?
An authorized official. The form says the person or persons whose signatures appear below are authorized to sign this assurance.
How long does the assurance last?
The form says it obligates the Signatory for the period during which VA extends Federal financial assistance to any of its programs, and for longer periods tied to real property improved with that aid.
What can VA do if the assurance is not met?
The form says VA will withhold financial assistance, facilities, or other benefits to ensure fulfillment, and that the United States shall have the right to seek judicial enforcement.