Project details
Project description, project location and FAI number.
10-0388-3
State Home Construction Grant Program Space Program Analysis—Nursing Home & Domiciliary
- Agency
- VA
- Revision
- July 2013
- Fillable fields
- 75
- Pages
- 2
- Official source
- VA form page
- Checked
- October 20, 2026
VA Form 10-0388-3: Space Program Analysis, Nursing Home and Domiciliary
VA Form 10-0388-3 is the U.S. Department of Veterans Affairs State Home Construction Grant Program Space Program Analysis for a nursing home and domiciliary. VA's form page lists it under the Veterans Health Administration (VHA). An authorized State official completes it for a State Home project and certifies the figures to VA. It is not filed by individual Veterans.
The form says it is required for all new construction or general renovations that affect the square footage or floor plan of an existing home. It lists the spaces of the home in three groups, support facilities, bed units, and bathing and toilet facilities, with a square footage figure for each line, a subtotal for each group and a grand total.
The form is two pages. 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 10-0388-3
Section 1: Support facilities
Offices for the administrator, medical officer or director of nursing and nurses, administration and clerical space, lobby, pharmacy, dietetic service, dining, canteen, medical support, therapy, chapel, library, storage, laundry, trash collection and an Other line that asks for a justification.
Section 2: Bed units
Counts of one, two and large 2 rooms, then lounge areas, resident quiet room, clean and soiled utility, linen and general storage, medication room, examination or treatment room, waiting area, unit supply and equipment, staff toilet, stretcher or wheelchair storage and kitchenette.
Section 3: Bathing and toilet facilities
Private or shared facilities, full bathroom and congregate bathing facilities.
Totals
Comprehensive subtotals for support facilities, bed units, and bathing and toilet facilities, then a grand total.
Certification and notice
A statement that the information is true and correct, the official's name, title, signature in ink and date, and a Paperwork Reduction Act notice with OMB Number 2900-0661 and an estimated burden of 2 hours.
How to complete VA Form 10-0388-3
- 1
Enter the project details
Fill in the project description, location and FAI number at the top of page 1.
- 2
Enter square footage for each space
Each line has a square footage column, headed Square Footage Proposed By on the form. The Other (Justify) line covers a space the form does not list.
- 3
Complete the bed unit counts
Section 2 has blanks for the number of one, two and large 2 rooms.
- 4
Add the subtotals and grand total
Page 2 has subtotals for support facilities, bed units, and bathing and toilet facilities, followed by the grand total.
- 5
Sign in ink and date
The authorized State official enters a name and title, signs in ink and dates the certification.
Why fill Form 10-0388-3 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
Submitted to VA
The certification says the information is submitted to VA. The form's notice says VA uses it with the other documents the States submit for the grant.
No address on the form
The form and VA's page do not print a mailing address, fax number or online submission option.
Edition
The PDF footer reads VA FORM JUL 2013, while VA's page gives a form revision date of June 2013. OMB Number 2900-0661.
Related forms
10-0388-4
State Home Construction Grant Program Space Analysis—Adult Day Health Care
53 fields, 2 pages
10-0388-5
Additional Documents and Information Required for State Home Construction and Acquisition Grants Application
7 fields, 2 pages
10-0388-1
Documents and Information Required for State Home Construction and Acquisition Grants Initial Application
7 fields, 2 pages
10-0388-14
Checklist of Major Requirements for State Home Construction/Acquisition Grants
90 fields, 2 pages
10-0388-13
Documents and Information Required for State Home Construction and Acquisition Grants—Post-Grant Requirements
7 fields, 1 page
10-0388-6
Certification of State Matching Funds to Qualify for Group 1 on Priority List
9 fields, 1 page
Who uses VA Form 10-0388-3?
The form describes who completes it and how VA uses it.
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Questions about Form 10-0388-3
What is VA Form 10-0388-3?
It is the State Home Construction Grant Program Space Program Analysis for a nursing home and domiciliary, a table of the square footage for each space in the proposed home.
When is VA Form 10-0388-3 used?
The form says it is required for all new construction or general renovations that affect the square footage or floor plan of an existing home.
Who signs it?
An authorized State official, who enters a name and title, signs in ink and dates the certification that the information is true and correct.
Is there a version for adult day health care?
Yes. VA Form 10-0388-4 is the State Home Construction Grant Program Space Analysis for Adult Day Health Care.
How long does it take to complete?
The Paperwork Reduction Act notice estimates an average of 2 hours per response.