Project details
Project description, project location and FAI number.
10-0388-4
State Home Construction Grant Program Space Analysis—Adult Day Health Care
- Agency
- VA
- Revision
- July 2013
- Fillable fields
- 53
- Pages
- 2
- Official source
- VA form page
- Checked
- October 20, 2026
VA Form 10-0388-4: Space Analysis, Adult Day Health Care
VA Form 10-0388-4 is the U.S. Department of Veterans Affairs State Home Construction Grant Program Space Analysis for adult day health care. The PDF heading reads Space Program Analysis, Adult Day Health Care. 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 support facilities of an adult day health care program, from offices and dining to participant toilets, laundry and quiet room, with a square footage figure for each line 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 10-0388-4
Offices and administration
Administrator's and assistant administrator's offices, medical officer or director of nursing, nurses' office and dictation area, general administration, clerical staff, computer area and conference room.
Participant and public areas
Lobby, receiving and waiting area, public and participant toilets, dining area, multipurpose room, participant laundry and participant quiet room.
Clinical, therapy and staff spaces
Medical support, physical and occupational therapy with offices if required, medical and dietary, medication room, examination or treatment room, employee lockers, lounge and toilets, and staff toilet.
Storage, utility and grand total
Building maintenance, resident, general warehouse and general storage, general laundry, trash collection, clean and soiled utility, program supply and equipment, wheelchair storage, kitchenette, an Other (Justify) line and the grand total.
Certification and notice
A statement that the information is true and correct, the official's name, title, signature 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 10-0388-4
- 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 list continues on page 2.
- 3
Justify any other space
The Other (Justify) line on page 2 covers a space the form does not list.
- 4
Add the grand total
Enter the grand total square footage at the end of the list on page 2.
- 5
Sign and date
The authorized State official enters a name and title, signs and dates the certification.
Why fill Form 10-0388-4 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
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- 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
10-0388-3
State Home Construction Grant Program Space Program Analysis—Nursing Home & Domiciliary
75 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 10-0388-4?
The form describes who completes it and how VA uses it.
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Questions about Form 10-0388-4
What is VA Form 10-0388-4?
It is the State Home Construction Grant Program Space Analysis for Adult Day Health Care, a table of the square footage for each support facility in the proposed program space.
When is VA Form 10-0388-4 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 and dates the certification that the information is true and correct.
How does it differ from VA Form 10-0388-3?
VA Form 10-0388-3 covers nursing home and domiciliary space and adds sections for bed units and bathing and toilet facilities. VA Form 10-0388-4 lists adult day health care support facilities and ends with one grand total.
How long does it take to complete?
The Paperwork Reduction Act notice estimates an average of 2 hours per response.