10-0491f
Health Professional Scholarship Program (HPSP) Agreement
VA Form 10-0491F is the Department of Veterans Affairs Health Professional Scholarship Program (HPSP) Agreement. The form says its purpose is to outline the roles and responsibilities of the HPSP Scholarship Program and the HPSP Scholarship Recipient, and that it is the recipient's responsibility to read through each section and make sure they understand their obligation before signing. It is a scholarship agreement, not a Veterans benefit application.
The PDF has four pages of terms in Sections A to G: the program's authority, the obligations of the Under Secretary for Health (USH), the obligations of the recipient, breach of the agreement, cancellation, suspension and waiver, consent for release of information and general provisions. The recipient initials each section, and the agreement ends with the applicant's printed name, signature and date and the signature of the USH or an authorized representative.
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HPSP is described in 38 United States Code, Sections 7601 to 7619 and 7631 to 7636. The USH provides an award covering tuition, reasonable educational expenses, monthly stipends and an annual book stipend, and appoints the recipient to a full-time direct patient care position.
Fourteen items, among them keeping enrollment and academic standing, submitting documentation and reporting changes on the Notice of Change Form, signing a mobility agreement and serving a period of obligated service.
The service obligation is validated by an SF-50 and runs one year for each school year or part thereof, but not less than two years. The form says recipients in obligated service are not eligible for recruitment and incentive programs.
For listed failures, such as leaving the program or not becoming licensed in time, the agreement says the participant pays the United States the sum of $1,500 as liquidated damages. For not beginning or completing obligated service, it prints a triple damages formula, A = 3P((t-s)/t).
Obligations are canceled upon the death of the participant. The USH may waive or suspend them in the cases listed, waiver requests go to the USH within one year of a breach determination, and the form says a waiver decision is final.
Consent for the school to report academic standing, then the general provisions: the period of obligated service, two initialed acknowledgements, the applicant's printed name, signature and date, and the USH signature and date.
The form says it is the recipient's responsibility to read through each section and make sure they understand their obligation before signing.
Each section ends with a statement that you have read and understand it, followed by an Initial Here line.
The instructions say to review, check, sign initials, print first and last name and sign. Section G item 1 states the period of obligated service, followed by initials.
Print the applicant's name, sign and enter the date (MM/DD/YYYY).
The USH or an authorized representative signs and dates the agreement. Section G says it is not effective until accepted.
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Section G says the Under Secretary for Health or authorized representative must accept this agreement before it becomes effective.
Section B says the appointment comes within 90 days after the recipient completes the HPSP-supported education or training and meets all VA qualification requirements, with notice of potential locations at least 60 days prior. The USH may extend these periods.
Section C asks the recipient to notify the HPSP Scholarship Program of any changes, minor or major, outlined in the Notice of Change Form.
The PDF footer reads VA FORM MAY 2026 10-0491f, matching the May 2026 revision date on VA's page. The agreement prints no mailing address and no OMB control number.
10-0491g
118 fields, 7 pages
10-0491d
15 fields, 1 page
10-0491h
18 fields, 1 page
10-0491i
60 fields, 2 pages
10-0491L
12 fields, 3 pages
10-0003K-2
14 fields, 2 pages
The agreement names the parties to it and the groups some of its terms apply to.
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It is the Health Professional Scholarship Program (HPSP) Agreement, which outlines the roles and responsibilities of the HPSP Scholarship Program and the scholarship recipient.
Section C says one year for each school year or part thereof, but not less than two years. Physician recipients incur 18 months per school year, and Vet Center recipients have a six (6) year obligation period.
Section B says the award covers the payments of tuition, reasonable educational expenses, monthly stipends and an annual book stipend, as authorized by 38 U.S.C. 7613.
Section D lists failures that carry the sum of $1,500 as liquidated damages, payable within one year of the breach finding, and a triple damages formula for failing to begin or complete obligated service.
No. A note in Section C says full-time VA employees are not eligible to receive the monthly stipends.
Section E says obligations are canceled on the death of the participant, and the USH may waive or suspend them when compliance is impossible due to circumstances beyond the participant's control, or in the best interest of VA.
