Program and training type
Boxes for HPSP or VIOMPSP, and for Residency or Fellowship.
10-0491j
Request for Deferment for Advanced Education—Health Professional Scholarship Program (HPSP) & Visual Impairment and Orientation and Mobility Professionals Scholarship Program (VIOMPSP)
- Agency
- VA
- Revision
- September 2026
- Fillable fields
- 24
- Pages
- 1
- Official source
- VA form page
- Checked
- October 20, 2026
VA Form 10-0491J: Request for Deferment for Advanced Education
VA Form 10-0491J is the U.S. Department of Veterans Affairs Request for Deferment for Advanced Education for the Health Professional Scholarship Program (HPSP) and the Visual Impairment and Orientation and Mobility Professionals Scholarship Program (VIOMPSP). VA's form page lists it under VHA.
The form says an HPSP Program recipient receiving a degree from a school of medicine, osteopathy, dentistry, optometry, or podiatry may request a deferment of beginning their obligated service to complete an approved program of advanced clinical training. It says the period of deferment is time designated for the specialty training, and that once a request is approved the additional time is added to the recipient's HPSP Agreement service obligation period.
The form is one page: the program and training type, the participant's details, questions about the match and accreditation, the residency or fellowship program, two acknowledgments and a signature. 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 10-0491J
Participant details
The participant's name (Last, First, Middle), Social Security number, address, phone number and email address.
Match and accreditation
Whether the selection is through a national match program, its name and the notification date received, and whether the match site is accredited, with the accrediting body's name.
Residency or fellowship program
The program's name, length, location, start and end dates, and its director or coordinator with phone and email.
Acknowledgments and signature
Two acknowledgments: that the training is at an accredited program in an institution with an affiliated agreement with a VA health care facility, and that added time goes on the service obligation with an updated HPSP agreement. Then signature and date.
How to fill out VA Form 10-0491J
- 1
Read the opening text
It explains the deferment, when obligated service begins and how the added time is handled.
- 2
Mark the program and training type
Check HPSP or VIOMPSP, and Residency or Fellowship.
- 3
Enter your details and the program's
Fill in your contact details, the match and accreditation answers and the residency or fellowship program details. The form asks for dates as MM/DD/YYYY.
- 4
Check both acknowledgments and sign
Check the two acknowledgment boxes, then sign and date the form.
- 5
Upload it with proof
The form says recipients complete and upload this form along with proof of documentation of the advanced clinical training program into the Application Management System (AMS).
Why fill Form 10-0491j 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
Sending it and other notes
Where it goes
The form says it is uploaded with proof of documentation of the advanced clinical training program into the Application Management System (AMS). It prints no mailing address.
Start of obligated service
The form says the assignment is made by the Secretary within 120 days prior to or no later than 30 days following the completion of the requested graduate training, and that this may be extended at USH's discretion.
Updated agreement
The form notes that failure of the recipient to sign the updated HPSP agreement will not negate the service obligation period.
Edition
The edition is dated SEP 2026. It carries OMB Control No. 2900-0793, which expires 09/30/2029, with an estimated burden of 10 minutes. The form says not to send the completed form to [email protected].
Related forms
10-0491f
Health Professional Scholarship Program (HPSP) Agreement
13 fields, 4 pages
10-0491c
Annual VA Employment or Deferment Verification—Health Professional Scholarship Program (HPSP) & Visual Impairment and Orientation and Mobility Professionals Scholarship Program (VIOMPSP)
35 fields, 1 page
10-0491d
Education Program Completion Notice/Service Obligation Placement—Health Professional Scholarship Program (HPSP) & Visual Impairment and Orientation and Mobility Professionals Scholarship Program (VIOMPSP)
15 fields, 1 page
10-0491h
Notice of Approaching Graduation—Health Professional Scholarship Program (HPSP) & Visual Impairment and Orientation and Mobility Professionals Scholarship Program (VIOMPSP)
18 fields, 1 page
10-0491i
Notice of Change and/or Annual Academic Status—Health Professional Scholarship Program (HPSP) & Visual Impairment and Orientation and Mobility Professionals Scholarship Program (VIOMPSP)
60 fields, 2 pages
10-0491L
VA Visual Impairment and Orientation and Mobility Professionals Scholarship Program (VIOMPSP) Agreement
12 fields, 3 pages
Who uses VA Form 10-0491J?
The form describes who requests a deferment and who decides it.
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Questions about Form 10-0491j
Who can request a deferment with VA Form 10-0491J?
The form says an HPSP Program recipient receiving a degree from a school of medicine, osteopathy, dentistry, optometry, or podiatry may request a deferment of beginning their obligated service to complete an approved program of advanced clinical training.
Where is VA Form 10-0491J submitted?
The form says recipients upload it, along with proof of documentation of the advanced clinical training program, into the Application Management System (AMS).
Does the training have to be at a VA affiliated program?
The form says a participant whose obligation is deferred takes all or part of the advanced clinical training in an accredited program at an educational institution with an affiliated agreement with VHA, with training completed at a VA health care facility.
Does a deferment change the service obligation?
The form says the additional time is added to the recipient's initial HPSP Agreement service obligation period, and that an updated HPSP agreement is signed to annotate it.
When does obligated service begin after the training?
The form says the Secretary makes the assignment within 120 days prior to or no later than 30 days following the completion of the requested graduate training, which may be extended at USH's discretion.