10-1245C

VA/Department of Defense Sharing Agreement

Agency
VA
Revision
April 2011
Fillable fields
20
Pages
2
Official source
VA form page
Checked
October 20, 2026
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Page 1 of form 10-1245C

VA Form 10-1245C: VA/Department of Defense Sharing Agreement

VA Form 10-1245C is the VA/Department of Defense Sharing Agreement, a Veterans Health Administration (VHA) form. It records an agreement between a VA facility and a Department of Defense (DoD) facility, listing the services each Department provides and how they are billed. Its general provisions cite the Department of Veterans Affairs and Department of Defense Health Resources Sharing and Emergency Operations Act, 38 U.S.C. 8111, and 10 U.S.C. 1104. It is an agreement between two federal facilities, not a Veterans benefit application.

The form is two pages. Page 1 holds eight numbered instructions and Items 1 to 8: agreement number, type of action, agreement period, the VA and DoD facilities, payment and billing offices and the general provisions. Page 2 describes the services provided by VA and by DoD, each with a number and estimated cost, then the signatures of the VA Medical Center Director and an authorized Department of Defense official.

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Top of page 1 of VA Form 10-1245C: VA/Department of Defense Sharing Agreement, as printed by VA

What's on VA Form 10-1245C

Instructions 1 to 8

Notes on submission and approval, resources, claims and billing, rates, amendments and termination, war or national emergency, availability of funds and further guidance.

Items 1 to 3: agreement details

The agreement number, which the form says to leave blank, the type of action (new agreement, renewal with what it replaces, or amendment with what it amends) and the agreement period by month and year.

Items 4 to 7: facilities and billing

Names and addresses of the VA facility, the DoD facility, who receives direct payment, and the office to be billed with the billing frequency.

Item 8: general provisions

Printed provisions for all agreements, naming the authorities 38 U.S.C. 8111 and 10 U.S.C. 1104, plus space for other provisions if applicable.

Items 9 and 10: services

A description of the services provided by VA and of the services provided by DoD, each with a number and an estimated cost column.

Items 11 and 12: signatures

Signature and date of the VA Medical Center Director and of the authorized Department of Defense official.

How to complete VA Form 10-1245C

  1. 1

    Set up the agreement

    Leave Item 1 blank, check the type of action in Item 2 and enter the agreement period in Item 3.

  2. 2

    Name the facilities and offices

    Enter the VA facility, the DoD facility, who receives direct payment, and the office to be billed with its billing frequency in Items 4 to 7.

  3. 3

    Add any other provisions

    Item 8 prints the general provisions for all agreements and leaves space for other provisions if applicable.

  4. 4

    Describe the shared services

    List the services each Department provides in Items 9 and 10, with a number and estimated cost for each. The instructions say rates should be established for all shared services.

  5. 5

    Sign and submit

    The VA Medical Center Director and an authorized DoD official sign and date Items 11 and 12. The instructions say the signed form goes to the approving authorities in each Department.

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Approval, billing and edition

When it takes effect

The instructions say agreements normally go into effect 46 days after receipt by the approving authorities if no disapproval has been sent in writing, earlier if both Departments approve, or later if a later date is shown in Box 3.

Additional resources

The instructions say that if additional resources are required, approval is obtained from the Department providing the resources before the proposal is submitted.

Claims and billing

The instructions say the organization providing care prepares a claim on an industry standard claim form (CMS 1500 / UB 04) if possible, sent by Electronic Data Interface (EDI) or by secured mail, and that the SF 1080 may still be used if both parties agree.

Amendments and termination

Amendments are submitted as new sharing agreements. The instructions say either party may end the agreement after thirty (30) days' notice in writing, and either Department may end it immediately on written notice in the event of war or national emergency.

Guidance

The form points to the VA-DoD Sharing Guidelines dated October 31, 2008, VHA Handbook 1660.4 and DoD Instruction 6010.23.

Edition

The PDF footer reads VA FORM 10-1245c APR 2011 and says it supersedes the DEC 2010 edition, matching the April 2011 revision date on VA's page.

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Who uses VA Form 10-1245C?

  • A VA facility

    Item 4 names the VA facility, Item 9 describes the services VA provides, and Item 11 is the signature of the VA Medical Center Director.

  • A Department of Defense facility

    Item 5 names the DoD facility, Item 10 describes the services DoD provides, and Item 12 is the signature of an authorized Department of Defense official.

  • Approving authorities in each Department

    The instructions say a proposed agreement includes this form, signed by both parties and submitted to the approving authorities in each Department.

  • Billing and payment offices

    Item 6 names who receives direct payment and Item 7 names the office to be billed and the billing frequency. The organization providing care prepares the claims.

  • Not a form for individual Veterans

    Every field on the form describes facilities, offices and shared services, and the only signature lines are for a VA Medical Center Director and a DoD official.

The form names the parties that complete, sign and receive it.

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Questions about Form 10-1245C

What is VA Form 10-1245C used for?

It records a sharing agreement between a VA facility and a Department of Defense facility, including the services each provides, the estimated costs and the billing offices.

Who signs VA Form 10-1245C?

Item 11 is for the VA Medical Center Director and Item 12 is for an authorized Department of Defense official, each with a date.

When does a sharing agreement take effect?

The instructions say normally 46 days after receipt by the approving authorities if no disapproval has been sent in writing, earlier if both Departments approve, or later if Box 3 shows a later date.

How is a sharing agreement amended?

The instructions say amendments to the agreement are submitted for approval as new sharing agreements. Item 2 has an Amendment box with space to show what it amends.

How are shared services billed?

The form says the organization providing care prepares a claim on an industry standard claim form such as CMS 1500 or UB 04 where possible, and that it is improper to exchange services without the preparation of bills.

Which edition of the form is current?

The PDF is dated APR 2011 and supersedes the DEC 2010 edition. VA's page lists a form revision date of April 2011.