10-2407
Residential Care Home Program Sponsor Application
VA Form 10-2407 is the U.S. Department of Veterans Affairs Residential Care Home Program Sponsor Application. VA's form page lists it under VHA. The form says the VA Residential Care Program provides room, board, and limited personal care and supervision to Veterans who do not require hospital or nursing home care but, because of medical or psychosocial health conditions, are not able to live independently and have no suitable family resources to provide the needed care.
The form says care is provided at the Veteran's own expense in private homes inspected by VA, and that the Veteran receives monthly follow-up visits from VA social workers and other health care professionals. A person who wants to become a sponsor in the program completes items 2 through 6. Item 1, the VA facility, is for VA use only.
The form is one page. It asks for the applicant's name, telephone number and address, four references including two neighbors, the applicant's agreement to five conditions, and a signature and date. You can fill out the PDF free in your browser on this page and download the result without an account.
OMB Control No. 2900-0491, which expires 01/31/2028, an estimated burden of 5 minutes, and a Privacy Act notice saying the information will be used to evaluate the suitability of the home for participation in the Residential Care Program.
A paragraph on what the VA Residential Care Program provides and who it serves, ending with the instruction to complete items 2 through 6.
Item 1 is the VA facility, for VA use only. Item 2 asks for the applicant's name (last, first, middle initial), telephone number and address.
Four references, two of them neighbors, each with a name, address and telephone number.
The applicant agrees to an initial and annual VA inspection, to VA contacting other agencies about the home's suitability, to comply with VA standards for residential care, to accept Veterans without discrimination on the basis of race, color, sex, age, religion or national origin, and to accept the agreed-upon monthly rate as full compensation for care given.
The applicant's signature and the date in MM/DD/YYYY format.
The VA facility box is for VA use only.
Fill in item 2 with your name, telephone number and address, including city, state and ZIP code.
Item 3 asks for four references, including two neighbors, with their names, addresses and telephone numbers.
Item 4 lists the five things the applicant agrees to in making the application.
Sign item 5 and enter the date in item 6 as MM/DD/YYYY.
You get the real form, filled in a browser tab, with nothing standing between you and the finished PDF.
The form and VA's page do not print a mailing address. Item 1 names the VA facility and is filled in by VA.
In making the application, the applicant agrees to an initial inspection of the home by a health care team from the VA facility and an annual inspection thereafter.
The form refers to an agreed-upon monthly rate accepted as full compensation for care given. It does not print an amount.
Comments on the burden estimate go to the VA Reports Clearance Officer at [email protected]. The form says not to send the completed VA Form 10-2407 to this email address.
The PDF is dated JAN 2025, and VA's form page lists a revision date of February 2025. It carries OMB Control No. 2900-0491, which expires 01/31/2028.
The form names who completes each part and who reviews the home.
No tool matches that search.
It is the application to become a sponsor in VA's Residential Care Home Program. The Privacy Act notice says the information will be used to evaluate the suitability of the home for participation in the Residential Care Program.
The person applying to become a sponsor completes items 2 through 6. Item 1, the VA facility, is for VA use only.
The form says it provides room, board, and limited personal care and supervision to Veterans who do not require hospital or nursing home care but are not able to live independently and have no suitable family resources to provide the needed care.
The form says care is provided at the Veteran's own expense in private homes inspected by VA. The sponsor agrees to accept the agreed-upon monthly rate as full compensation. The form prints no amount.
Four, including two neighbors, each with a name, address and telephone number.
In item 4 the applicant agrees to an initial inspection of the home by a health care team from the VA facility and an annual inspection thereafter.
