Waiver statement
The volunteer agrees, for an indefinite period, to waive all claims to monetary benefits for services rendered as a volunteer worker on a "without compensation" basis.
10-5392
Occasional Volunteer Time Sheet
- Agency
- VA
- Revision
- June 2016
- Fillable fields
- 120
- Pages
- 1
- Official source
- VA form page
- Checked
- October 20, 2026
VA Form 10-5392: Occasional Volunteer Time Sheet
VA Form 10-5392 is the U.S. Department of Veterans Affairs Occasional Volunteer Time Sheet, issued under the Veterans Health Administration, Voluntary Service. Each person who signs it records their volunteer time under a statement printed at the top: as an Occasional Volunteer, they agree for an indefinite period to waive all claims to monetary benefits for services rendered as a volunteer worker on a "without compensation" basis.
The form is a single landscape page with rows for many entries. Each row has the individual's printed name, signature, date or dates of service, organization name, VA service assignment and hours. The form says the waiver applies only to compensation for specific services rendered in a VA Voluntary Service (VAVS) Program and is not related to any other VA services or benefits. 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 10-5392
Scope of the waiver
The waiver applies only to remuneration (compensation) for specific services rendered in a VA Voluntary Service (VAVS) Program, and is not related to any other VA services or benefits to which the volunteer is entitled.
Authority and cancellation
A note says VA has entered into the agreement by the authority of 38 U.S.C. 7405(a)(1)(D), and that either party may cancel it upon written notice.
Name and signature columns
Individual name, which the form asks to be printed, and the signature.
Service columns
Date or dates of service, organization name, VA service assignment and hours.
How to fill out VA Form 10-5392
- 1
Read the statement
The waiver at the top of the sheet is the agreement each person makes by signing a row.
- 2
Print the name
Enter the name in the Individual Name column, which says Please print.
- 3
Sign the row
Sign in the Signature column on the same row.
- 4
Record the service
Enter the date or dates of service, the organization name, the VA service assignment and the hours.
These steps follow the form's column headings.
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Filing and edition details
No address on the form
The PDF and VA's form page print no mailing address, fax number or email for this form.
Cancelling the agreement
The form says the agreement may be cancelled by either party upon written notice.
Edition
The PDF is dated JUNE 2016, matching the June 2016 revision date on VA's form page. It prints no OMB number.
Related forms
Who signs VA Form 10-5392?
The form is a sign-in sheet for volunteers in a VA Voluntary Service (VAVS) Program.
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Questions about Form 10-5392
What is VA Form 10-5392?
It is the Occasional Volunteer Time Sheet from the Veterans Health Administration, Voluntary Service. Each row records a volunteer's name, signature, dates of service, organization, VA service assignment and hours.
What does the waiver on the form say?
The volunteer agrees, for an indefinite period, to waive all claims to monetary benefits for services rendered as a volunteer worker on a "without compensation" basis.
Does the waiver cover other VA benefits?
The form says the waiver applies only to remuneration (compensation) for specific services rendered in a VA Voluntary Service (VAVS) Program and is not related to any other VA services or benefits to which the volunteer is entitled.
How long does the agreement last?
The statement says the volunteer agrees for an indefinite period, and the note says either party may cancel the agreement upon written notice.
Can several volunteers sign the same sheet?
The page has rows for many entries, each with its own printed name, signature, dates of service and hours.