10-5588

State Home Report and Statement of Federal Aid Claimed

Agency
VA
Revision
November 2024
Fillable fields
99
Pages
5
Official source
VA form page
Checked
October 20, 2026
Fill 10-5588 online
Page 1 of form 10-5588

VA Form 10-5588: State Home Report and Statement of Federal Aid Claimed

VA Form 10-5588 is the U.S. Department of Veterans Affairs State Home Report and Statement of Federal Aid Claimed. Its instructions describe it as a monthly statement of gains and losses, days of care, average daily census, allowable cost, total per diem cost, per diem claimed and total amount claimed for nursing home, domiciliary and adult day health care. They say monthly payments will be made to the State Home only after the State submits a completed VA Form 10-5588 and required supporting documentation.

The PDF has five pages: the report on pages 1 and 2, then three pages of instructions. Section 8 is the certification by the State Veterans Home (SVH) administrator, or a State employee when a contractor runs the facility, and Section 9 is a receiving report marked for VA use only. The form asks for facility counts and costs, not an individual Veteran's details. You can fill out the PDF free in your browser on this page and download the result without an account.

Top of page 1 of VA Form 10-5588: State Home Report and Statement of Federal Aid Claimed, as printed by VA

What's on VA Form 10-5588

Section 1: General information

Station number and VISN, both marked required, the month and year, the report quarter, To (the VA Medical Center of jurisdiction), From (level of care and State Home) and Pay To.

Sections 2 and 3: Residents

Residents at the end of the prior month, admissions, returns from leave, discharges, deaths, leave of absence and residents at the end of the month, then non-eligible residents, Veterans who are 70% to 100% SC, TDIU or need care for an SC disability, and female Veteran residents.

Section 4: Non-eligible days

Total days of care furnished to non-eligible Veterans and civilians, including Medicare days if applicable, for each level of care.

Sections 5 and 6: Per diem claimed

Basic per diem by level of care: days of care, average daily census, direct and indirect cost, daily cost of care, per diem claimed and total. Then SC per diem at the VA prevailing rate for the 70% to 100% SC, TDIU or SC need categories.

Sections 7 and 8: Capacity and certification

Recognized beds approved by VA for DOM, NHC and ADHC, then the certification signed by the SVH Administrator or, when applicable, a State employee, and remarks.

Section 9: Receiving report

For VA use only: the total amount approved for payment, the VA approving official, obligation numbers and amounts due by level of payment, and the auditor.

How to complete VA Form 10-5588

  1. 1

    Fill in the general information

    Enter the station number and VISN of the VA Medical Center of jurisdiction, the month and year, and the fiscal quarter: 1 for October to December, 2 for January to March, 3 for April to June, 4 for July to September.

  2. 2

    Count residents for the month

    Line 8 matches line 16 of the prior month. Line 16 equals the sum of lines 8, 9, 10 and 11 minus lines 12, 13, 14 and 15 in each column.

  3. 3

    Work out the daily cost of care

    Divide the month's direct and indirect cost in column C by all residents' days of care for that level of care, computed under the cost principles in 2 CFR 200.400 to 200.475.

  4. 4

    Claim basic and SC per diem

    Column E is the current fiscal year per diem rate or one-half the daily cost of care, whichever is the lesser. In Section 6, multiply the days of care by the VA prevailing rate published by the SHPDP Office.

  5. 5

    Enter recognized beds and sign

    Enter the beds approved by VA during the latest recognition survey in blocks 28 to 30. The SVH Administrator, or a State employee at a contractor-run home, prints a name and title, signs and dates.

  6. 6

    VA completes Section 9

    The VA approving official and auditor complete the receiving report. The form notes that if it is not completed in its entirety, it could result in an improper payment.

These steps follow the form's own instructions.

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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. Item 5 is addressed To the VA Medical Center of jurisdiction, not the Health Care System.

Why it is collected

The notice says completion is voluntary, but VA will be unable to provide reimbursement for services rendered without a completed form.

Legal authority

The form cites Title 38 CFR Parts 51 and Title 38, U.S.C., Sections 1741, 1742, 1743 and 1745.

Edition

The PDF is dated NOV 2024 and says previous editions are not to be used. It carries OMB Control No: 2900-0160, Expiration Date: 11-30-2027, with an estimated burden of 30 minutes.

Related forms

Who completes VA Form 10-5588?

  • State Homes claiming per diem

    The report covers domiciliary, nursing home and adult day health care. The instructions say monthly payments are made to the State Home only after the State submits a completed form and required supporting documentation.

  • The SVH administrator

    Item 31 is the signature of the SVH Administrator, under a certification that the report is correct based on the documentation provided to VA.

  • A State employee at contractor-run homes

    If an entity contracting with the State operates the facility, the form says the State assigns a State employee to monitor it full time on site, and that employee signs Item 32. The SVH Administrator signature is then not required.

  • VA approving official and auditor

    Section 9, marked for VA use only, holds the total approved for payment, the VA approving official's signature, the accounting certification audit block and the auditor's signature.

  • Not a form for individual Veterans

    The form reports counts of residents, days of care and costs for the home. It has no fields for an individual Veteran's name.

The form is a claim from a State Home to VA, with a final section for VA staff.

Official sources and the blank

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Questions about Form 10-5588

What is VA Form 10-5588?

It is the State Home Report and Statement of Federal Aid Claimed, a monthly statement of residents, days of care, costs and per diem claimed for nursing home, domiciliary and adult day health care.

Who signs VA Form 10-5588?

The SVH Administrator signs Item 31. When an entity contracting with the State runs the facility, a State employee signs Item 32 instead. A VA approving official and an auditor sign Section 9.

How is the per diem claimed worked out?

The instructions say column E is the current fiscal year per diem rate or one-half the daily cost of care, whichever is the lesser, and column F is the product of columns A and E.

What counts as a day of care?

For domiciliary and nursing home care, an overnight stay by an eligible Veteran. For adult day health care, at least six hours in one calendar day or any two periods of at least 3 hours each in any two calendar days in a calendar month. The day of discharge is not counted.

How are report quarters numbered?

The instructions say to enter 1 for October to December, 2 for January to March, 3 for April to June and 4 for July to September.

Can an older edition be used?

No. The NOV 2024 edition says previous editions of this form are not to be used.