10-5588A

Claim for Payment for Nursing Home Care Provided to Veterans Awarded Retroactive Service Connection

Agency
VA
Revision
November 2024
Fillable fields
80
Pages
2
Official source
VA form page
Checked
October 20, 2026
Fill 10-5588A online
Page 1 of form 10-5588A

VA Form 10-5588A: Claim for Payment for Veterans Awarded Retroactive Service Connection

VA Form 10-5588A is the U.S. Department of Veterans Affairs form that VA's form page names Claim for Payment for Nursing Home Care Provided to Veterans Awarded Retroactive Service Connection. The PDF itself is titled Claim for Increased Per Diem Payment for Veterans Awarded Retroactive Service Connection. Its instruction sheet says a State Veteran Home (SVH) completes it to VA for the balance due for a service connected (SC) Veteran, and that it is intended to reduce burden hours for State Homes claiming retroactive payment.

The PDF has two pages: the claim on page 1 and an instruction sheet on page 2. Page 1 holds the general information, a table of retroactive claim lines, the certification by State Home personnel, a VA approval and audit block, and a Veteran information table. 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 10-5588A: Claim for Payment for Veterans Awarded Retroactive Service Connection, as printed by VA

What's on VA Form 10-5588A

Items 1 to 8: General information

VISN, station number, month ending, report quarter, fiscal year, To (the VA facility), From (level of care and State Home) and Pay To.

Items 9 to 18: Retroactive claim lines

Per line: last name initial and last 4 of SSN, month and year, days of care, basic per diem rate paid, total amount claimed, daily cost of care, FY prevailing rate, amount at the SC rate and amount due, then the total per diem claimed.

Item 19: Remarks

Space for supporting comments regarding the claims.

Items 20 and 21: Certification

A certification that the report is correct and that all residents included were physically present during the period claimed, except for authorized absences for which VA paid per diem.

Items 22 to 25: VA approval and audit

The total amount approved by VA for retroactive payment, the VA approving official, the obligation number, the amount due and the auditor.

Items 26 to 30: Veteran information

Name of Veteran, last 4 digits of SSN, SC award effective date, SC disability and SC rating.

How to complete VA Form 10-5588A

  1. 1

    Gather the attachments

    The instructions say VA needs a letter showing the SVH has or will reimburse any payer sources it collected from on behalf of the Veteran, and a copy of the VBA Service Connected Notification letter for the SC rating.

  2. 2

    Fill in the general information

    Several months in the same quarter and fiscal year can go on one form. The instructions give the example of October to December 2021, entered as Dec 2021. The federal fiscal year runs October to September.

  3. 3

    Enter one month per line

    The instructions say not to enter more than one month of days of care per line. Column (d) is the basic per diem rate paid from the original 10-5588 invoice, and column (e) is column (c) times column (d).

  4. 4

    Work out the SC amount

    For claims from February 2, 2013 forward, leave column (f) blank and multiply days of care by the prevailing rate in column (g). For earlier periods, multiply days of care by the lesser of columns (f) or (g). For ADHC, the form says retroactive payment only goes back to March 27, 2018.

  5. 5

    Find the amount due

    Subtract column (e) from column (h) on each line, then add the amounts in item 17 for the total per diem claimed in item 18.

  6. 6

    Add Veteran details and sign

    Enter each Veteran's name, last four SSN digits, SC award effective date, SC disability and new combined SC rating. The SVH administrator, or the State employee when applicable, signs and dates.

These steps follow the form's instruction sheet.

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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. The instructions say to enter the VA Medical Center of Jurisdiction in item 6, 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 to 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 20 minutes.

Related forms

Who completes VA Form 10-5588A?

  • State Veteran Homes

    The instruction sheet says the SVH completes the form to VA for the balance due for an SC Veteran when claiming retroactive payment.

  • The SVH administrator

    Item 20 is the SVH administrator's printed name and title, signature and date, under a certification that the report is correct.

  • A State employee at contractor-run homes

    When an entity contracting with the State operates the facility, the State employee assigned to monitor it signs Item 21, and the SVH administrator's signature is not required.

  • VA approving official and auditor

    Items 22 to 25 hold the total amount approved by VA for retroactive payment, the VA approving official's signature, the obligation number, the amount due and the auditor's signature.

  • Veterans under VA contract

    The Veteran information section says all Veterans under VA contract with SVHs are not authorized for retroactive per diem payment.

The form is a claim from a State Veteran Home to VA, with blocks for VA staff.

Official sources and the blank

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Questions about Form 10-5588A

What is VA Form 10-5588A?

It is a State Veteran Home's claim to VA for the per diem balance due for a Veteran awarded retroactive service connection. The instruction sheet says it is intended to reduce burden hours for State Homes claiming retroactive payment.

Why do the page and the PDF use different names?

VA's form page names it Claim for Payment for Nursing Home Care Provided to Veterans Awarded Retroactive Service Connection. The PDF is titled Claim for Increased Per Diem Payment for Veterans Awarded Retroactive Service Connection.

How does it relate to VA Form 10-5588?

Column (d) takes the basic per diem rate paid from the original 10-5588 invoice, and column (f) the daily cost of care reported on the original 10-5588. Both forms carry OMB Control No: 2900-0160.

What goes with the claim?

The instructions say a letter showing the SVH has or will reimburse any payer sources it collected from on behalf of the Veteran, and a copy of the VBA Service Connected Notification letter for the SC rating.

Can one form cover several months?

Yes. The instructions say multiple months can be logged on one form within the same quarter and fiscal year, with no more than one month of days of care per line.

How far back does ADHC retroactive payment go?

The instructions say that for ADHC, retroactive payment only goes back to the date of PL 115-159, which was signed March 27, 2018.