Funeral honors provider organization
Organization name, address with street, city, state and zip code, phone number in the (999) 999-9999 format and email.
VA Form 40-10190
Funeral Honors Providers Certification Form
- Agency
- VA
- Revision
- May 2025
- Fillable fields
- 12
- Pages
- 1
- Official source
- VA form page
- Checked
- October 20, 2026
VA Form 40-10190: Funeral Honors Providers Certification Form
VA Form 40-10190 is the U.S. Department of Veterans Affairs Funeral Honors Providers Certification Form. It is completed by a funeral honors provider organization, not by a Veteran or family. The organization gives its name and contact details and those of its designated representative, the person authorized to represent the organization, who then signs a set of certifications made in accordance with 38 CFR 38.619. VA's form page lists it under burials and memorials.
The form is one page. All provider organizations certify that they and their members will comply with VA security, safety and law enforcement regulations under 38 CFR 1.218, maintain and operate any equipment in a safe manner and not solicit for or accept donations on VA property except as authorized under 38 CFR 1.218(a)(8). Non-DoD funeral honors provider organizations make three additional certifications. The form carries OMB number 2900-0865, which expires July 31, 2028.
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 40-10190
Designated representative's information
The representative's name, title, phone number and email, plus an address if different than the organization's.
Certification
Statements that the signer is an authorized representative for the organization performing funeral honors activities and that the contact information is valid, then the 38 CFR 38.619 statements on VA regulations under 38 CFR 1.218, safe equipment use and donations on VA property.
Additional certification for non-DoD organizations
Activities on federal property as an independent entity, not as an agent or employee of VA unless registered as a VA volunteer, completed training on funeral honors tasks and equipment, and services in accordance with the agreement with the personal representative of the individual being honored.
Signature and date
The funeral honors provider representative signature, which the form marks as digital or ink signature required, and the date as MM/DD/YYYY.
Burden and privacy notices
OMB number 2900-0865, a respondent burden of about 5 minutes per respondent, per year, and a Privacy Act note that VA considers the responses confidential under 38 U.S.C. 5701.
How to complete VA Form 40-10190
- 1
Enter the organization's details
Fill in the funeral honors provider organization's name, address, phone number and email.
- 2
Add the designated representative
Enter the representative's name, title, phone number and email. The form asks for an address only if it is different than the organization's.
- 3
Name the signer in the certification
The first certification line has a blank after "I certify that I" for the name of the authorized representative.
- 4
Review the certifications
Every provider organization's representative certifies to the 38 CFR 38.619 statements. The non-DoD section applies to non-DoD funeral honors provider organizations.
- 5
Sign and date it
The form says a digital or ink signature is required. Enter the date as MM/DD/YYYY.
Why fill Form VA Form 40-10190 on indox
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Sending it and getting help
Where to send it
The PDF and VA's form page print no mailing address or submission method for the completed form.
Not to the burden email
Burden comments go to the VA Reports Clearance Officer at [email protected], referring to OMB Control No. 2900-0865. The form says do not send your completed VA Form 40-10190 to this email address.
Online version
VA's form page offers the PDF download and lists no online version of this form.
Edition
The PDF footer reads VA FORM MAY 2025 40-10190, while VA's page lists a form revision date of August 2025. OMB number 2900-0865 expires July 31, 2028.
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Who uses VA Form 40-10190?
Every field on the form describes the provider organization and its representative.
Official sources and the blank
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Questions about Form VA Form 40-10190
What is VA Form 40-10190?
It is VA's Funeral Honors Providers Certification Form. A funeral honors provider organization lists its contact details and its designated representative, who signs certifications made in accordance with 38 CFR 38.619.
Who signs VA Form 40-10190?
The funeral honors provider representative, the person authorized to represent the organization. The form says a digital or ink signature is required.
Do families or Veterans complete this form?
The form asks no questions about a Veteran or family. Its fields describe the funeral honors provider organization and its representative.
What extra certifications apply to non-DoD organizations?
The form says non-DoD organizations certify that they act on federal property as an independent entity, not as an agent or employee of VA unless registered as a VA volunteer, that members have completed training on funeral honors tasks and the safe use of funeral honors equipment, and that services follow the agreement with the personal representative of the individual being honored.
Which regulations does the form cite?
38 CFR 38.619 for the certifications, 38 CFR 1.218 for VA security, safety and law enforcement regulations, and 38 CFR 1.218(a)(8) for donations on VA property.
Where do I send VA Form 40-10190?
The PDF and VA's form page print no mailing address. The form says not to send the completed form to the [email protected] burden comment address.
How long does the form take?
The form estimates about 5 minutes per respondent, per year.