
N NUMBER COMMERCIAL VENDOR REGISTERED IN SAM.GOV NCA VHA VBA (Required IAW FAR 4.1102) UNIQUE ENTITY IDENTIFIER (UEI) STATION CONTACT STATION PHONE NUMBER STATION FAX NUMBER EFT IDENTIFER SSN/TIN STATION EMAIL ADDRESS PAYEE/VENDOR TYPE (Select one) NPI C - COMMERCIAL/ALAC F - FEDERAL AGENCY FACTS ID E - EMPLOYEE O - FOREIGN I - INDIVIDUAL/HONORARIUM A - AGENT CASHIER V - VETERAN U - UTILITY CAREGIVER MEDICAL PROVIDER MISCELLANEOUS ACTIONS (Select one) ASSIGNMENT OF CLAIMS.
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How to fill out the VA 10091 online
The VA 10091 is a vital form for vendors to request or update their information within the VA system. This guide will provide you with step-by-step instructions on how to navigate and complete the form online efficiently.
Follow the steps to fill out the VA 10091 online
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Select the appropriate box to indicate whether you are a new vendor or updating an existing record.
- Enter the VA facility information. Provide the three-digit station number associated with the VA Station completing the form.
- Fill in the station contact name, direct phone number, fax number, and email address.
- Choose the payee/vendor type by checking the appropriate box applicable to your status. Ensure this is completed as it is required.
- If your vendor type requires additional documentation, select the appropriate miscellaneous actions box as needed.
- Indicate if you are a commercial vendor registered in SAM.gov and enter your Unique Entity Identifier (UEI), which is required if applicable.
- Provide your Social Security Number (SSN) or Tax Identification Number (TIN) as required.
- If you are a medical provider, fill in your National Provider Identifier (NPI) where applicable.
- Enter the legal name of the payee/vendor as it appears on file with the IRS and use the Doing Business As (DBA) name if applicable.
- Complete the details for the authorized representative, including their name, email, and phone number.
- Fill in your current address, as well as the previous address if there are any changes.
- In the EFT/ACH section, provide the bank name, address, nine-digit routing number, account number, and account type.
- Print your name and title, followed by the handwritten signature of the authorized representative.
- Once all fields are completed, ensure to save your changes, download a copy, print, or share the form as needed.
Start filling out your VA 10091 online today to ensure your vendor information is up to date.
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Get answers to your most pressing questions about US Legal Forms API.
How do I become a VA vendor?
Be able to demonstrate that your firm is responsible. Complete the GSA Pathway to Success education seminar. ... Meet all the requirements of the solicitation. Be able to fulfill all contract obligations outlined in the solicitation.
What is VA FSC?
The Financial Services Center (FSC), located in Austin, Texas, is a franchise fund (fee-for-service) organization in the Department of Veterans Affairs (VA). ... FSC is divided into Services that are organized around revenue centers and product lines to better focus service delivery and accountability.
How do I fill out VA FSC vendor file request?
If you are a new vendor in the FMS system, check "New" box. ... VA Facility Information part has to contain 3 digit station number, VA Station employee name, direct phone number, email address, and fax number. ... Choose the applicable type of payee/vendor in the "Payee/Vendor Type" section;
What is a VA FSC vendor file request form?
The VA-FSC Vendor File Request Form, VA Form 10091, was previously created to streamline the data required to establish a vendor record from multiple sources into a single form.
What is VA Form 10091 used for?
VA Form 10091 will be used throughout the VA to gather essential payment data from vendors (commercial, individuals, Veterans, employees, etc.) to establish or update vendor records in order to process electronic payments through the ACH network to the vendor's financial institution.
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