Get Va 10-0361d 2021-2025

The VA 10-0361D is an essential document that facilitates the Per Diem Payment process for eligible veterans. Completing this form accurately ensures timely processing of payment requests and supports the ongoing care of veterans in need.

Follow the steps to fill out the VA 10-0361D online successfully.

1. Press the ‘Get Form’ button to access the VA 10-0361D online and open it in the editor.
2. Enter the program name and address in the designated field to identify the specific program for which you are submitting the voucher.
3. Fill in the date of submission to provide a clear record of when the form is completed.
4. Complete the FAIN / project number section as required to ensure that the submission is linked to the appropriate funding source.
5. Provide the EIN (Employer Identification Number) to ensure proper identification of the entity submitting the request.
6. Indicate the billing period by entering the start and end dates in the format mm/dd/yy, clarifying the timeframe for the services provided.
7. Calculate the total bed days of care provided and enter this number in the designated field.
8. Multiply the total bed days by the per diem rate to determine the total amount requested for reimbursement.
9. Enter the amount that the VA Medical Center (VAMC) approves for payment, which may differ from the total amount requested.
10. Complete the validation section by signing and providing your name, title, and date, certifying the accuracy of the billing request.
11. Ensure the VA GPD liaison validation signature section is filled out accurately by the authorized agent, including signatures and necessary details.
12. Once completed, save any changes, and download, print, or share the form as needed.

Complete your VA 10-0361D online today to ensure timely and accurate payment for your services.