VA Form 10-0103 at a glance
What it is: This form is the Veterans Application for Assistance in Acquiring Home Improvements and Structural Alterations.
Who signs: Box 8, Signature of Veteran: sign your full name in ink.
What to bring and attach to VA Form 10-0103
Attach a signed copy of the bid and include plans and specifications for the work to be done.
A filled-in VA Form 10-0103 example: a Veteran applies for the first time and asks for an advance payment
How to fill out VA Form 10-0103, box by box
Your previous application
Section I, Veteran's Information, is to be completed by the Veteran.
Have you made a previous application for home improvements and structural alterations (HISA)? Mark NO or YES. If Yes, give the date (MM/DD/YYYY) and time.
Your name, SSN and VA file number
Box 1, Name of Veteran: write it as Last, First, MI. This is a mandatory field.
Box 2, SSN: write it as 999-99-9999. This is a mandatory field.
Box 3, VA File Number: write it.
Your address and telephone number
Box 4, Address: write the number and street or rural route, P.O. Box, City, State and ZIP Code.
Box 5, Telephone Number of Veteran: write it with the area code, as (999) 999-9999.
The person or firm that bid on the work
Box 6: write the name of the person or firm with whom you satisfactorily bid for necessary labor and materials.
Certification
Certification: I am applying for assistance in acquiring home improvement and structural alterations.
I understand that there are medical and economic features yet to be considered before I am eligible for this benefit, and that I will soon be notified of the action taken on this application.
I also understand that cost limitations for improvements and structural alternation apply in the aggregate as a one lifetime benefit. Entitlements to this benefit terminates when the cost limit is reached. Limitations cannot be exceeded either for one project or for any accumulation of projects.
When the anticipated total cost of a necessary or appropriate home improvement or structural alteration exceeds the remaining balance of my allowable benefit, I agree to pay the difference or the benefit will not be authorized.
I acknowledge that the VA assumes no responsibility for maintenance, repair or replacement of requested improvement, alteration or installation; assumes no product liability for, and extends no warranties, expressed or implied, including merchantability, as to equipment or devices installed; and assumes no liability for damage caused by such equipment or devices or for their removal.
I understand that this benefit can only be used within each of the several States, Territories, and Possessions of the United States, the District of Columbia, and the Commonwealth of Puerto Rico.
Advance payment
Box 7: If approved for HISA benefits, are you requesting an advance payment? Mark YES or NO. VA may make an advance payment to the beneficiary equal to 50 percent of the total benefit authorized for the HISA project (38 CFR 17.3130(a)).
Signature and date
Box 8, Signature of Veteran: sign your full name in ink.
Box 9, Date Signed: write the date (MM/DD/YYYY).
The law provides severe penalties including fine or imprisonment, or both, for willful submission of any false statement or evidence of material fact.
Common questions about VA Form 10-0103
Where do I file it?
Submit this application to the VA health care facility where the Veteran receives care.
Sources
[1] VA Form 10-0103 (MAR 2025), Veterans Application for Assistance in Acquiring Home Improvements and Structural Alterations, U.S. Department of Veterans Affairs (the Official source link on this page).
