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The CARE PROVIDER CERTIFICATION OF SERVICES (FORM FV13) is a document designed for care providers to report the types of care services they provide to veterans or their spouses applying for benefits from the Department of Veterans Affairs (VA). It outlines the necessary information required, including details about the claimant, care provider, and specific services offered, such as assistance with daily living activities. The form also emphasizes the importance of certifying that the claimant is in a 'Protected Environment' and requires signatures from both the care provider and claimant to validate the information provided.

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Click ‘Get Form’ to open it in the editor.
Begin by filling in Line 1 with the name of the person receiving care services, which can be a veteran or their spouse.
In Line 2, enter the name of the veteran for VA purposes. This is essential for identification.
Line 3 requires the veteran's Social Security Number or VA Case Number. Ensure accuracy as this is crucial for processing.
Complete Lines 4 through 10 with relevant details about the care service provider, including their address and contact information.
Select the type of service offered by checking the appropriate box. This helps clarify the nature of care provided.
Fill in any additional details regarding monthly charges and service duration as required in subsequent sections.
Finally, ensure both the claimant and care provider sign at the end of the form to validate all information provided.

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Versions	Form popularity	Fillable & printable
2016	4.8 Satisfied (121 Votes)
2012	4 Satisfied (22 Votes)

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