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- Click ‘Get Form’ to open the va describe payment online in the editor.
- Begin by entering the NAME OF STATE HOME, followed by the STREET ADDRESS, CITY, STATE, ZIP CODE, and PHONE number. Ensure all details are accurate for proper identification.
- Next, provide the NAME OF STATE REPRESENTATIVE along with their PHONE, FAX, and EMAIL. This information is crucial for communication regarding your application.
- Indicate which PROGRAM(S) your facility receives per diem payments for by checking the appropriate boxes: DOMICILIARY, NURSING HOME, HOSPITAL, or ADULT DAY HEALTH.
- Describe and document the nursing shortage in detail. Attach credible evidence such as state home records that establish vacancies or support overtime needs.
- Outline your EMPLOYEE INCENTIVE SCHOLARSHIP PROGRAM or other incentive programs. Include a detailed explanation of costs and attach relevant documentation.
- Specify the AMOUNT APPLIED FOR, ensuring it does not exceed 2 percent of total per diem payments estimated by VA for the fiscal year.
- Detail the AVAILABILITY OF MATCHING FUNDS and attach a letter from an authorized state budget official certifying fund availability.
- Explain measures to ensure individuals receiving benefits work at the state home as nurses for a period commensurate with benefits provided. Attach supporting documentation.
- Describe how your employee incentive program will address nursing shortages and provide an estimated timeline for achieving this goal. Attach necessary documentation.
- If applicable, indicate whether the state home has received a refund payment due to breach of agreement terms and provide details if yes.
- Finally, sign as the State Representative and include today's date before submitting your application with all supporting documents.
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2007 | 4.9 Satisfied (451 Votes) |
What is the VA $3600 payment?
If youre a Veteran, youll see your payment history for disability compensation, pension benefits, and education benefits. View your history by visiting and signing in.
What is the VA $3600 benefit?
VA disability pay or disability compensation is a tax-free monthly payment given to veterans with a service-related disability and an other than dishonorable discharge. Those veterans may qualify for a tax-free, monthly benefit ranging from $165 to over $3,600.
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