Homepage Fill Out Your Va 10091 Form
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The VA Form 10091 is an essential document used by vendors seeking to establish or update their vendor records with the Department of Veterans Affairs. This form, less than a half-hour commitment to complete, caters to various types of payees, including individuals, commercial entities, and federal agencies. To ensure efficient processing, it gathers vital information such as the vendor’s DUNS number, taxpayer identification number, and banking details for electronic payments. Vendors are also prompted to indicate their status as small businesses, if applicable. Completing the VA Form 10091 involves selecting the correct type of payee, confirming registration in the System for Award Management, and providing both current and previous addresses. Furthermore, the form includes sections for miscellaneous actions, which may require additional documentation depending on the vendor's situation. With a typical processing time of three to five business days, it is crucial that all requested information is accurately filled out to prevent delays. The VA emphasizes the importance of the Privacy Act in its operations, assuring vendors that their personal data will be handled in compliance with applicable laws. Before submission, it is advised to check all entries and utilize the provided contact information for any questions.

Va 10091 Example

OMB Approved No. 2900-0846

Respondent Burden: 15 Minutes

Expiration Date: 07-31-2019

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VA-FSC VENDOR FILE REQUEST FORM

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NEW

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

UPDATE

DATE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VA FACILITY INFORMATION

 

 

 

 

 

 

 

 

 

 

 

 

PAYEE/VENDOR INFORMATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STATION NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

COMMERCIAL VENDOR REGISTERED IN SAM.GOV

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Required IAW FAR 4.1102)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STATION CONTACT

 

 

 

 

 

 

 

 

 

 

 

 

DUNS NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STATION PHONE NUMBER

STATION FAX NUMBER

 

 

 

DUNS+4

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STATION EMAIL ADDRESS

 

 

 

 

 

 

 

 

 

 

 

 

SSN/TIN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PAYEE/VENDOR TYPE (Select one)

 

 

 

 

 

 

 

 

 

 

 

 

NPI

 

 

 

 

 

 

 

 

 

 

C - COMMERCIAL

 

 

 

F - FEDERAL AGENCY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E - EMPLOYEE

 

 

 

O - FOREIGN FACTS ID

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SMALL BUSINESS - PAYEE/VENDOR MUST BE QUALIFIED AS SMALL

 

 

 

 

 

 

I - INDIVIDUAL/HONORARIUM

 

 

 

A - AGENT CASHIER

 

 

 

 

 

 

 

 

 

 

BUSINESS IN SAM OR FURNISH SBA CONFIRMATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PAYEE/VENDOR NAME

 

 

 

 

 

 

 

 

 

 

V - VETERAN

 

 

 

U - UTILITY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MISCELLANEOUS ACTIONS (Select one)

 

 

 

 

 

 

 

 

 

 

 

 

DBA

 

 

 

 

 

 

 

 

 

 

WINRS

 

 

 

ASSIGNMENT (All applicable documents)

 

 

 

 

 

 

 

 

 

 

BILL OF COLLECTIONS

 

 

 

SETTLEMENT/TORTS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CONTACT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ALAC/LGY ACCOUNT #

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EMAIL ADDRESS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PHONE NUMBER

 

 

 

 

 

 

 

 

 

 

 

FOR QUESTIONS REGARDING THIS FORM:

 

 

 

 

 

 

 

 

 

 

 

 

 

NVF CONTACT INFORMATION:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VA-FSC CUSTOMER SERVICE HELP DESK:

 

 

 

 

 

CURRENT ADDRESSS (Include Street, City, State and Zip Code)

 

 

 

 

 

 

 

PHONE: 512-460-5380

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EMAIL: VAFSCCSHD@VA.GOV

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FOR ALL OTHER INQUIRIES:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CUSTOMER CARE CENTER: 1-877-353-9791

 

 

 

 

 

PREVIOUS ADDRESSS (Include Street, City, State and Zip Code)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STATION CARE CENTER: 1-866-372-1141

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SUBMIT ALL DOCUMENTATION VIA:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECURE FAX: 512-460-5221

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EFT/ACH (Required IAW 31 CFR Part 208)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

BANK NAME

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

BANK ADDRESSS (Include City, State and Zip Code)

 

 

 

 

 

 

NINE-DIGIT BANK ROUTING NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ACCOUNT NUMBER

 

 

 

 

 

 

PRIVACY ACT STATEMENT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The following information is provided to comply with the Privacy

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Act of 1974 (P.L. 93-579). All information collected on this form

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

is required under the provisions of 31 U.S.C. 3322 and 31 CFR

 

ACCOUNT TYPE

 

 

 

 

 

 

210. This information will be used by the Treasury Department to

 

 

 

CHECKING

 

 

SAVINGS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

transmit payment data, by electronic means to vendor's financial

 

NAME AND TITLE OF PAYEE/VENDOR

 

 

 

 

 

 

institution. Failure to provide the requested information may delay

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

or prevent the receipt of payments through the Automated

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Clearing House Payment System.

 

SIGNATURE OF PAYEE/VENDOR

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NORMAL PROCESSING TIME IS 3 - 5 BUSINESS DAYS. WE DO NOT ACCEPT INVOICES

VA FORM 10091

SEP 2017

Instructions for FMS Vendor File Request Form

1.NEW box option - Check box if you are a new vendor not in the FMS system.

2.UPDATE box option - Check box if you are an existing vendor in the FMS system.

VA Facility Information

3.Station # - This portion pertains to the VA Station submitting this form, provide your station 3 digit station number. FOR STATION USE

ONLY

4.Station Contact Name - VA Station employee. FOR STATION USE ONLY

5.Station Phone - VA Station employee direct number. FOR STATION USE ONLY

6.Station Fax Number - VA Station fax number. FOR STATION USE ONLY

7.Station Email - VA Station employee work email address. FOR STATION USE ONLY

Payee/Vendor Type - Check the appropriate Payee/Vendor Type box. REQUIRED

Miscellaneous Actions - Check the appropriate Payee/Vendor Type box, some additional documentation required.

OPTIONAL

·ALAC Vendors - USE ONLY IF ALAC include the 6 digit account number

·Assignment of Claims- USE ONLY IF ASSIGNMENT include Notice of Assignment & Instrument of Assignment

·Federal Vendors- USE ONLY IF FEDERAL AGENCY include the 2 digit Facts

·Foreign Vendors- USE ONLY FOR FOREIGN COUNTRY include W8Ben with foreign identification number

Payee/Vendor Information

8.Commercial Vendor Registered in SAM.gov - If you are registered in System of Awards Management & have a DUNS number check this box. OPTIONAL

9.DUNS # - Data Universal Numbering System (DUNS) is a unique 9-digit number that is administered by Dun and Bradstreet (D&B)

OPTIONAL

10.DUNS+4 - If you have more than one EFT account number for the same DUNS number and same physical location as defined by the DUNS address complete this section. OPTIONAL

11.SSN/TIN - The Social Security Number (SSN) is the nine-digit number. The Tax Identification Number (TIN) is the nine-digit number which is either an Employer Identification Number (EIN); complete this section with SSN, TIN, EIN or ITIN. REQUIRED

12.NPI - A standard 10 digit unique identifiers for health care providers, complete this section if applicable. OPTIONAL

13.Small Business - Check box if applicable OPTIONAL

14.Vendor Name - Provide legal name as it is on file with the IRS REQUIRED

15.DBA - Doing Business As name complete if applicable OPTIONAL

16.Contact - Name of Point of Contact if additional information is required OPTIONAL

17.Email - Point of Contact email address OPTIONAL

18.Phone - Point of Contact phone number OPTIONAL

19.Current Address - Provide your most current address, city, state & zip code REQUIRED

20.Previous Address - Provide previous address, city, state and zip code REQUIRED FOR ADDRESS CHANGES

EFT/ACH (REQUIRED IAW 31CFR Part 208)

21.US. Bank Name - provide financial institution name city, state & zip code. REQUIRED

22.US. Nine-Digit Bank Routing Number - Provide 9 digit routing number from check ( DO NOT use Deposit slip routing number)

REQUIRED

23.US. Account # - Provide bank account number maximum 17 digits REQUIRED

24.Account Type - Check appropriate box that is associated with account number provide above REQUIRED

25.Name & Title of Payee/Vendor - REQUIRED

26.Signature of Payee/Vendor - REQUIRED

Please fax the completed form to 512-460-5221 for processing.

PRIVACY ACT NOTICE: The following information is provided to comply with the Privacy Act of 1974 (P.L. 93-579). All information collected on this form is required under the provisions of 31 U.S.C. 3322 and 31 CFR 210. This information will be used by the Treasury Department to transmit payment data, by electronic means to vendor's financial institution. Failure to provide the requested information may delay or prevent the receipt of payments through the Automated Clearing House Payment System.

RESPONDENT BURDEN: The Nationwide Vendor File Division needs this information to establish, modify/change your VA Vendor Record.

31 U.S.C. 3322 and 31 CFR 210, allow us to ask for this information. We estimate that you will need an average of 15 minutes to review the instructions, find the information, and complete this form. VA cannot conduct or sponsor a collection of information unless a valid OMB control number is displayed. You are not required to respond to a collection of information if this number is not displayed. Valid OMB control numbers can be located on the OMB Internet Page at www.reginfo.gov/public/do/PRAMain.

Form Characteristics

Fact Name Fact Detail
OMB Approval This form is OMB Approved under No. 2900-0846.
Respondent Burden Estimated time to complete is approximately 15 minutes.
Expiration Date The current expiration date for the form was July 31, 2019.
Vendor Registration Requirement Commercial vendors must be registered in SAM.gov as per FAR 4.1102.
Vendor Type Options Available types include Commercial, Federal Agency, Employee, Foreign, Individual, Honorarium, Agent, Small Business, Veteran, and Utility.
Privacy Act Compliance The form complies with the Privacy Act of 1974, ensuring the protection of collected information.
EFT/ACH Requirement Completing this form is necessary for Automated Clearing House payments, mandated by 31 CFR Part 208.
Contact Information The VA-FSC Customer Service Help Desk can be reached at 512-460-5380 for support.
Signature Requirement A signature from the payee/vendor on the form is required for processing.

Guidelines on Utilizing Va 10091

After completing the VA 10091 form, it needs to be submitted for processing. Ensure that all the required sections are filled out accurately to avoid delays in processing your request. Follow the steps below to complete the form correctly.

  1. Check the appropriate box indicating whether you are a new vendor or an existing vendor.
  2. In the VA Facility Information section, enter the three-digit station number.
  3. Provide the name of the station contact person.
  4. Input the direct phone number for the station contact.
  5. List the fax number for the station.
  6. Provide the work email address for the station contact.
  7. Check the box that represents the Payee/Vendor Type that applies to you.
  8. In the Miscellaneous Actions section, select the relevant option and include any necessary documents if applicable.
  9. If you are registered in SAM.gov, check the corresponding box and provide your DUNS number.
  10. If applicable, complete the DUNS+4 section by entering additional EFT account numbers.
  11. Input your Social Security Number (SSN) or Tax Identification Number (TIN).
  12. If you are a health care provider, provide your National Provider Identifier (NPI), if applicable.
  13. Check the box if you are a small business, if applicable.
  14. Provide your legal vendor name as recognized by the IRS.
  15. If you have a “Doing Business As” name, fill this out if applicable.
  16. Enter the name, phone number, and email of your point of contact for additional information, if needed.
  17. List your current address, including city, state, and zip code.
  18. If you are providing a previous address, include it as well.
  19. Fill in the bank name and the associated address for your financial institution.
  20. Provide your nine-digit bank routing number and account number.
  21. Indicate the type of account linked to the account number you provided.
  22. Enter your name and title as the vendor payee.
  23. Finally, provide your signature to verify the information.

Once the form is completed, submit it via fax to the designated number for processing. Double-check that all details are correct to ensure a smooth transaction.

What You Should Know About This Form

What is the VA Form 10091?

The VA Form 10091 is a Vendor File Request Form used by the Department of Veterans Affairs (VA) to gather necessary information from vendors or payees. This form is crucial for establishing or updating vendor records in the VA system. It includes sections for both vendor information and banking details required for electronic payments.

What information is required on the VA Form 10091?

Essential information needed includes the vendor's legal name, address, Tax Identification Number (TIN) or Social Security Number (SSN), and banking details such as the bank's name, routing number, and account number. Additionally, vendors must select their type and indicate any miscellaneous actions that apply to their situation.

How long does it take to complete the VA Form 10091?

The estimated time to complete the VA Form 10091 is approximately 15 minutes. This includes reviewing the instructions, gathering necessary information, and filling out the form accurately.

How do I submit the completed VA Form 10091?

Once filled out, the completed form must be submitted via secure fax to the number 512-460-5221. It’s essential to ensure that all required fields are completed to avoid delays in processing.

What happens after I submit the VA Form 10091?

After submission, the VA will process the form. The normal processing time is 3 to 5 business days. The information submitted will be used to establish or update your vendor record in the VA system for future payment processing.

Who should I contact for questions related to the VA Form 10091?

For questions specifically about the VA Form 10091, you can reach the VA-FSC Customer Service Help Desk at 512-460-5380 or email VAFSCCSHD@VA.GOV. They can provide assistance and clarification regarding the form and the submission process.

What is the purpose of the DUNS number in the VA Form 10091?

The DUNS number, or Data Universal Numbering System number, is a unique nine-digit identification assigned to businesses. It is used by the VA to verify the vendor's identity and to ensure accurate and secure payment processing. Vendors must provide their DUNS number if they have one, as it is considered beneficial during the registration process.

Is it mandatory to be registered in SAM.gov to complete the VA Form 10091?

While it is not mandatory to be registered in the System for Award Management (SAM.gov) to submit the VA Form 10091, it is strongly recommended. Registration in SAM.gov streamlines the process and is required for certain types of vendors to be eligible for government contracts.

What should I do if I have moved since the last time I submitted the VA Form 10091?

If you have moved, you must provide your current address on the form. In addition, you should fill in your previous address to ensure that the VA can update their records correctly. Accurate address information helps prevent payment delays.

What are the consequences of not providing the required information on the VA Form 10091?

Failing to provide the required information could lead to delays in processing your vendor application or updates. Incomplete forms may also result in an inability to receive payments through the Automated Clearing House Payment System, negatively impacting financial transactions with the VA.

Common mistakes

Filling out the VA 10091 form can be a straightforward process, but many people make common mistakes that can lead to delays or issues down the road. Understanding these pitfalls can help ensure smooth processing. Here are seven frequent errors to avoid when completing the form.

First, many applicants fail to select the correct Payee/Vendor Type. This section requires careful attention, as choosing the wrong type can hinder your application. Make sure you read each option thoroughly and select the one that accurately reflects your status, such as individual, employee, or commercial vendor.

Another common mistake is leaving out essential information like the DUNS number or the Social Security Number (SSN) / Tax Identification Number (TIN). These numbers are crucial for identifying and processing your account, so double-check that you've included them accurately. Omitting them may lead to significant processing delays.

A third mistake occurs when applicants do not provide their current and previous addresses correctly. Ensure both addresses are complete, including city, state, and zip code. Missing or incorrect information can create confusion and slow down your application.

Additionally, some users neglect to specify whether they are a new or existing vendor by marking the appropriate box. It's a simple step, but one that is often overlooked, which may complicate the processing of your form.

Inaccuracies in the bank information section can also cause problems. It is essential to provide correct bank details, including the nine-digit routing number and account number. Even a small error could prevent the timely processing of payments.

Another issue arises when applicants fail to check if they are registered in SAM.gov. This registration is mandatory for commercial vendors. If you miss this step, it can delay your application process as well.

Finally, don't forget to sign the form. The signature of the payee/vendor is a crucial part of the application. Without it, your submission will be considered incomplete and will likely be returned.

By avoiding these common mistakes, you can help ensure that your VA 10091 form is processed without delay. Take your time, review your information, and double-check for accuracy before submitting the form.

Documents used along the form

The VA Form 10091 is primarily used for vendor registration and updating information within the Veteran Affairs system. There are several other forms and documents that are often needed in conjunction with the VA Form 10091. Below is a list of these related documents along with a brief description of each. Understanding these documents can facilitate a smoother process for registering or updating vendor information.

  • VA Form 21-4142: This form, also known as the Authorization to Disclose Information to the Department of Veterans Affairs, allows veterans to authorize the release of their personal medical or other records from healthcare providers to the VA.
  • W-9 Form: This form is used to provide the IRS with a Taxpayer Identification Number (TIN). Vendors must submit this for tax reporting purposes and to confirm their status as a business entity.
  • VA Form 10-2210: This document is the application for a VA federally recognized vendor to obtain a unique identifier. It is often utilized by healthcare providers seeking to work with the VA.
  • DBA Registration: If a vendor operates under a doing business as name, they need to include registration documentation. This proves that the business name is legally recognized.
  • EFT Authorization Form: Required to set up electronic payment transfers, this form provides the necessary banking details for vendors to receive payments directly to their accounts.

Utilizing these forms, in addition to the VA Form 10091, can streamline the registration process for vendors interacting with the VA. It is important for vendors to ensure that all necessary documentation is completed accurately to avoid delays in processing.

Similar forms

The VA Form 10091 is a vendor file request form, but several other forms serve similar purposes within different contexts. Here are six documents similar to the VA 10091 form:

  • W-9 Form: This form is used to provide taxpayer identification information to an organization so they can correctly report income to the IRS. Like the VA 10091, it collects essential financial and identification data, such as the tax identification number (TIN).
  • SAM Registration Form: The System for Award Management (SAM) registration collects vendor information for federal contracts. Similar to the VA 10091, it requires details like the DUNS number and banking information to facilitate electronic payments.
  • Form 5500: This form is utilized by employers to report information about employee benefit plans. It is similar because both forms require detailed information regarding the organization and its financial structure.
  • ACH Authorization Form: This document authorizes electronic transfers of funds. The process parallels the VA 10091 in that it requires bank details and serves the purpose of setting up efficient payment methods.
  • Vendor Registration Form: Many organizations use vendor registration forms to gather information about suppliers. Like the VA 10091, this form collects vendor identification, assessment of business size, and contact information.
  • IRS Form 8862: This form is filed by taxpayers who previously had their Earned Income Tax Credit (EITC) denied but wish to claim it again. Similarity lies in the need for providing personal and financial information to rectify prior discrepancies, much like what is required in the VA 10091.

Dos and Don'ts

When filling out the VA 10091 form, there are several important guidelines to keep in mind to ensure a smooth application process. Below is a helpful list of things to do and avoid.

  • Do check the appropriate box to indicate whether you are a new vendor or updating your information, as this is crucial for processing your application correctly.
  • Do provide your current and previous addresses accurately, including street names, city, state, and zip code. This information is essential for verifying your identity and locating your records.
  • Do ensure that your SSN or TIN is entered correctly. Double-check these numbers as errors can cause delays in payment processing.
  • Do include all required documents if you're applying as a specific vendor type that requires additional information, such as the Assignment of Claims or W8Ben forms for foreign vendors.
  • Do fax the completed form to the designated number promptly to avoid any unnecessary delays in your application.
  • Don't leave any required fields blank. Each section requesting information is crucial for your submission to be complete.
  • Don't use incorrect or outdated information, especially regarding your bank details. Use your current bank routing and account numbers to ensure payments are processed smoothly.
  • Don't forget to sign the form. An unsigned application may be rejected or cause processing delays.
  • Don't send invoices along with this form. The VA cannot process invoices through this vendor registration form.
  • Don't submit documentation via email unless specified. Use the secure fax number provided for all documentation submissions.

By following these dos and don'ts, you can help ensure a more efficient and effective application process for your VA vendor registration.

Misconceptions

Here are some common misconceptions about the VA Form 10091:

  • It's only for new vendors. Many believe this form is solely for new vendors. In reality, it is also used by existing vendors who need to update their information.
  • You cannot track the submission process. Some think that once they submit the form, they have no way to know its status. However, vendors can contact the customer service help desk to inquire about their application.
  • Only large businesses need to fill it out. There is a misconception that only large commercial vendors use this form. In truth, it is designed for various types of payees and vendors, regardless of their size.
  • It requires extensive documentation. Many feel overwhelmed by the thought of gathering extensive documentation. Although certain additional documents may be needed for specific types of vendors, much of the required information is straightforward and manageable.

Key takeaways

When filling out the VA 10091 form, consider these key takeaways:

  • Understand the purpose: The form is used to establish or update vendor information in the VA's vendor file.
  • Processing time: After submission, expect a normal processing time of 3-5 business days.
  • Submission methods: Fax the completed form to 512-460-5221 for processing.
  • Required fields: Ensure all mandatory information is filled, including the payee/vendor name and financial details.
  • New vs. Existing: Mark the appropriate box to indicate if you are a new vendor or updating existing information.
  • Vendor registration: If applicable, confirm registration in SAM.gov and include your DUNS number.
  • Address updates: Provide both current and previous addresses when necessary.
  • Financial information: Accurately fill in your bank's details, including routing and account numbers, to enable electronic payments.
  • Privacy notice: Be aware that the information collected is protected under the Privacy Act of 1974.
  • Contact information: Provide a point of contact with a phone number and email for follow-up questions.