Va Form 10-0388-4 - State Home Construction Grant Programadult Day Health Care
Download a blank fillable Va Form 10-0388-4 - State Home Construction Grant Programadult Day Health Care in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Va Form 10-0388-4 - State Home Construction Grant Programadult Day Health Care with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3
4OMB Number 2900-0661
Estimated Burden: 6 hours
STATE HOME CONSTRUCTION GRANT PROGRAM-
ADULT DAY HEALTH CARE
PROJECT LOCATION
PROJECT NAME:
FAI#
NUMBER BEDS
IN PROJECT
PROPOSED BY
PROPOSED BY
TOTAL VA
TOTAL VA
Number of Participants
1. SUPPORT FACILITIES
VA CRITERIA
VA CRITERIA
in Program
STATE
STATE
ALLOWED
ALLOWED
ADMINISTRATOR'S OFFICE
200
ASST. ADMINISTRATOR
150
150
MEDICAL OFFICER, DIRECTOR OF NURSING OR EQUIVALENT
NURSES' OFFICE AND DICTATION AREA
120
(each office/person)
120
GENERAL ADMINISTRATION
120
120
120
120
120
120
120
120
MAY INCLUDE: MEDICAL RECORDS
120
SOCIAL SERVICES
120
RECEPTION / INFORMATION
120
CLERICAL STAFF (Each) #
80@
COMPUTER AREA
40
CONFERENCE ROOM / CONSULTATION AREA/IN-SERVICE TRAINING
500
3/PARTICIPANT
LOBBY / WAITING AREA
(150 min. 600
PUBLIC TOILETS (MALE, FEMALE)
25/FIXTURE
DIETETIC SERVICE
AR
AS REQUIRED
AR
DINING AREA
20/PARTICIPANT
CANTEEN, RETAIL SALES
2/PARTICIPANT
VENDING MACHINE
1/PARTICIPANT
PARTICIPANTS TOILETS
25/FIXTURE
MEDICAL SUPPORT (Each)
140@
140
140
140
140
140
MAIL ROOM
120
JANITORS CLOSET
40
VA FORM
Page 1 of 4
10-0388-4
MAR 2005
ADVERTISEMENT
0 votes
Related Articles
Related forms
Va Form 10-0388-3 - State Home Construction Grant Program Space Program Analysis - Nursing Home & Domiciliary
Legal
Va Form 10-0388-13 - Documents And Information Required For State Home Construction And Acquisition Grants - Post-grant Requirements
Legal
Va Form 10-0388-10 - Certification Of Compliance With Federal Requirements State Home Construction Grant
Legal
Va Form 10-0388-5 - Additional Documents And Information Required For State Home Construction And Acquisition Grants Application
Legal
Va Form 10-0388-14 - Checklist Of Major Requirements For State Home Construction/acquisition Grants
Legal
Va Form 10-0388-1 - Documents And Information Required For State Home Construction And Acquisition Grants Initial Application
Legal
Va Form 10-0388-11 - Memorandum Of Agreement For A Grant To Construct Or Acquire A State Veterans Home
Legal
Va Form 10-0388-6 - Certification Of State Matching Funds To Qualify For Group 1 On The Priority List
Legal
Related Categories
Parent category: Legal