VA Form FL-10-90: Request to Submit Quotation | Download – VA Form FL-10-90, officially titled Request to Submit Quotation, is a standardized form used by the U.S. Department of Veterans Affairs (VA). It enables VA facilities—primarily Prosthetics and Sensory Aids Services—to request price quotations from vendors for medical equipment, prosthetic devices, repairs, or related services for veterans.
This form streamlines procurement by gathering competitive, itemized estimates before issuing a formal purchase order. It is not a purchase order or authorization to begin work or delivery.
Purpose and Importance of VA Form FL-10-90
The primary purpose of VA Form FL-10-90 is to help VA secure cost-effective quotations for items or services needed by veterans, ensuring compliance with federal procurement rules while supporting timely care.
It is commonly used for:
- Prosthetic devices and repairs
- Durable medical equipment (DME)
- Home modifications or related services
- Other specialized items prescribed for veteran care
By requesting detailed estimates, the VA can compare options, control costs, and ensure veterans receive high-quality, appropriately priced support. Vendors benefit from a structured process to bid on VA opportunities.
Who Uses VA Form FL-10-90?
- VA Facilities: Prosthetics staff at VA Medical Centers (VAMCs) complete Section I with vendor details, veteran information, and a list of required items or services.
- Vendors/Suppliers: Approved or potential suppliers fill out Section II with itemized pricing, including materials, labor, discounts, and totals.
- Veterans: Indirectly benefit as the form facilitates access to necessary equipment without direct involvement in the quoting process.
This form supports the VA’s mission to provide efficient, veteran-centered healthcare procurement across the United States.
How to Download VA Form FL-10-90?
The official, fillable version is available directly from the VA website. Always download the latest form from an official source to ensure compliance.
Download VA Form FL-10-90 (Fillable PDF)
Form revision date: September 2008 (still current as of 2026). OMB Number: 2900-0188. Estimated completion time: 5 minutes.
Step-by-Step Guide to Completing VA Form FL-10-90
For VA Facility Staff (Section I)
- Provide vendor name, address, phone, and fax.
- Enter requesting VA facility details.
- Include veteran information (name, phone).
- List specific items/services with HCPCS codes (if known), quantity, and description.
- Have the approving official sign and date.
For Vendors (Section II)
- Review the requested items.
- Contact the veteran if needed for evaluation (authorized by the form).
- Provide an itemized estimate: separate materials and labor, include unit costs, quantities, subtotals, discounts, and grand total.
- Sign and date as the company official.
- Return via fax or as instructed within 5 business days unless otherwise arranged.
Important Note: Submitting a quotation does not authorize work or delivery. A separate purchase order must be issued first.
Key Instructions and Privacy Information
The form includes Privacy Act and Paperwork Reduction Act notices. Information is used to determine the most cost-effective provider under Title 38 U.S.C. Disclosure is voluntary but required for processing. Data may be shared as permitted by law.
Vendors should provide the most accurate estimate possible based on assessment.
Common Use Cases: Prosthetics and Medical Equipment
VA Form FL-10-90 is frequently used in the prosthetics procurement workflow. After a prescription or consult, VA staff send the form to selected vendors for quotes on items like artificial limbs, wheelchairs, or repairs. Once the best quote is selected, a purchase order follows.
This process ensures veterans receive timely, high-quality equipment while maintaining fiscal responsibility.
Tips for Vendors Responding to VA Form FL-10-90
- Respond promptly (within 5 business days) to strengthen your relationship with VA facilities.
- Itemize thoroughly and separate material/labor costs.
- Ensure pricing is competitive and compliant with any VA contracts or schedules.
- Retain a copy for your records.
- Contact the listed VA approving official with questions.
Vendors interested in doing business with the VA should also explore registration on SAM.gov and VA-specific vendor programs.
Where to Find More VA Forms and Resources?
For additional VA forms and procurement information, visit the official VA Forms page:
VA Forms Portal
Learn more about VA health benefits, prosthetics services, and vendor opportunities through your local VA Medical Center or the main VA website.
Conclusion
VA Form FL-10-90 plays a vital role in the efficient procurement of medical supplies and services for America’s veterans. Whether you are a VA staff member, vendor, or veteran advocate, understanding this form helps ensure smooth processes and better outcomes for those who served.
Download the form today and reference official VA resources for the most accurate guidance. This article is for informational purposes and does not replace official VA instructions.