VA Form 10-9055: GME Affiliation Agreement Guide

VA Form 10-9055: GME Affiliation Agreement Guide – If your academic institution sponsors accredited graduate medical education (GME) programs and you want to train residents or fellows at a Department of Veterans Affairs (VA) medical facility, VA Form 10-9055 is the required foundational legal document. This Graduate Medical Education Affiliation Agreement establishes the formal relationship between the VA and institutions sponsoring GME programs. It defines roles, responsibilities, compliance requirements, and liability protections while supporting VA’s statutory mission to train health professionals under VHA Directive 1400.03.

This guide explains everything U.S. GME program directors, Designated Institutional Officials (DIOs), VA Designated Education Officers (DEOs), and academic affiliates need to know about VA Form 10-9055, including its purpose, how to complete it correctly, signature requirements, and current official resources.

What Is VA Form 10-9055?

VA Form 10-9055, officially titled “Graduate Medical Education Affiliation Agreement Between Department of Veterans Affairs (VA) and Institutions Sponsoring Graduate Medical Education,” is the standard template used to create a master affiliation agreement. The current version is dated August 2018 and remains the active form hosted on va.gov.

It is an 8-page fillable PDF that creates a binding agreement between a VA medical center (and its Veterans Integrated Service Network) and a Sponsoring Institution (the “Affiliate”) that operates ACGME-accredited or AOA-accredited GME programs. The agreement does not create automatic training slots or funding; it provides the legal and philosophical framework for subsequent Program Letters of Agreement (PLAs) and trainee rotations.

Purpose and Importance of the GME Affiliation Agreement

The primary purpose of VA Form 10-9055 is to:

  • Enable clinical training of residents and fellows at VA facilities while protecting VA patients and resources.
  • Clarify that the Sponsoring Institution retains primary responsibility for the educational program and accreditation, while the VA retains full responsibility for patient care and administration of its healthcare system.
  • Ensure compliance with federal laws (including HIPAA, the Federal Tort Claims Act, and civil rights statutes) and VA policies in the 1400 series.
  • Support VA’s mission under 38 U.S.C. § 7302 to provide education and training for health personnel.

According to VHA Directive 1400.03 (Educational Relationships), an affiliation agreement must be in place before any Health Professions Trainees (HPTs) from an affiliate-sponsored GME program can receive clinical training involving patient contact or protected health information at a VA facility.

Who Needs VA Form 10-9055?

You need this agreement if:

  • Your institution sponsors ACGME- or AOA-accredited residency or fellowship programs.
  • You plan to send trainees to a VA medical center for clinical rotations (one month or longer typically requires a Program Letter of Agreement in addition to this master agreement).
  • You are a VA medical center, VISN, or Office of Academic Affiliations (OAA) official responsible for establishing or renewing GME affiliations.

Both new affiliations and renewals of expiring agreements require execution of this form. Short-term or observational experiences may still require the master agreement if patient contact or PHI access occurs.

Key Requirements from VHA Directive 1400.03

VHA Directive 1400.03 (published February 23, 2022) governs educational relationships and affiliation agreements. Key rules include:

  • Affiliation agreements must use the approved OGC-reviewed template without amendment (changes require OAA and Office of General Counsel approval).
  • All GME affiliation agreements require signatures at the VA medical facility, VISN, and OAA levels.
  • Agreements are valid for a maximum of 10 years and should expire on June 30 of the chosen year.
  • Program Letters of Agreement (PLAs) supplement but cannot replace or amend the master affiliation agreement.
  • The Sponsoring Institution must maintain accreditation and verify trainee qualifications through the Trainee Qualifications, Credentials, and Verification Letter (TQCVL) process.

How to Complete VA Form 10-9055 Step by Step?

VA Form 10-9055 is a fillable PDF. Do not alter the standard legal language. Follow these steps:

  1. Download the current form from the official VA website (link below).
  2. Coordinate with your local VA contact — usually the Designated Education Officer (DEO) or Education Office at the target VA medical center. They will guide the process and provide facility-specific information.
  3. Complete the fillable fields:
    • VA Medical Center name and location
    • Veterans Integrated Service Network (VISN) / Network
    • Sponsoring Institution (Affiliate) name
    • Accrediting Body (ACGME or AOA selection)
    • ACGME program number(s) if applicable
    • Proposed end date of the agreement (maximum 10 years from start, ending June 30)
  4. Review all sections — Background/Recitals, Definitions, Responsibilities (VA and Affiliate), Trainee Supervision, Liability, Term/Termination, and Compliance provisions (HIPAA, drug-free workplace, non-discrimination, etc.).
  5. Obtain required signatures in the proper order (typically Affiliate leadership first, followed by VA facility, VISN, and finally OAA Chief Academic Affiliations Officer).
  6. Retain fully executed copies at both the VA facility and the Sponsoring Institution. Agreements are considered educational activity records.

Important: The form must be duly executed and approved by the Department of Veterans Affairs before any trainee rotations begin.

Download VA Form 10-9055 Fillable PDF

Download VA Form 10-9055 (Fillable PDF) — Official current version (August 2018)

Also available on the dedicated form page: VA Form 10-9055 – va.gov

Responsibilities of the VA and the Sponsoring Institution

VA Responsibilities (Medical Center, VISN, and OAA)

  • Provide a safe, appropriate learning environment and necessary resources for training.
  • Appoint qualified VA staff as supervisors and Site Directors.
  • Handle trainee appointments (paid or Without Compensation/WOC), onboarding, and orientation (including Mandatory Training for Trainees).
  • Ensure compliance with duty-hour rules, supervision standards, and patient safety.
  • Notify the Affiliate of relevant updates to VHA Directives and Handbooks in the 1400 series.
  • Retain full authority over VA patient care and facility operations.

Sponsoring Institution (The Affiliate) Responsibilities

  • Maintain ACGME or AOA accreditation for all GME programs.
  • Develop Program Letters of Agreement (PLAs) for specific rotations lasting one month or longer.
  • Select and verify trainee qualifications, credentials, immunizations, and background checks via the TQCVL process.
  • Provide faculty development and ensure faculty meet VA appointment and privileging requirements.
  • Monitor the learning environment and address accreditation standards (meals, transportation, fatigue mitigation, etc.).
  • Acknowledge VHA Directive 1400.09 (or current overriding GME policy) and inform trainees that VA is a drug-free workplace subject to random testing per Executive Order 12564.

Term, Renewal, and Termination

The agreement remains in force until the date inserted by the parties (maximum 10 years, expiring June 30 of that year). Both parties should monitor the expiration date and begin renewal well in advance to prevent any lapse in training authority.

Termination may occur by mutual written consent (considering ongoing patient care and trainee commitments) or by either party providing at least six months’ written notice before the start of the next academic year.

Best Practices for Executing and Maintaining VA GME Affiliation Agreements

  • Start early — Multi-level signature routing (facility → VISN → OAA) can take several weeks to months.
  • Work closely with the local VA DEO from the beginning. They are your primary point of contact.
  • Do not modify template language without prior written approval from OAA and VA Office of General Counsel.
  • Use PLAs appropriately for rotation-specific details; they supplement but do not replace the master agreement.
  • Keep records — Retain executed agreements and related documents according to VA records retention policies (typically 7 years after program closure or agreement end).
  • Plan for renewal — Begin the renewal process 6–12 months before expiration.
  • Ensure TQCVL compliance for every trainee before they begin VA rotations.

Related VA Forms for Medical Education Affiliations

  • VA Form 10-9054 — Medical Education Affiliation Agreement for Undergraduate Medical Education (UME)
  • Disbursement agreement templates (when VA provides stipend funding) — coordinated through OAA
  • Program Letter of Agreement (PLA) templates — developed locally per ACGME requirements

Frequently Asked Questions About VA Form 10-9055

Is VA Form 10-9055 still current in 2026?

Yes. The August 2018 version remains the official fillable form posted on va.gov. VHA Directive 1400.03 (2022) continues to require use of approved affiliation agreement templates for GME.

Can I change or add language to the agreement?

No. The template must be used without amendment. Any requested changes to legal terms must be submitted through the Office of Academic Affiliations for review by the VA Office of General Counsel.

How long does it take to get a new affiliation agreement signed?

Timeline varies by facility workload and routing through VISN and OAA. Begin the process as early as possible and maintain close communication with the VA DEO.

Do short rotations (less than one month) still require this agreement?

The master affiliation agreement should be in place before any trainee has patient contact or access to protected health information. Specific short rotations are usually covered by a Program Letter of Agreement once the master agreement exists.

Who pays the trainees?

This agreement itself does not address funding. Stipend and benefit arrangements are handled separately through disbursement agreements or other mechanisms when VA funds positions.

Official Resources and References