VA Form FL-10-90: Request to Submit Quotation (Download)

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 allows VA facilities to request detailed price quotations from vendors for goods or services, most commonly prosthetic devices, medical equipment, repairs, or related supplies for veterans.

Revised in September 2008 (with OMB Number 2900-0188), this form streamlines procurement while ensuring cost-effectiveness for veteran care. It is not a purchase order and does not authorize delivery or work to begin.

Download the official fillable PDF here: VA Form FL-10-90 (PDF) Download Here.

Who Uses VA Form FL-10-90?

  • VA Facilities & Prosthetics Services: VA medical centers (VAMCs) and prosthetics representatives use Section I to identify vendors and list required items or services for veterans.
  • Vendors & Suppliers: Medical equipment providers, prosthetic manufacturers, repair services, and other qualified businesses complete Section II with itemized estimates.

This form primarily supports VA’s efforts to provide high-quality, cost-effective care to veterans through community vendors when appropriate.

Purpose and Importance of the VA Request to Submit Quotation

The main purpose of FL-10-90 is to solicit competitive, accurate quotations so the VA can select the most cost-effective provider while maintaining quality standards for veteran care. Key benefits include:

  • Ensures transparency and compliance with federal procurement rules.
  • Allows vendors to evaluate needs (including direct veteran contact for assessments).
  • Separates the quotation process from actual purchase orders.
  • Supports timely provision of prosthetics, durable medical equipment (DME), repairs, and other items.

Note: Quotations are typically expected within 5 business days unless otherwise arranged.

How to Fill Out VA Form FL-10-90 as a Vendor (Step-by-Step)?

Section I (Completed by VA Facility)

This section includes:

  • Vendor and VA facility contact information.
  • Veteran details (name, phone).
  • Description of required items/services (often with HCPCS codes).

Section II (Vendor’s Estimate)

  1. Review the items/services listed.
  2. Contact the veteran if needed for evaluation or additional details (authorized by the form).
  3. Provide an itemized estimate, clearly separating materials and labor costs.
  4. Fill in the table: HCPCS (if applicable), Item/Service, Quantity, Unit, Unit Cost, Total Cost.
  5. Add subtotals, discounts (if any), and grand total.
  6. Include company official’s name, title, and date.
  7. Return via fax or as instructed to the VA facility.

Important: This is only a quote — do not start work or deliver items until you receive a formal purchase order.

Common Use Cases for VA Form FL-10-90

  • Prosthetic limbs and components.
  • Wheelchairs, hospital beds, and other DME.
  • Medical equipment repairs.
  • Custom orthotics or specialized supplies.
  • Home modification-related items.

Vendors familiar with VA processes often receive this form after a veteran’s prescription or consult is submitted to the prosthetics department.

Tips for Vendors Submitting Quotations to the VA

  • Be competitive yet realistic on pricing to improve selection chances.
  • Ensure estimates are detailed and accurate to avoid delays.
  • Respond promptly within the 5-business-day window.
  • Maintain compliance with VA vendor requirements and any applicable federal regulations.
  • Keep a copy of the form and correspondence for your records.

Where to Find More VA Forms and Resources

For official information, visit the VA Forms Library: VA.gov Forms.

Vendors interested in becoming VA suppliers should explore VA contracting opportunities and registration requirements through the appropriate channels.

Official Download Link: VA Form FL-10-90 Fillable PDF Download Official Form.

This article provides general guidance based on official VA sources. Always refer to the latest instructions on the form or contact the requesting VA facility for specific questions. Information is current as of the form’s revision and associated federal notices.