VA Resident Processing

Preparing for Rotation at VA Hospital

One of the possible rotations for a resident may be at the Louis Stokes Cleveland Veterans Affairs Medical Center. To insure a smooth transition into the VA system, please submit a complete application packet, as described below. These forms are necessary to provide you with computer access and to provide coverage against any Federal Tort (Malpractice Claims).

Submit the completed application packet to the VA Medical Center at this mailing address:

Associate Chief of Staff for Education 14(W)
Louis Stokes Cleveland VA Medical Center
10701 East Boulevard
Cleveland, OH 44106

Please submit all 7 of the following documents together to create a complete application packet. Use your local contact information whenever possible. Submit your completed application packet at least one month before your first day at the VA. Where signatures are required, you must sign by hand. When printing, please print single-sided. Improperly completed application packets may delay your onboarding, so read carefully.

  1. Application for Health Professions Trainees (10-2850D)
    • Download from U.S. Department of Veterans Affairs and complete document to the fullest extent possible
    • Often missed items: 15, 16, 17, 19; if you haven’t received your NPI yet, you may leave item 15 blank; if you have an NPI, you must include it in item 15
    • Place your name and SSN at the top of pages 2, 3, & 4; sign and date on page 4
  2. Declaration of Federal Employment (OF 306)
    • Download from U.S. Department of Veterans Affairs and complete document to the fullest extent possible
    • Assure that you explain a response of “No” to 7b (if you are male) and any responses of “Yes” to items 9 – 15, in the space provided in field 16.
    • Sign and date on BOTH 17a and 17b
  3. Appointment Affidavits (SF61)
    • Download the SF61 and do ONLY the following:
    • Print your name on the line between “I,” and “, do solemnly swear…”
    • Sign on the line that says “Signature of Appointee”
    • DO NOT HAVE THIS FORM NOTARIZED, we will process it for you at no charge
  4. WOC Appointment Letter
    • Download items 4-7 (WOC, VA ID, and Personnel Health Form)
    • Print your name on the highlighted line at the top
    • Circle your responses to the 3 highlighted items
    • Sign and date on the highlighted line at the bottom
  5. VA Identification Form
    • Include your NPI# if you have one
    • Complete all fields with your local information, if at all possible
  6. Personnel Health Form
    • Complete all fields
  7. Certificate of completion for VA Mandatory Training for Trainees (MTT)
    • Download MTT instructions for completing this online course in our Talent Management System (TMS)
    • Complete the online training
    • Print the certificate of completion and submit that with your application packet
    • If you have any difficulties with this step, please contact the person indicated for your specialty on the last page of the MTT instructions (link above)
  8. VA Access / PIV and CPRS forms
    • Complete the VA Access / PIV form completely and submit to VA Servicing ADPAC contact (VA Servicing ADPAC list is an Excel spreadsheet labeled entitled tms-posting-for-residents-2019; Scroll to the bottom of the attachment and find your service)
    • Review the Steps to Getting a PIV card
    • Complete the PIV Card Application and submit to VA Servicing ADPAC contact
    • Please complete the CPRS Training (Computerized Patient Records System) form by following this link

For additional information, please call the Education Office at the Louis Stokes Cleveland VA Medical Center at 216-791-3800

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