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Use VA Form 21-0779 if you’re a resident of a nursing home and you're providing supporting information for your claim application for VA Aid and Attendance benefits.
VA uses this form to determine eligibility for pension and aid and attendance benefits based on nursing home status. For more information you can contact us online through Ask VA: https://ask. va.gov, or call us toll-free at 1-800-827-1000 (TTY:711). VA forms are available at www.va.gov/ vaforms.
If you’re in a nursing home, you’ll also need to fill out a Request for Nursing Home Information in Connection with Claim for Aid and Attendance (VA Form 21-0779). Get VA Form 21-0779 to download. Mail your completed form, and any evidence or additional information, to this address:
Download Fillable Va Form 21-0779 In Pdf - The Latest Version Applicable For 2024. Fill Out The Request For Nursing Home Information In Connection With Claim For Aid And Attendance Online And Print It Out For Free.
If you’re in a nursing home, you’ll also need to fill out a Request for Nursing Home Information in Connection with Claim for Aid and Attendance (VA Form 21-0779). Download VA Form 21-0779 (PDF)
21-0779 INSTRUCTIONS : If you have any questions about completing this form, call VA toll-free at 1-800-827-1000 (Hearing Impaired TDD federal relay number is 711).
We use this form to determine eligibility in connection with a claim for aid and attendance. For more information, contact us at https://iris.custhelp.va.gov, or call us toll-free at 1-800-827-1000. If you use a Telecommunications Device for the Deaf (TDD), the Federal relay number is 711.
The VA form 21-0779 “Request for Nursing Home Information In Connection With Claim for Aid and Attendance” is used only for certain non-service-connected pension claims, and its primary purpose is to document the level of care required by a claimant or a claimant’s dependent.
View, download and print fillable Va 21-0779 - Request For Nursing Home Information In Connection With Claim For Aid And Attendance - 2017 in PDF format online. Browse 3 Va Form 21-0779 Templates collected for any of your needs.
You can apply for VA Aid and Attendance or Housebound benefits in one of these ways: Send a completed VA form to your pension management center (PMC) Fill out VA Form 21-2680 (Examination for Housebound Status or Permanent Need for Regular Aid and Attendance) and mail it to the PMC for your state.