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VA Aid and Attendance Application Instructions

You will need the following documents. Make sure you keep copies of everything you submit.

1. Your DD214 discharge papers or standard form 180. If you no longer have them in your possession go to:
http://www.archives.gov/veterans/military-service-records

2. Copy of your marriage certificate

3. Copy of death certificate (surviving spouse only)

4. Social Security award letter from January

5. Physician statement VDVA 10 required in Illinois

6. Net worth information - Bank accounts, CDs, trusts, stocks, bonds, annuities, etc.

7. Proof of income - Pensions, retirement, interest income from investments, annuities, etc.)

8. Proof of medical expenses – Insurance premiums, medications, medical bills and any other medical expenses that are not reimbursed by insurance, Medicare or Medicaid.

9. List of all doctors and hospitals visited in the last year.

10. Banking information for direct deposits of A&A monthly payments (include a voided check).

11. If you are a court-appointed Guardian of the veteran or surviving spouse, a certified copy of the court order of the appointment is required.

12. Employment history – Does not apply if applicant is over 65.

Fill Out These Forms:

VDA-21P-527EZ Vet or Couple Only

VBA-21P-534EZ Spouse Only

VBA21-2680 Exam for Housebound Status or Permanent Need

VDVA 10 Physician statement

VBA21P-84216 Medical Expense Report Form

VA21-4142 Consent Form

VBA21-0845 Authorization to Disclose Personal Information

VDA21P-8416 Medical Expense Form

VBA21-0779 Nursing Home Information Form (for those living in a facility)

*VA21-22 Appoint Veterans Service Organization as Rep

*VA21-22A Appoint Representative (Non-Service Organization)

*Fill out either VB21-22 or VA21-22A depending on who your advocate is. APPLY through an advocate to get the VA Aid and Attendance Benefit. Do not apply directly to the VA. Call 847-462-0885 for an advocate advocates in your area. The forms are available at

http://www.elderwerks.com/resources/guides/veterans-area-14-1.aspx

Elderwerks.org 855-462-0100

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