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Get VA Form 21-2680, Examination for Housebound Status or Permanent Need for Regular Aid and Attendance. Use this VA form to apply for Aid and Attendance benefits that will be added to your monthly compensation or pension benefits.
Use this form to determine eligibility for aid and attendance or housebound benefits. For more. information, you can contact us online through Ask VA: https://ask.va.gov/. Ask us a question online or call us toll-free at 1-800-827-1000 (TTY: 711). VA forms are available at www.va.gov/vaforms.
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Fill out VA Form 21-2680 (Examination for Housebound Status or Permanent Need for Regular Aid and Attendance), You can have your doctor fill out the examination information section. Get VA Form 21-2680 to download
VA Form 21-2680 can help support your claim for VA aid and attendance benefits to either disability compensation or non-service-connected pension claims.
You may apply for Aid and Attendance or Housebound benefits by submitting the prescribed VA form(s) to the Pension Management Center (PMC) that serves your state. You may also visit your local regional benefit office to file your request.
purpose of determining your eligibility to receive VA benefits, as well as to collect any amount owed to the United States by virtue of your participation in any benefit program administered by the Department of Veterans Affairs.
VA Form 21-2680, and also include the following: • VA Form 21P-8416, Medical Expense Report, if claiming care expenses. • VA Form 21-0779, Request for Nursing Home Information in
PENALTY: The law provides severe penalties which include fine or imprisonment, or both, for the willful submission of any statement of a material fact, knowing it to be false or for the fraudulent acceptance of any payment to which you are not entitled. VA FORM 21-2680, SEP 2018. Page 3.
Print, fill out, and mail or bring VA Form 21-2680 (PDF) to your nearest VA benefits office. A VA pension may provide income to make life more secure for Veterans and their loved ones.