Home
Forms Library
OMB Approved No: 2900-0652 RESPONDENT BURDEN: 10 Minutes REQUEST FOR NURSING HOME INFORMATION IN CONNECTION WITH CLAIM FOR AID AND ATTENDANCE VA DATE STAMP (Do Not Write In This Space) INSTRUCTIONS: For free help in completing this form,

OMB Approved No: 2900-0652 RESPONDENT BURDEN: 10 Minutes REQUEST FOR NURSING HOME INFORMATION IN CONNECTION WITH CLAIM FOR AID AND ATTENDANCE VA DATE STAMP (Do Not Write In This Space) INSTRUCTIONS: For free help in completing this form,-2025

Show details

4 out of 5

53 votes

The document is a VA form requesting information from nursing homes to support claims for Aid and Attendance benefits. It includes sections for identification, nursing home details, patient care information, and medical expense reporting. The form aims to gather necessary data to determine eligibility for benefits and the appropriate payment rate, while ensuring compliance with privacy regulations.

Here's how it works

01. Edit your form online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send it via email, link, or fax. You can also download it, export it or print it out.

How to modify OMB Approved No: 2900-0652 RESPONDENT BURDEN: 10 Minutes REQUEST FOR NURSING HOME INFORMATION IN CONNECTION WITH CLAIM FOR AID AND ATTENDANCE VA DATE STAMP (Do Not Write In This Space) INSTRUCTIONS: For free help in completing this form, online

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

With DocHub, making changes to your paperwork requires only some simple clicks. Follow these quick steps to modify the PDF OMB Approved No: 2900-0652 RESPONDENT BURDEN: 10 Minutes REQUEST FOR NURSING HOME INFORMATION IN CONNECTION WITH CLAIM FOR AID AND ATTENDANCE VA DATE STAMP (Do Not Write In This Space) INSTRUCTIONS: For free help in completing this form, online free of charge:

Register and log in to your account. Sign in to the editor with your credentials or click on Create free account to test the tool’s capabilities.
Add the OMB Approved No: 2900-0652 RESPONDENT BURDEN: 10 Minutes REQUEST FOR NURSING HOME INFORMATION IN CONNECTION WITH CLAIM FOR AID AND ATTENDANCE VA DATE STAMP (Do Not Write In This Space) INSTRUCTIONS: For free help in completing this form, for redacting. Click on the New Document option above, then drag and drop the file to the upload area, import it from the cloud, or via a link.
Modify your document. Make any changes required: insert text and photos to your OMB Approved No: 2900-0652 RESPONDENT BURDEN: 10 Minutes REQUEST FOR NURSING HOME INFORMATION IN CONNECTION WITH CLAIM FOR AID AND ATTENDANCE VA DATE STAMP (Do Not Write In This Space) INSTRUCTIONS: For free help in completing this form,, underline important details, remove parts of content and substitute them with new ones, and add symbols, checkmarks, and fields for filling out.
Complete redacting the template. Save the modified document on your device, export it to the cloud, print it right from the editor, or share it with all the people involved.

Our editor is very easy to use and efficient. Try it now!

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How long does VA aid and attendance pay for a nursing home?

If the veteran or veterans surviving spouse is a patient in a nursing home, VA should automatically allow 12 months worth of nursing home costs to be applied as medical expenses.

Who fills out the VA aid and attendance form?

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. You can also include with your VA form: Other evidence, like a doctors report, that shows you need Aid and Attendance or Housebound care.

What is request for nursing home information in connection with claim for aid and attendance?

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 claimants dependent.

Do veterans get free nursing home care?

No, VA nursing homes do not take all your money. However, some veterans may have to pay a copayment based on their priority rating and financial status.