Va child care expense statement 2026

1. Click ‘Get Form’ to open the VA Child Care Expense Statement in the editor.
2. Begin by filling out Section 1: General Information. Enter the VA Claim Number or SSN, Veterans Name, and Patient’s Name. Select the appropriate care status by checking one of the boxes provided.
3. Provide details about the facility or care provider, including their name, phone number, and address. Indicate when the patient entered the facility or when in-home care began.
4. Answer whether the patient will need care indefinitely and provide total monthly charges. Also, indicate if they have applied for Medi-Cal (Medicaid) and if any costs are covered by insurance.
5. If applicable, complete Section 2 for In-Home Care Information by detailing services provided and confirming if you are a licensed health professional.
6. For nursing home patients, fill out Section 3 with licensing information and patient diagnosis. If in another type of facility, complete Section 4 accordingly.
7. Finally, ensure that both the facility administrator/care provider and veteran/widow sign and date Section 5 to certify accuracy.

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