Va 4 claimants certification 2026

1. Click ‘Get Form’ to open the va 4 claimants certification in our editor.
2. Begin by entering the Name of Claimant, which can be either the Veteran or Surviving Spouse. Ensure accuracy for proper identification.
3. Fill in the Claimant's Address, including City, State, and Zip Code. This information is crucial for correspondence.
4. Input the Name of Veteran and their VA Claim Number or Veteran’s SSN. This helps link the claim to the correct individual.
5. In the Statement of Charges section, list all recurring monthly charges such as assisted living or home care. Be sure to total these amounts accurately.
6. Add any monthly health insurance premiums applicable to both the veteran and spouse in the designated field.
7. Subtract any reimbursements received for these charges to calculate your Monthly out-of-pocket after reimbursement.
8. In the Claimant Certification section, confirm that you are paying these expenses from personal household funds by signing where indicated. If signing with a mark, ensure two witnesses sign as well.
9. Finally, date your certification to complete the form.

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