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VA Form 21-0779 - Veterans Benefits Administration

VA Form 21-0779 - Veterans Benefits Administration-2025

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The document is a VA form (21-0779) used to request nursing home information for determining eligibility for pension and aid and attendance benefits. It includes sections for veteran and claimant identification, nursing home details, and certification by a nursing home official. The form emphasizes the importance of accurate information under the Privacy Act and outlines the estimated time required to complete it.

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What is VA Form 21 0779 used for?

Use VA Form 21-0779 if youre a resident of a nursing home and youre providing supporting information for your claim application for VA Aid and Attendance benefits.

How do I download VA forms?

How to download and open a VA.gov PDF form Click the Download VA form link for the form you want to fill out. The PDF will download to your Downloads folder. Open docHub Reader. From the File menu, choose Open. Go to your Downloads folder or the location on your device where you saved the PDF.

What is the difference between VA Form 21 4142 and VA Form 21 4142a?

Complete VA Form 21-4142, Authorization to Disclose Information to the Department of Veterans Affairs (VA) and VA Form 21-4142a, General Release for Medical Provider Information to the Department of Veterans Affairs (VA); submit completed forms with your claim and VA will attempt to obtain your records through our

What is the income limit for aid and attendance?

To be eligible for the Housebound Benefit: A single veteran must have a yearly countable income of less than $16,540. A married veteran must have a yearly countable income of less than $20,731 a year.

What is the difference between 21-4142 and 21 4142a?

Thats where VA Forms 21-4142 (Authorization to Disclose Information) and 21-4142a (General Release for Medical Provider Information) come into play. These forms authorize the VA to request medical records from private healthcare providers to support a Veterans claim.

Is VA unemployability the same as 100% disability?

The VA Form 21-4142 is valid for 12 months from the date signed. It is permissible to authorize release of, and disclose, information created after the consent is signed.

VA Form 21-0779 - Veterans Benefits Administration-2025

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