1170 form-2025

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The document is an application form for furnishing long-term care services to beneficiaries of Veterans Affairs, requiring information about the provider's qualifications, licensing, and capacity. It outlines the estimated time to complete the form, legal requirements under the Paperwork Reduction Act, and includes sections for provider details, service schedules, and agreements.

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2006	4.9 Satisfied (32 Votes)

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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.

What is Form 21 4142?

Use VA Form 21-4142 to give us permission to obtain your personal information from a non-VA source like a private doctor or hospital. Examples of personal information may include your medical treatment, hospitalizations, psychotherapy, or outpatient care.

Is VA correcting an error a good thing?

Keep in mind that while identifying an error can sound concerning, its an error made by the VA, not the veteran, so having the VA identify and fix their mistake is typically a positive development.

What is VA form 21 4192 used for?

If youre the surviving spouse, child, or parent of a service member who died in the line of duty, or the survivor of a Veteran who died from a service-related injury or illness, you may be able to get a tax-free monetary benefit called VA Dependency and Indemnity Compensation (VA DIC).

When a husband dies, does the wife get his VA disability?

PENALTY: The law provides severe penalties which include fine or imprisonment, or both, for the willful submission of any statement or evidence of material fact knowing it to be false. If you do not revoke this authorization, it will automatically expire in 12 months from the date you sign and date the form.

What is VA form 21 0958?

To file the NOD, submit the VA-Form 21-0958, Notice of Disagreement that was included with your claim decision. This is your chance to tell VA how you feel the decision is wrong. If you dont feel confident enough to do this on your own, your VSO can help you.