2025 Printable Template
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Form last updated: 03/2024. Please verify this is the current version before use.
Easily complete & submit your VA 21-0779 form
Follow these simple steps to fill, sign, and send your VA 21-0779 form online.
Fill out your form
Our user-friendly editor helps you quickly enter personal & business details in the VA 21-0779 template.
Sign the form
Add your electronic signature to the fillable VA 21-0779 form to certify it came directly from you.
Send it to the requester
Download and instantly print or share your signed VA 21-0779 with the requester.
What is a VA 21-0779 used for?
VA Form 21-0779 is used by the Department of Veterans Affairs to collect information from nursing homes regarding the care provided to veterans or their dependents. This information is necessary to determine eligibility for additional pension benefits, specifically Aid and Attendance, which can help cover medical expenses.
Who needs to fill out a VA 21-0779 form
Nursing home officials providing care to veterans or their dependents who are applying for Aid and Attendance benefits.
How to fill out a VA 21-0779 online?
Follow these steps to complete your VA 21-0779 form online.
Frequently Asked Questions
Find quick answers to common questions about our PDF editor.
You must provide personal details such as the claimant's name, Social Security number, and nursing home information.
Yes, you can edit your form before submission, but ensure all changes are accurate.
You can reach out to the VA's online support service, Ask VA, for assistance.
