VA 21-0779 Form – Free PDF | Fill Online in Minutes

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How to fill out a VA 21-0779 online?

Follow these steps to complete your VA 21-0779 form online.

Step 01

Access the form in the PDF editor without uploading anything.

Step 02

Fill in Section I with the claimant's personal information.

Step 03

Complete Section II with details from a nursing home official.

Step 04

Ensure all entries are clear and all relevant checkboxes are marked.

Step 05

Download the completed form in PDF format.

Department of Veterans Affairs

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.

What information do I need to provide on form VA 21-0779?

You must provide personal details such as the claimant's name, Social Security number, and nursing home information.

Can I make changes to my form after I've filled it out?

Yes, you can edit your form before submission, but ensure all changes are accurate.

What if I have questions while filling out the form?

You can reach out to the VA's online support service, Ask VA, for assistance.

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