Aid and Attendance or housebound examination
Documents medical findings about assistance needs or housebound status.
Nursing-home information for Aid and Attendance
Request for Nursing Home Information in Connection with Claim for Aid and Attendance
Obtains nursing-home residency and care information for an Aid and Attendance claim.
Purpose and use
This is completed by a nursing-home official when VA requests facility information.
When not to use it
Do not use this form for a different benefit or review path unless current VA instructions identify it for that purpose.
Who completes and signs it?
- Completed by
- nursing home official
- Signed by
- nursing home official
- Availability
- online and pdf
- Submission
- follow current form instructions
Always start with the official page
Open the current VA version.
Check the revision, instructions, signature requirements, and delivery options immediately before use.
Read before use
Important limitations
- Verify the current revision and submission instructions on the official VA page before signing or sending the form.
- This planner identifies forms that may fit a situation; it does not determine eligibility or filing strategy.
Related records