Nursing-home information for Aid and Attendance
Obtains nursing-home residency and care information for an Aid and Attendance claim.
Aid and Attendance or housebound examination
Examination for Housebound Status or Permanent Need for Regular Aid and Attendance
Documents medical findings about assistance needs or housebound status.
Purpose and use
Use when VA directs a medical professional to document Aid and Attendance or housebound needs.
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
- health care provider
- Signed by
- health care provider
- 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.
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