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Use this form to determine eligibility for aid and attendance or housebound benefits. For more. information, you can contact us online through Ask VA: https://ask.va.gov/. Ask us a question online or call us toll-free at 1-800-827-1000 (TTY: 711). VA forms are available at www.va.gov/vaforms.
Get VA Form 21-2680, Examination for Housebound Status or Permanent Need for Regular Aid and Attendance. Use this VA form to apply for Aid and Attendance benefits that will be added to your monthly compensation or pension benefits.
Fill out VA Form 21-2680 (Examination for Housebound Status or Permanent Need for Regular Aid and Attendance), You can have your doctor fill out the examination information section. Get VA Form 21-2680 to download. You can also include with your VA form:
You may apply for Aid and Attendance or Housebound benefits by submitting the prescribed VA form(s) to the Pension Management Center (PMC) that serves your state. You may also visit your local regional benefit office to file your request.
VA Form 21-2680 can help support your claim for VA aid and attendance benefits to either disability compensation or non-service-connected pension claims.
The VA form 21-2680 “Examination for Housebound Status or Permanent Need for Regular Aid and Attendance” is used to document the level of care required by a claimant or a claimant’s dependent. The VA form 21-2680 is completed by a physician based on his/her medical evaluation of the patient.
Complete VA Form 21-2680, Examination for Housebound Status or Permanent Need for Regular Aid and Attendance., and mail it to the Pension Management Center for your state. You can have your doctor fill out the examination information section.
IMPORTANT: Please read Privacy Act and Respondent Burden information before completing the form. SECTION I: VETERAN'S IDENTIFICATION INFORMATION. NOTE: You can either complete the form online or by hand. Please print the information requested in ink, neatly and legibly to help process the form.
purpose of determining your eligibility to receive VA benefits, as well as to collect any amount owed to the United States by virtue of your participation in any benefit program administered by the Department of Veterans Affairs.
VA Form 21-2680. OMB Control No. 2900-0721 Respondent Burden: 30 minutes. Expiration Date: 09-30-2021. VA DATE STAMP DO NOT WRITE IN THIS SPACE. EXAMINATION FOR HOUSEBOUND STATUS OR PERMANENT NEED FOR REGULAR AID AND ATTENDANCE. SECTION I: VETERAN'S IDENTIFICATION INFORMATION.