21-0779

Request for Nursing Home Information in Connection with Claim for Aid and Attendance

Agency
VA
Revision
2023-09-18
Fillable fields
51
Fill 21-0779 online
21-0779

Form 21-0779: Request for Nursing Home Information in Connection with Claim for Aid and Attendance

Use this form if you’re a nursing home official to verify a Veteran or someone connected to a Veteran is a patient in a qualifying extended care facility.

How to fill out Form 21-0779 online

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  3. 3

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