Items 1 to 4: identification
First name, middle initial and last name, Social Security number, VA file or claim number, and date of birth.
26-4555
Application in Acquiring Specially Adapted Housing or Special Home Adaptation Grant
- Agency
- VA
- Revision
- August 2026
- Fillable fields
- 20
- Pages
- 1
- Official source
- VA form page
- Checked
- October 20, 2026
VA Form 26-4555: Specially Adapted Housing or Special Home Adaptation Grant Application
VA Form 26-4555 is the U.S. Department of Veterans Affairs Application in Acquiring Specially Adapted Housing or Special Home Adaptation Grant, under Title 38 U.S.C. Section 2101(a) or 2101(b). VA's form page says to use it to apply for a Specially Adapted Housing grant or a Special Home Adaptation grant, and that the information helps VA determine or verify eligibility for these disability housing grants.
The form is one page with 12 items: identification and contact details, three yes or no questions about earlier applications and nursing home or medical care facility confinement, a remarks box, and a signed certification. The instructions say to submit it to the VA regional office where your claim file is located, or to complete it online at www.va.gov.
VA's page says you can apply online instead of filling out and sending the paper form. You can fill out the PDF free in your browser on this page and download the result without an account.
What's on VA Form 26-4555
Items 5 to 7: contact details
Email address, mailing address, and daytime, evening and cell phone numbers with area code.
Items 8 to 10: yes or no questions
Previous application for Specially Adapted Housing, previous application for a Home Improvement and Structural Alteration grant, and confinement to a nursing home or medical care facility.
Item 11: remarks
Open space for anything else the applicant wants to add.
Item 12: certification
The applicant states an understanding that medical and economic features are yet to be considered and that notice of the action taken will follow. Item 12A is the signature in ink and 12B the date.
How to apply with VA Form 26-4555
- 1
Enter your details
Fill in items 1 to 7 with your name, Social Security number, VA file or claim number, date of birth, email, address and phone numbers.
- 2
Answer items 8 to 10
Check yes or no for each question. For a yes, give the date in MM/DD/YYYY format and place, or the name and address of the facility.
- 3
Add remarks
Use item 11 for any other information.
- 4
Sign and date it
Read the certification, sign your full name in ink in item 12A and enter the date in item 12B.
- 5
Send it or apply online
The form says to submit it to the VA regional office where your claim file is located, or to complete it online at www.va.gov.
Why fill Form 26-4555 on indox
You get the real form, filled in a browser tab, with nothing standing between you and the finished PDF.
- Fill the form right in your browser, no software to install
- Free to fill and free to download, with no account
- The official blank straight from the VA, not a copy someone retyped
- Works on a phone, tablet or computer
Where to send it
VA regional office
The instructions say the application should be submitted to the VA regional office where your claim file is located. The form prints no mailing address.
Online
VA's form page says you can apply online instead of filling out and sending the paper form.
Not by email
The form gives an email address for comments on the burden estimate and says not to send the completed VA Form 26-4555 to that address.
Edition
The AUG 2026 edition supersedes VA Form 26-4555, MAY 2024, which will not be used. It carries OMB Approved No. 2900-0132, which expires 08/31/2029, with a respondent burden of 10 minutes.
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Who uses VA Form 26-4555?
The form and VA's page describe who applies and what the questions cover.
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Questions about Form 26-4555
What is VA Form 26-4555 used for?
VA's form page says to use it to apply for a Specially Adapted Housing grant or a Special Home Adaptation grant, and that the information helps VA determine or verify eligibility for these disability housing grants.
Can I apply online instead?
Yes. VA's form page says you can apply online instead of filling out and sending the paper form.
Where do I send the paper form?
The instructions say to submit it to the VA regional office where your claim file is located. The form does not print a mailing address.
Does the form ask for my Social Security number?
Yes, in item 2. The Privacy Act notice says VA will not deny an individual benefits for refusing to provide the SSN unless the disclosure is required by a Federal Statute of law in effect prior to January 1, 1975, and still in effect.
What happens after I submit it?
The certification says there are medical and economic features yet to be considered, and that the applicant will be notified of the action taken on the application as soon as possible.
Which edition is current?
The AUG 2026 edition. The form says it supersedes the MAY 2024 edition, which will not be used.