Section I, items 1 to 4: contact
Name of the Veteran or Servicemember, VA file number or Social Security number, address, daytime, evening and cell phone numbers, and email.
26-4555c
Veteran/Servicemember's Supplemental Application for Assistance in Acquiring Specially Adapted Housing
- Agency
- VA
- Revision
- October 2023
- Fillable fields
- 44
- Pages
- 1
- Official source
- VA form page
- Checked
- October 20, 2026
VA Form 26-4555c: Supplemental Application for Specially Adapted Housing
VA Form 26-4555c is the U.S. Department of Veterans Affairs Veteran/Servicemember's Supplemental Application for Assistance in Acquiring Specially Adapted Housing. The form says VA needs this information to determine or verify eligibility for a grant for specially adapted housing, and that Title 38, U.S.C. 2101(a) or 2101(b) allows VA to ask for it.
The form is one page. Section I, completed by the Veteran or Servicemember, covers contact details, the type of grant plan, the property, monthly income and any power of attorney or guardian. Section II covers the mortgage, loan data and the yearly cost of keeping the property. Section III is for VA use only.
VA's form page offers the form as a downloadable PDF. 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 26-4555c
Item 5: grant plan
Check one: land and housing to be acquired (Plan 1), housing to be erected on land now owned (Plan 2), remodeling a house now owned or to be acquired (Plan 3), or suitable property needing no remodeling (Plan 4).
Items 6 to 9: property and income
The location of the property to be adapted if known, sources of income with monthly amounts, starting with VA compensation and Social Security, and the power of attorney or guardian question.
Section II: mortgage and loan data
The mortgage servicer, lending official, whether the loan is new or existing, amount or unpaid balance, purchase price, monthly installment, remaining repayment period, interest rate, liens or judgments, and type of financing.
Annual costs and certification
Estimated yearly taxes, condominium or HOA fee, insurance, heat and utilities and repairs with a total, then a fair housing certification, the signature and the date.
How to fill out VA Form 26-4555c
- 1
Complete Section I
Enter your name, VA file or Social Security number, address, phone numbers and email.
- 2
Pick one plan
Check one of Plans 1 to 4 in item 5 and describe the property's location in item 6 if known.
- 3
List your income
Give each source of income and the monthly amount in items 7 and 8, then answer item 9.
- 4
Complete Section II
Enter the mortgage servicer, the loan data and the estimated annual cost of maintaining the property. Lending official details are only required for new financing.
- 5
Sign and date it
The Veteran, Servicemember or fiduciary signs item 4 and dates item 5 in MM/DD/YYYY format. Section III is left for VA.
Why fill Form 26-4555c 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
Sending it and getting help
Where it goes
The form prints no mailing address or submission instructions, and VA's form page offers only the downloadable PDF.
VA's part
Section III is marked for VA use only and holds the opinion and signature of VA personnel.
Comments on the form
The form says you can call 1-800-827-1000 to get information on where to send comments or suggestions about this form.
Edition
The OCT 2023 edition supersedes VA Form 26-4555C, JAN 2021, which will not be used. It carries OMB Control No. 2900-0031, which expires 10/31/2026, with a respondent burden of 15 minutes.
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Who uses VA Form 26-4555c?
The form marks which section each person completes.
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Questions about Form 26-4555c
What is VA Form 26-4555c used for?
The form says VA needs this information to determine or verify eligibility for a grant for specially adapted housing.
What are Plans 1 to 4?
Item 5 lists four choices: land and housing to be acquired (Plan 1), housing to be erected on land now owned (Plan 2), remodeling a house now owned or to be acquired (Plan 3), and suitable property needing no remodeling (Plan 4). The form says to check one.
Who signs VA Form 26-4555c?
The Veteran, Servicemember or fiduciary signs Section II. VA personnel sign Section III, which is for VA use only.
Do I fill in the lending official?
The form says the lending official's name and title are only required if new financing, and the phone number is asked for new financing.
What does Section III decide?
VA personnel record whether the terms of payment in the mortgage plus other ownership expenses do or do not bear a proper relationship to the Veteran's present and anticipated income and expenses.