About VA Form 21-2680
- Form name: Examination for Housebound Status or Permanent Need for Regular Aid and Attendance
- Related to: Disability, Family member benefits, Pension
- Form revision date: February 2023
When to use this form
Use VA Form 21-2680 to apply for Aid and Attendance benefits that will be added to your monthly compensation or pension benefits.
Downloadable PDF
Related forms and instructions
VA Form 21-0779
Form name: Request for Nursing Home Information in Connection with Claim for Aid and Attendance
Use VA Form 21-0779 if you’re a resident of a nursing home and you're providing supporting information for your claim application for VA Aid and Attendance benefits.
Helpful links related to VA Form 21-2680
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If you need help with daily activities, or you’re housebound, learn about these benefits and if you qualify.