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VA Form 21-2680

Form name:Examination for Housebound Status or Permanent Need for Regular Aid and Attendance
Form revision date: February 2023
Related to: Disability, Family member and caregiver benefits, Pension

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

Online tool

You can apply online instead of filling out and sending us the paper form.

Related forms and instructions

VA Form 21-0779

Form name: 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.