VA Form 21-0779: Nursing Home Info for Aid & Attendance – VA Form 21-0779 is a key supporting document for veterans and eligible claimants seeking VA Aid and Attendance (A&A) pension benefits while residing in a nursing home. This one-page form, completed primarily by a nursing home official, verifies the veteran’s or claimant’s residency, level of care, admission date, and related financial details to help determine eligibility for enhanced pension payments.
What Is VA Form 21-0779?
VA Form 21-0779, officially titled “Request for Nursing Home Information in Connection with Claim for Aid and Attendance,” helps the Department of Veterans Affairs (VA) confirm that a claimant requires skilled or intermediate nursing care due to mental or physical disability. The current revision date is September 2023 (superseding earlier versions).
The form collects:
- Veteran and claimant identification (name, SSN, VA file number, DOB).
- Nursing home details (name, address).
- Admission date, Medicaid status, out-of-pocket costs.
- Type of care provided (skilled nursing or intermediate).
- Certification by a nursing home official.
Download the official form here: VA Form 21-0779 PDF
Who Should Use VA Form 21-0779?
Nursing home officials primarily complete this form to verify patient status for a veteran or their qualifying dependent (such as a surviving spouse) applying for or receiving Aid and Attendance benefits. Veterans or claimants in a nursing home due to disability-related loss of physical or mental abilities typically need it as part of their A&A claim.
It applies mainly to non-service-connected pension claims and supports higher benefit levels beyond the basic pension by documenting the need for institutional care.
Connection to VA Aid and Attendance Benefits
Aid and Attendance is a special monthly pension that helps cover costs of long-term care for veterans who:
- Qualify for a basic VA pension.
- Need assistance with activities of daily living (ADLs) like bathing, dressing, feeding, or toileting.
- Are bedridden for significant portions of the day.
- Reside in a nursing home due to disability.
- Have severe visual impairment.
Residing in a nursing home due to disability qualifies a claimant for A&A. Form 21-0779 provides official verification of this status, admission details, and costs, which strengthens the claim and helps the VA determine the proper benefit rate. It is often submitted alongside VA Form 21-2680 (Examination for Housebound Status or Permanent Need for Regular Aid and Attendance).
Eligibility for Aid and Attendance with Nursing Home Care
To qualify:
- The veteran must have served at least 90 days of active duty, with at least one day during a wartime period, and received an honorable discharge.
- The claimant must meet income and net worth limits (these are adjusted annually; check current VA guidelines).
- Medical need must be established (often via physician certification).
For 2026, maximum monthly A&A rates can reach approximately $2,400–$2,874 depending on marital status and circumstances (subject to income deductions). Nursing home residents may use these benefits toward facility costs, as a significant portion of such expenses often qualifies as unreimbursed medical deductions.
How to Complete and Submit VA Form 21-0779?
- Veteran/Claimant Section: Provide identification details for the veteran and, if applicable, the claimant.
- Nursing Home Section: A nursing home official completes information on the facility, admission date, Medicaid status, out-of-pocket responsibility, and type of care (skilled or intermediate nursing).
- Certification: The official signs and dates the form.
Submission Options:
- Online via VA portals for supporting forms.
- Mail to: Department of Veterans Affairs, Evidence Intake Center, P.O. Box 4444, Janesville, WI 53547-4444.
- Include with the main pension application (e.g., VA Form 21P-527EZ for veterans or 21P-534EZ for survivors).
Review the completed form for accuracy before submission. Call 1-800-827-1000 (TTY: 711) for assistance.
Why This Form Matters for Nursing Home Residents?
Submitting VA Form 21-0779 can help maximize benefits by documenting the need for institutional care. It supports claims for higher pension amounts and verifies medical expenses, potentially reducing countable income. For veterans in qualifying facilities, this can make a significant difference in offsetting high nursing home costs.
Common Questions About VA Form 21-0779
Is it only for veterans? Primarily yes for the veteran claimant; surviving spouses or other dependents may need alternative verification in some cases.
How long does it take? The estimated burden is about 10 minutes for the nursing home official.
Expiration? OMB approval expires 09/30/2026 for the current version—use the latest form from va.gov.
Can I submit it online? Yes, through VA’s supporting forms submission tools.
Tips for a Successful Aid and Attendance Claim
- Gather all required documents early, including DD-214, medical records, and financial statements.
- Consider working with a Veterans Service Officer (VSO), accredited attorney, or claims agent.
- Report all medical expenses accurately, as they can lower countable income.
- Check va.gov regularly for updates on rates and forms.
For the most current information on eligibility, rates, and application processes, visit the official VA pages:
Important Note: This article provides general information based on official VA sources as of 2026 and is not a substitute for professional VA claims assistance. Consult the VA or a qualified representative for personalized advice.