Required Documents for Benefits

After you have acquired all documents, please be sure to contact our office for an appointment if you need assistance completing your application. Due to the personal nature of information required when filling out claim forms, we respectfully request calling ahead to schedule an appointment in order to afford other veterans, spouses and their family's privacy. Office hours are Monday through Friday, 8:30 - 4:00 pm. (724)830-3530.

Document Aid & Attendance Service Connected Disability Comp. Housebound or Pension
Application Form 21-526EZ Complete application for compensation as per instruction on form.

Application Form 21P-527EZ Complete application for compensation as per instruction on form.
Application Form 21P-534EZ For Surviving Spouse Only Complete application for Aid & Attendance/Pension as per instructions on form.
Veterans Military Discharge/Separation Papers (DD-214) Please provide a copy of all military discharge papers. Instructions for obtaining a discharge
Copy of Marriage Certificate/Divorce Decree/Death Certificate All marital and divorce information (past and present) are required. Death certificate for surviving spouses only.
Net Worth Information/Proof of Income Including check and savings accounts, CDs, stocks, bonds, trusts, annuities etc. Social Security Award Letter required. Verification of all income from pensions, retirement, interest income from investments, annuities, etc. Please note that financial information for claimant and spouse must be provided.

Medical Expenses or Form 21-8416 Verification of ALL medical expense and insurance premiums paid out-of-pocket that are not reimbursed by insurance, Medicaid or Medicare

Power of Attorney If you are a court-appointed guardian of the veteran or surviving spouse, a certified copy of this document

Letter from Attending Physician or Form 21-2680 Letter must be detailed as to the patient’s prognosis and diagnosis including competency and MUST be on physician’s letterhead. If using form 21-2680, it MUST be filled out and signed by physician.
Voided Check or Account/Routing Numbers Please provide current checking account information, because if you are awarded benefits, it will be direct deposited to your account.
Dependent Information Copies of birth certificates and social security numbers for any dependents under the age of 18 living with you or who you support financially.
Statement in Support of Claim Form 21-4138 Please complete this form by simply stating you’re submitting an Aid & Attendance/Pension/Compensation claim
Social Security/Photo ID ID is not required, submit if available. Copies of social security cards for you and your spouse, and valid photo ID for veteran
Employment History Does not apply if you’re over 65

Appointment of Veteran Service Org. as Claim Representative Form 21-22 This form allows you to choose a Veteran’s Organization to represent you with your claim. We are accredited through the Pennsylvania Department of Military and Veteran Affairs.
Medical Records of Disabilities Provide names and addresses of all doctors seen for disabilities. We will include Form 21-4142 (the last page of VA Form 21-526), giving consent for the VA to obtain medical records. Please note that many conditions also require the submission of a specific Disability Benefit Questionnaire, please contact our office for more info.

Letter from Assisted Living/Personal in Home Care/Nursing Home or Form 21-0779 Provided letter from nursing facility MUST include; name, entry date, cost per day (room rate), level of care, amount paid out-of-pocket to date. If using Form 21-0779, it must be filled out and signed by facility. For persons receiving care in their own home, proof of payment to an outside caregiver (cancelled check or bank statement) MUST be provided. A minimum of 1 month’s care is required.