Article Structure
The VA Form 10-8678, known as the Application for Annual Clothing Allowance, plays a crucial role in ensuring that veterans receive financial support for clothing that has been damaged due to the use of prescribed prosthetic devices or skin medications related to service-connected disabilities. This form requires veterans to provide important personal information, including their Social Security number, contact details, and a list of qualifying items that may have caused wear and tear to their clothing. Eligible individuals can receive this annual allowance if their prosthetic appliances cause substantial damage to multiple articles of clothing or if their skin medications lead to irreparable staining. With the completion of this form, veterans may apply for more than one clothing allowance in cases where their needs warrant it, reflecting a consideration that some may require assistance for multiple service-connected conditions. The process of filing a claim involves submitting this form to the Prosthetic and Sensory Aids Service at the local VA Medical Center, ensuring that applications are received by August 1st of the benefit year for which the allowance is sought. By providing accurate and complete information, veterans can secure the necessary assistance to offset costs associated with maintaining their clothing while managing their health conditions.
Va 10 8678 Example
2. VETERAN'S SSN
OMB Approved No.
Respondent Burden: 10 minutes
Expiration Date: 5/31/2018
APPLICATION FOR ANNUAL CLOTHING ALLOWANCE
PRIVACY ACT INFORMATION: No benefits may be granted unless this form is completed fully as required by law (38 C.F.R. 3.810). Responses you submit are considered confidential (38 U.S.C. 5701). They may be disclosed outside VA only if the disclosure is authorized under the Privacy Act, including the routine uses identified in the VA system of records, 24VA136 “Patient Medical Record - VA”, published in the Federal Register. Information submitted is subject to verification through computer matching programs with other agencies.
RESPONDENT BURDEN: VA may not conduct or sponsor, and the respondent is not required to respond to this collection of information unless it displays a valid OMB Control Number. Public reporting burden for this collection of information is estimated to average 10 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. If you have comments regarding this burden estimate or any other aspect of this collection of information, call
ELIGIBLITY / ENTITLEMENT FOR AN ANNUAL CLOTHING ALLOWANCE: A Veteran who wears or uses a prescribed prosthetic, orthopedic appliance, and/or skin medication for a service connected disability may be eligible for an annual clothing allowance. To be entitled, the prosthetic, orthopedic appliance must cause wear / tear; skin medication must cause irreparable staining to your outergarments.
WHO IS ELIGIBLE FOR MORE THAN ONE ANNUAL CLOTHING ALLOWANCE? Effective December 16, 2011, Veterans who wear or use more than one qualifying prescribed prosthetic or orthopedic appliance and/or prescription medication for more than one
WHAT TYPES OF CLOTHING ARE INCLUDED? Clothing such as shirts, blouses, pants, skirts, shorts and similar garments permanently damaged by qualifying appliances and/or skin medications are considered in clothing allowance decisions. Shoes, hats, scarves, underwear, socks, and similar garments are not included.
WHERE TO FILE A CLAIM? If you have previously submitted a claim for disability compensation, send this application (VA Form
INSTRUCTIONS: This application should be submitted to the Prosthetic and Sensory Aids Service at your nearest VA Medical Center
on or before August 1st of the benefit year for which you are applying. For example: If you are applying for the 2014 benefit, this application should be received on or before August 1, 2014.
1. LAST NAME, FIRST NAME, MIDDLE NAME OF VETERAN
3.MAILING ADDRESS OF VETERAN (No. and Street or Rural Route, City or P.O., State and Zip Code) If new address check box.
4. VETERAN'S DAYTIME TELEPHONE NUMBER (include area code) |
4a. EVENING TELEPHONE NUMBER (include area code) |
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4b. VETERAN'S EMAIL ADDRESS |
5. CALENDAR YEAR FOR APPLICATION |
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CERTIFICATION: I hereby apply for the annual clothing allowance benefit authorized under 38 USC §1162. In doing so I certify that because of my
ACKNOWLEDGEMENT: I acknowledge that by applying or receiving more than one clothing allowance benefit, an application for the annual clothing allowance benefit requires a yearly submission to the nearest Prosthetic and Sensory Aids Office on or before August 1st of the calender year.
6. SIGNATURE OF VETERAN (Sign in ink)
DATE
VA FORM |
Page 1 of 2 |
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JUNE 2015 |
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8. List of |
9. Month and |
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11. List all impacted |
FOR VA USE |
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7. Type of Appliance or Name of Skin |
Year Appliance |
10. Name and location of VA facility that issued appliance or |
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location(s) |
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Medication (Artificial leg, metal brace, |
Disability/Disabilities Requiring Use |
or Skin |
skin medication (if not a VA facility include facility's phone |
ONLY |
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(Chest, Back, Buttock, Left or |
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wheelchair, etc.) |
of Appliance(s) or Skin Medication(s) |
Medication was |
number) |
APPROVED? |
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Right Leg, Left or Right Arm) |
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issued (MM/YYYY) |
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Example B |
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PENALTY- The law provides severe penalties which include fine or imprisonment, or both, for the willful submission of any statement or evidence of a material fact, knowing it to be false, or for the fraudulent acceptance of any payment to which you are not entitled.
FOR VA USE ONLY
12. AMOUNT OF CLOTHING ALLOWANCES |
# ELIGIBLE |
# NOT ELIGIBLE |
# UPPER Extremity (2 maximum) |
# LOWER Extremity (2 maximum) |
13.EXAMINATION/EVALUATION DATE (If applicable)
14.NOTES:
15. GENERATED BY:
DATE
16. AUTHORIZED BY:
DATE
VA FORM |
Page 2 of 2 |
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JUNE 2015 |
Form Characteristics
| Fact Name | Detail |
|---|---|
| Purpose | The VA Form 10-8678 is used by veterans to apply for an annual clothing allowance due to service-connected disabilities. |
| Eligibility | Veterans using prescribed prosthetic and orthopedic appliances or skin medication that damages clothing may qualify for this allowance. |
| Submission Deadline | This form must be submitted by August 1st of the benefit year for which the allowance is being requested. |
| Privacy Protections | The personal information provided on this form is protected under the Privacy Act and can only be shared under specific circumstances. |
| Governing Law | This form is governed by 38 U.S.C. § 1162 and 38 C.F.R. § 3.810. |
Guidelines on Utilizing Va 10 8678
Filling out the VA Form 10-8678 can be a straightforward process if you follow the steps carefully. It’s important to provide accurate information to ensure your application is processed efficiently. Here’s how to fill out the form:
- Begin by writing your last name, first name, and middle name in the designated fields.
- Enter your mailing address including the street address, city, state, and zip code. If your address has changed, check the box provided.
- Provide your daytime telephone number, including the area code.
- If applicable, fill in your evening telephone number.
- Include your email address in the space provided.
- Indicate the calendar year for your application. Ensure it's the year you are applying for.
- Read and then certify the statement regarding the use of prosthetic devices or skin medications that cause wear and tear or staining to your clothing.
- Sign and date the form in the designated fields, ensuring your signature is in ink.
- In section 7, list the type of appliance or skin medication you are using. Provide specific details.
- Complete sections 8, 9, and 10 with the list of service-connected disabilities, month, and year of appliance issuance, and indicate where each appliance or skin medication was obtained.
- Answer the YES/NO questions in section 11 by checking the box that applies.
Once completed, ensure you send your application to the Prosthetic and Sensory Aids Service at your local VA Medical Center. Aim to submit your application on or before August 1st of the benefit year you are applying for.
What You Should Know About This Form
What is VA Form 10-8678 used for?
VA Form 10-8678 is used to apply for an annual clothing allowance for veterans. This benefit is available to those who wear or use a prescribed prosthetic or orthopedic appliance, or who use skin medication for a service-connected disability that results in wear and tear on clothing or irreparable staining.
Who is eligible for the clothing allowance?
A veteran may be eligible for an annual clothing allowance if they regularly use a prescribed prosthetic or orthopedic appliance that causes wear and tear on clothing, or if skin medication they use leads to irreparable staining of outerwear. Additionally, veterans who use multiple qualifying items for different service-connected disabilities may be eligible for multiple clothing allowances.
What types of clothing are covered under this allowance?
This allowance specifically covers outer garments such as shirts, blouses, pants, skirts, and shorts that are permanently damaged by qualifying appliances or medications. However, it does not cover items like shoes, socks, underwear, or hats.
How do I submit my application for the clothing allowance?
If you have submitted a claim for disability compensation before, you should send the completed VA Form 10-8678 to the Prosthetic and Sensory Aids Service at your local VA Medical Center. If you have never applied for disability compensation, you first need to complete VA Form 21-526 and send it to the nearest VBA regional office.
Common mistakes
When filling out the VA Form 10-8678, applicants often make critical mistakes that can delay their claim for the annual clothing allowance. One common mistake is failing to provide a complete mailing address. It is crucial for the form to include the full address—number and street, city, state, and zip code. Without this information, the VA cannot send notifications or correspondence regarding the claim.
Another frequent error involves incorrect or missing identification details, particularly the veteran's Social Security Number (SSN). The SSN is essential for identifying the applicant’s records within the VA system. Omitting it or entering an incorrect number can lead to confusion and even rejection of the application.
Many applicants overlook the importance of signing the form. Without the veteran’s signature, the application lacks validity. Additionally, it is essential to sign and date the form where indicated. Failing to do so not only delays the processing but also raises questions about the authenticity of the application.
The section for the list of service-connected disabilities and appliances often features inaccuracies. Applicants may forget to mention all relevant disabilities or appliances affecting their clothing through wear and tear. Each item should clearly indicate its impact to ensure a fair evaluation by the VA.
Providing incomplete contact information is another area where applicants falter. It's not enough to give just one phone number; both daytime and evening numbers should be included. This allows the VA to reach the veteran easily for any clarifications or additional information needed to process the claim.
Another mistake that tends to occur is submitting the application too late. The form must be submitted on or before August 1st of the benefit year for which the allowance is requested. Late submissions can result in denial of the benefit, regardless of eligibility.
Some veterans misunderstand eligibility criteria and therefore don’t properly document their prosthetic devices or skin medications. The form requests specific details related to how these items wear or damage clothing. A lack of specificity can lead to confusion regarding the eligibility for the clothing allowance.
Additionally, failings in record-keeping are common. Veterans should ensure they maintain copies of all submitted documents, including this form. Having a personal record can be beneficial if issues arise or if the application is lost.
Often, veterans select the wrong VA facility while filling out the application. It's vital to include the correct name and location of the facility that issued the appliances or medications. Any inaccuracies can result in the claim being sent to the wrong department, causing unnecessary delays.
Lastly, many applicants disregard the acknowledgment of annual reapplication. It is essential to remember that applying for the allowance requires yearly submissions. Veterans should keep track of their submissions to avoid missing deadlines in subsequent years.
Documents used along the form
When applying for the Annual Clothing Allowance, it's important to consider other forms and documents that can help streamline the process. These additional documents not only support the VA Form 10-8678 but may also be necessary to establish eligibility and provide the required information for a smooth claims experience. Below is a list of other related forms and documents frequently used in conjunction with the VA Form 10-8678.
- VA Form 21-526: This is the standard application for veterans seeking disability compensation. If you have not previously submitted a claim for benefits, you will need to complete this form and submit it to a regional office before applying for the clothing allowance.
- VA Form 10-TP: This form is used to report the loss or need for replacement of prosthetic appliances. It can be submitted in conjunction with the clothing allowance application if the prosthetic causes clothing wear or tear.
- Dependency Evidence: Additional proof may be required if the veteran has dependents. Documents like marriage certificates or birth certificates should be included to demonstrate any benefits associated with dependents.
- Medical Records: These records must substantiate the service-connected disability, detailing the conditions and treatments related to the prosthetic or skin medication.
- Prosthetic Prescription: A formal prescription from a medical provider detailing the need for prosthetics, braces, or other appliances will help establish eligibility for the clothing allowance.
- Skin Medication Records: Documentation of prescribed skin medications, including their purpose and impact on clothing, should accompany the application if used in conjunction with the allowance request.
- Proof of Clothing Damage: Photographs or other evidence showcasing the damage to clothing caused by the prosthetics or medications can strengthen the application and support claims for the allowance.
- VA Medical Facility Intake Form: This document may be required at the local VA Medical Center to register the veteran’s information and establish a file at the facility, particularly if the veteran is accessing services for the first time.
Submitting these additional forms and documentation can enhance your application for the Annual Clothing Allowance. It is essential to gather the information thoroughly and ensure everything is completed accurately to avoid delays in processing your claim.
Similar forms
- VA Form 10-10EZ: This is the Application for Health Benefits. Like the VA Form 10-8678, it is used by veterans to access benefits, requiring personal information and specifics about the veteran's conditions.
- VA Form 21-526: This form is for applying for disability compensation. Similar to Form 10-8678, it also requires disclosure of service-connected disabilities but focuses on financial compensation rather than clothing allowances.
- VA Form 10-1000: This is a claim form for VA medical care. Both forms collect detailed information about the veteran's medical situations, although Form 10-1000 is broader in scope.
- VA Form 21-4138: Known as the Statement in Support of Claim, this document allows veterans to provide additional details that support their benefit claims. Like Form 10-8678, it supports a specific claim laid out by the veteran.
- VA Form 21-8940: This is the application for increased compensation based on unemployability. It shares similarities with Form 10-8678 as both are related to financial assistance but target different types of needs.
- VA Form 22-1990: This form is for veterans applying for educational benefits. Though focused on a different area of support, it similarly requires personal and service-related information.
- VA Form 26-1880: This form is used to apply for a Certificate of Eligibility for a VA home loan. Like Form 10-8678, it provides a means for veterans to access benefits, but is centered on home financing rather than clothing allowances.
Dos and Don'ts
When filling out the VA Form 10-8678, keeping certain dos and don'ts in mind can ensure a smoother application process. Here are seven important points to consider:
- Do provide accurate personal information.
- Do carefully read the instructions before starting your application.
- Do make sure that all required fields are completed.
- Do submit your application by the August 1st deadline each year.
- Don't leave any sections blank unless specified.
- Don't submit false information or exaggerate details regarding your condition.
- Don't forget to sign and date the application before submission.
Following these guidelines will help you maximize your chances of approval for the annual clothing allowance. Thoroughly checking your form will avoid unnecessary delays and complications.
Misconceptions
- Misconception 1: The form can be submitted at any time during the year.
- Misconception 2: All types of clothing are covered by the clothing allowance.
- Misconception 3: Veterans can only apply for one clothing allowance, regardless of their needs.
- Misconception 4: The form does not require any specific personal information.
This is not correct. The VA Form 10-8678 must be submitted on or before August 1st of the benefit year for which the application is being made.
This is a common misunderstanding. Only certain types of clothing, specifically outer garments permanently damaged by qualifying prosthetic devices or skin medications, are included. Items like shoes, hats, and underwear are not eligible.
Actually, Veterans can apply for more than one annual clothing allowance if they use multiple qualifying appliances or medications that cause wear and tear on different types of clothing.
This is incorrect. The form requires detailed personal information, including the Veteran’s name, address, and social security number, among other things. Incomplete forms can delay the processing of the application.
Key takeaways
Filling out the VA Form 10-8678 is an important step for veterans seeking an annual clothing allowance. Consider the following key points for a successful application:
- Eligibility Criteria: Veterans must demonstrate they wear or use prescribed prosthetic or orthopedic appliances due to service-connected disabilities. Skin medications that cause irreparable staining to clothing can also qualify.
- Multiple Allowances: Veterans who use more than one qualifying appliance or medication for different disabilities may be eligible for multiple clothing allowances if each leads to distinct wear and tear on clothing.
- Clothing Types Covered: Eligible garments include shirts, pants, skirts, and similar items permanently damaged. However, items like shoes and undergarments are typically excluded from coverage.
- Application Deadline: Submit the completed form to the Prosthetic and Sensory Aids Service by August 1st of the benefit year for which you are applying to avoid delays.
- Prior Claims: If you have already submitted a disability compensation claim, send the form to your local VA Medical Center. New applicants must complete a different form, VA Form 21-526.
- Required Information: Ensure you complete all required fields on the form, including personal details such as your name, mailing address, and contact information.
- Acknowledgement of Benefits: You must acknowledge that receiving more than one clothing allowance necessitates annual submissions to the VA.
- Signature Requirement: The form must be signed in ink by the veteran, verifying the accuracy of the information provided.
- Understanding Penalties: Be aware that submitting false information intentionally can result in severe penalties, including fines or imprisonment.
- Timely Follow-up: After submitting the form, keep a copy and follow up with the VA to ensure your application is being processed.
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