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The VA Form 26-4555 serves as an essential application for veterans seeking financial assistance to acquire specially adapted housing or request special home adaptation grants. Designed under Title 38 U.S.C. Section 2101(a) and 2101(b), this form addresses the unique needs of individuals with service-connected disabilities who require modifications to their living environments. It is crucial for applicants to provide detailed personal information, including their Social Security number and VA claim number, to facilitate eligibility verification. The form also includes questions about prior applications for similar grants and the current residential situation, ensuring the VA can accurately assess each individual's circumstances. Furthermore, it is important to highlight that the VA must adhere to privacy regulations, safeguarding any information shared on this form under the Privacy Act of 1974. By completing this application, veterans express their need for housing support, reaffirming their commitment to overcome the challenges posed by their disabilities. Understanding the completion process and the accompanying requirements will help streamline the pathway to obtaining these significant benefits.

Va 26 4555 Example

(If "Yes," give name and address of facility)

OMB Approved No. 2900-0132

Respondent Burden: 10 minutes

Expiration Date: 6/30/2024

APPLICATION IN ACQUIRING SPECIALLY ADAPTED HOUSING OR

SPECIAL HOME ADAPTATION GRANT (Title 38 U.S.C. Section 2101(a) or 2101(b))

PRIVACY ACT NOTICE: VA will not disclose information collected on this form to any source other than what has been authorized under the Privacy Act of 1974

or Title 38, CFR 1.576 for routine uses (for example: Authorizing release of information to Congress when requested for statistical purposes) identified in the VA system of records, 55VA26, Loan Guaranty Home, Condominium and Manufactured Home Loan Applicant Records, Specially Adapted Housing Applicant Records, and Vendee Loan Applicant Records - VA, published in the Federal Register. Your obligation to respond is required to obtain or retain benefits. Giving us your SSN account information is mandatory. Applicants are required to provide their SSN under Title 38, CFR 3.809. The VA will not deny an individual benefits for refusing to provide his or her SSN unless the disclosure of the SSN is required by a Federal Statute of law in effect prior to January 1, 1975, and still in effect.

RESPONDENT BURDEN: We need this information to determine or verify your eligibility for a specially adapted housing or special home adaptation grant. Title 38, U.S.C. 2101(a) or 2101(b) allows us to ask for this information. We estimate that you will need an average of 10 minutes to review the instructions, find the information, and complete this form. VA cannot conduct or sponsor a collection of information unless a valid OMB control number is displayed. Valid OMB control numbers can be located on the OMB Internet Page at www.reginfo.gov/public/do/PRAMain. If desired, you can call 1-800-827-1000 to get information on where to send comments or suggestions about this form.

INSTRUCTIONS: This application should be submitted to the VA regional office where your claim file is located or this form can be completed online by visiting www.ebenefits.va.gov.

1. FIRST NAME - MIDDLE INITIAL - LAST NAME

2. SOCIAL SECURITY NO.

3. VA FILE /CLAIM NUMBER

 

 

 

4. DATE OF BIRTH (MM/DD/YYYY)

5. E-MAIL ADDRESS

 

 

 

 

6.ADDRESS (Number and street or rural route, city or P.O., State and ZIP Code)

 

 

 

 

 

7. TELEPHONE NUMBERS OF APPLICANT (Include Area Code)

 

 

 

 

 

 

A. DAYTIME

 

B. EVENING

 

C. CELL

 

 

 

 

 

 

 

 

 

 

 

8. HAVE YOU MADE PREVIOUS APPLICATION FOR SPECIALLY ADAPTED HOUSING?

 

 

 

YES

 

NO (If "Yes," give date (MM/DD/YYYY) and place)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9. HAVE YOU MADE PREVIOUS APPLICATION FOR HOME IMPROVEMENT AND STRUCTURAL ALTERATION GRANT?

 

 

 

YES

 

 

NO (If "Yes," give date (MM/DD/YYYY) and place)

 

 

 

 

 

 

 

 

 

 

10. ARE YOU CONFINED TO A NURSING HOME OR MEDICAL CARE FACILITY?

YES NO

11. REMARKS

CERTIFICATION

I am applying for assistance in acquiring specially adapted housing or special home adaptation grant because of the nature of my service-connected disability. I understand that there are medical and economic features yet to be considered before I am eligible for this benefit, and that I will be notified of the action taken on this application as soon as possible.

12A. SIGNATURE OF APPLICANT (Sign full name in ink.)

12B. DATE SIGNED (MM/DD/YYYY)

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.

VA FORM

26-4555

SUPERSEDES VA FORM 26-4555, SEP 2018,

JUN 2021

WHICH WILL NOT BE USED.
Get Va 26 4555 PDF Form

Form Characteristics

Fact Name Details
Purpose The VA Form 26-4555 is used to apply for specially adapted housing or a special home adaptation grant.
Governing Laws Title 38 U.S.C. Sections 2101(a) and 2101(b) govern the application process.
OMB Approval This form is approved by OMB under No. 2900-0132.
Time Commitment Completing the form typically takes about 10 minutes.
Privacy Notice The information provided will be protected under the Privacy Act of 1974.
Submission Instructions Submit the completed application to the VA regional office or online at www.ebenefits.va.gov.

Guidelines on Utilizing Va 26 4555

Completing the VA Form 26-4555 is an essential step in applying for assistance with specially adapted housing or a special home adaptation grant. After filling out this form, you will submit it to the appropriate VA regional office or complete it online through the specified website. Follow the steps below carefully to ensure that your application is accurate and complete.

  1. Fill in your First Name, Middle Initial, and Last Name.
  2. Provide your Social Security Number.
  3. Enter your VA File or Claim Number.
  4. Input your Date of Birth in MM/DD/YYYY format.
  5. Write your E-mail Address.
  6. List your Address, including Number and Street, City or P.O., State, and ZIP Code.
  7. Provide your Telephone Numbers:
    • Daytime
    • Evening
    • Cell
  8. Indicate if you have made a previous application for specially adapted housing by selecting Yes or No. If Yes, include the date and place.
  9. Indicate if you have made a previous application for home improvement and structural alteration grant by selecting Yes or No. If Yes, provide the date and place.
  10. Answer whether you are confined to a nursing home or medical care facility by selecting Yes or No.
  11. Complete the Remarks section, if necessary.
  12. Read the Certification statement and provide your signature in ink.
  13. Enter the Date Signed in MM/DD/YYYY format.

Double-check all entries for accuracy and completeness before submitting the form. Once submitted, be prepared for further communication regarding the next steps in the process. Your application will undergo evaluation, and you will be informed of the outcome as soon as possible.

What You Should Know About This Form

What is the purpose of VA Form 26-4555?

VA Form 26-4555 is used by veterans and service members to apply for specially adapted housing or special home adaptation grants. These grants assist individuals with service-connected disabilities in making necessary modifications to their homes. By completing this form, applicants can provide the Department of Veterans Affairs (VA) with essential information to assess their eligibility for these benefits.

How do I complete and submit VA Form 26-4555?

To complete VA Form 26-4555, you can either fill it out manually or complete it online. It requires personal information such as your name, Social Security number, VA file number, and details about your service-connected disability. After completing the form, submit it to the VA regional office associated with your claim or access the online application through www.ebenefits.va.gov for electronic submission. Ensure all sections are filled accurately to avoid processing delays.

What information is required on VA Form 26-4555?

The form requests essential details, including your name, Social Security number, date of birth, contact information, and a summary of any previous applications for specially adapted housing or related grants. Additionally, you must indicate if you are currently confined to a nursing home or medical care facility. This information allows the VA to evaluate your application for benefits effectively.

What happens after I submit VA Form 26-4555?

Once you submit VA Form 26-4555, the VA will process your application and notify you of the outcome. This notification will include details on whether you qualify for the specially adapted housing or home adaptation grant. Keep in mind that the VA may require additional information, and it will assess both medical and economic factors related to your service-connected disability before making a final decision.

Common mistakes

Applying for a specially adapted housing or special home adaptation grant can provide essential support for veterans facing unique challenges. However, filling out the VA Form 26-4555 incorrectly can lead to delays or even denials of benefits. Here are eight common mistakes that people make when completing this important form.

First, overlooking required fields is a frequent error. Each section of the form is designed to gather specific information. Failing to provide your Social Security Number or date of birth can result in your application being incomplete. Always double-check that every section is filled in as instructed.

Second, many applicants do not provide accurate contact information. Ensure that your telephone numbers and email address are current. This allows the VA to reach you quickly if they need additional information regarding your application.

Another common mistake is neglecting to read the instructions carefully. The instructions detail how to submit the form and the necessary information. Submitting the form to the wrong VA regional office can cause unnecessary delays in processing your application.

Additionally, some applicants fail to disclose previous applications. If you have made a prior application for specially adapted housing, it is vital to answer "Yes" and provide the requested dates and locations. Leaving this out can raise red flags during the review process.

People also often forget to sign and date the application. Section 12A clearly states that the applicant must sign in ink, and failing to do so means the application is not valid. Also, providing an incorrect or missing date can lead to complications.

Another pitfall is providing incomplete remarks. If there are any special circumstances or additional information that might support your application, include them in the remarks section. A lack of detail could hinder your chances of approval.

Lastly, submitting outdated forms can be problematic. Always check for the most recent version of the VA Form 26-4555 to ensure that you are using the correct document. Using an outdated form may lead to processing issues or could even result in a denial.

By being aware of these common mistakes, applicants can improve their chances of successfully acquiring the benefits they deserve. Taking the time to carefully complete the VA Form 26-4555 can make a significant difference in the processing of your application.

Documents used along the form

The VA Form 26-4555 is crucial for veterans seeking assistance in acquiring specially adapted housing or a special home adaptation grant. Alongside this application, several other documents are typically required to help streamline the process and verify eligibility. Below are key forms that are often used in conjunction with the VA Form 26-4555.

  • VA Form 21-526EZ: This is the application for disability compensation and related compensation benefits. It establishes the veteran’s service-connected disabilities, which are critical for determining eligibility for the housing grants.
  • VA Form 21-2680: Known as the Examination for Housebound Status or Permanent Need for Regular Aid and Attendance, this form assesses the veteran’s overall physical condition. It is essential for identifying any special needs that should be considered when providing housing options.
  • VA Form 26-4555a: This form provides additional information specific to the construction or modification of the housing as requested by the veteran. It details plans for adaptation that address the unique requirements of the veteran’s service-connected disabilities.
  • Income Verification Documents: A variety of income verification documents, such as tax returns, pay stubs, or bank statements, may be needed to assess the financial resources of the applicant. These documents help determine eligibility based on income levels.

Ensuring that all relevant documents are completed accurately and submitted promptly can significantly expedite the approval process. Proper preparation is vital for maximizing the chances of receiving the necessary support through these housing grants.

Similar forms

  • VA Form 26-1880 - This form is used to apply for a Certificate of Eligibility for VA home loan benefits. Like the VA 26-4555, it requires information about the applicant's service-connected disabilities and aims to verify eligibility for specific benefits.
  • VA Form 21-526EZ - Used for applying for disability compensation and related benefits, this form collects personal information and details about service-related conditions. Both forms focus on veterans' benefits, necessitating similar eligibility assessment processes.
  • VA Form 26-1802a - This document is an application for a VA Direct Loan. Similar to the VA 26-4555, it aims to assist veterans in obtaining housing assistance. Both require details that establish eligibility based on past military service and current circumstances.
  • VA Form 21-3500 - This form is for applying for vocational rehabilitation and employment services. It parallels the VA 26-4555 in that it addresses accessibility to assistance based on specific disabilities related to military service.
  • VA Form 21-4142 - This form provides the VA with permission to obtain records from medical providers. It functions similarly to the VA 26-4555 by ensuring all necessary documentation about the applicant’s medical conditions is available for eligibility determination.
  • VA Form 22-1990 - Used for applying for education benefits under the GI Bill, this form is again similar in purpose, focusing on aiding veterans through benefits tied to their service, enabling access to educational resources.

Dos and Don'ts

When completing the VA Form 26-4555, it is important to adhere to specific guidelines to ensure accuracy and efficiency. The following list outlines actions you should and should not take during the process:

  • Do read the instructions carefully before starting the form.
  • Do provide your Social Security Number as it is mandatory.
  • Do ensure that all your contact information is current and clearly written.
  • Do verify that you have included the correct dates and any prior application details if applicable.
  • Don't leave any sections of the form blank; any missing information could lead to delays.
  • Don't sign the form until you have reviewed all the information for accuracy.

Completing the form accurately can facilitate the processing of your application and help you receive the benefits you may be entitled to. Take the time you need to ensure everything is in order.

Misconceptions

  • Misconception 1: The VA 26 4555 form is only for veterans who are homeless.

    • This form is designed for veterans who need specially adapted housing due to service-connected disabilities, not just for those without homes. It applies to a broader range of needs related to housing adaptations.

  • Misconception 2: Providing Social Security Numbers is optional.

    • In fact, supplying a Social Security Number is mandatory. The VA requires this information to accurately process applications and verify eligibility for grants.

  • Misconception 3: Filling out the form takes a long time.

    • The form is estimated to take about 10 minutes to complete. Most applicants find that with the right documentation, they can fill it out relatively quickly.

  • Misconception 4: You can submit the form anywhere.

    • This application must be submitted to the VA regional office where the claim file is located or online through the specified eBenefits website, ensuring that it reaches the correct processing center.

  • Misconception 5: The VA will disclose personal information without consent.

    • Under the Privacy Act of 1974, the VA cannot share personal information collected from the form without proper authorization. This helps to protect applicants from unauthorized disclosures.

  • Misconception 6: Having applied before disqualifies you from future applications.

    • Previous applications do not automatically disqualify an individual from applying again. Each application is assessed on its own merits, and individuals are encouraged to reapply if their circumstances have changed.

  • Misconception 7: The form is only for those currently living in nursing homes.

    • Applicants do not have to be living in a nursing home. The form is applicable to any veteran experiencing difficulties with housing adaptations due to disabilities, regardless of their current living arrangements.

  • Misconception 8: The VA 26 4555 is a one-time application.

    • While many may complete the form for a specific grant, veterans can apply multiple times for different needs or grants over time as their situations evolve.

  • Misconception 9: Approval for housing adaptation grants is automatic.

    • The process is thorough, and applicants must meet certain criteria. The VA attempts to notify applicants as soon as possible regarding their application status and potential eligibility, but approval is not guaranteed.

Key takeaways

Here are key takeaways regarding the VA Form 26-4555, which applies to applications for specially adapted housing or special home adaptation grants:

  • Purpose of the Form: This form is used to apply for assistance in acquiring specially adapted housing or for a special home adaptation grant under Title 38 U.S.C. Section 2101(a) or 2101(b).
  • Mandatory Information: Applicants must provide their Social Security Number, which is essential for verifying eligibility. The VA requires this information under Title 38, CFR 3.809.
  • Submission Process: Applicants should submit the completed form to the VA regional office where their claim file is maintained, or they may complete it online through eBenefits.
  • Estimated Completion Time: The VA estimates that filling out this form will take approximately 10 minutes, considering the time needed for review and gathering required information.
  • Previous Applications: The form inquires about any previous applications for specially adapted housing or home improvement grants, necessitating disclosure of dates and locations for any past submissions.
  • Certification Requirement: The applicant must certify the application by signing the form, affirming the nature of their service-connected disability and understanding that further considerations may be required.
  • Privacy Protection: The form contains a Privacy Act Notice, assuring that the information collected will be kept confidential and used only as authorized, protecting the applicant's personal data.

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