Official VA Form

VA Form 21-0779

Request for Nursing Home Information in Connection with Claim for Aid and Attendance

VA Form 21-0779 — Request for Nursing Home Information in Connection with Claim for Aid and Attendance is an official U.S. Department of Veterans Affairs form used for disability. The current version was last revised 2023-09-27. It is 2 pages long. Download the up-to-date PDF below — BaseNeed syncs form data directly from VA.gov so you always get the current edition.

Download the official PDF (VA.gov) →

Last revised: 2023-09-27
First issued: 2023-10-26
Pages: 2
Administered by: VBA

Disability

Frequently asked questions

What is VA Form 21-0779 used for?

Request for Nursing Home Information in Connection with Claim for Aid and Attendance. It is an official VA form in the Disability category, administered by VBA.

Where can I download the current VA Form 21-0779?

Download the official PDF from VA.gov here: https://www.vba.va.gov/pubs/forms/VBA-21-0779-ARE.pdf (last revised 2023-09-27).

How long is VA Form 21-0779?

VA Form 21-0779 is 2 pages long, last revised 2023-09-27.

Always the current version — synced from VA.gov. BaseNeed is not affiliated with the U.S. Department of Veterans Affairs.

You are not the first person to deal with this

BaseNeed is a members-only community for service members, veterans, spouses and their families. Nothing posted inside is public — not on Google, not on Facebook. That is the point: people talk about moves, money and paperwork there, and that only works behind a door.

Join free — 30 seconds →

No account needed for these: VA facilities · BAH calculator · Jobs · Housing

More Disability forms

VA Form 21-4142a — General Release for Medical Provider Information to the Department of Veterans Affairs
VA Form 21P-0969 — Income and Asset Statement in Support of Claim for Pension or Parents' Dependency and Indemnity Compensation (DIC)
VA Form 21-0538 — Mandatory Verification of Dependents
VA Form 21-0845 — Authorization to Disclose Personal Information to a Third Party
VA Form VA9 — Appeal to Board of Veterans' Appeals
VA Form 21-4192 — Request for Employment Information in Connection with Claim for Disability Benefits
VA Form 21-4142 — Authorization to Disclose Information to the Department of Veterans Affairs (VA)
VA Form 21P-8416 — Medical Expense Report

Nearby form numbers

VA Form 21-0307 — Award Attachment for Qualifying Veteran’s Child Born with Disabilities
VA Form 21-0506 — Notice of Your Due Process Rights
VA Form 21-0538 — Mandatory Verification of Dependents
VA Form 21-0781 — Statement in Support of Claim for Service Connection for PTSD
VA Form 21-0781a — Statement in Support of Claim for Service Connection for PTSD Secondary to Personal Assault
VA Form 21-0788 — Information Regarding Apportionment of Beneficiary's Award