VA Form 21-2680
- Form name: Examination for Housebound Status or Permanent Need for Regular Aid and Attendance
- Form revision date: February 2023
- Related to: Disability, Family member benefits, Pension
When to use this form
Use VA Form 21-2680 to apply for Aid and Attendance benefits that will be added to your monthly compensation or pension benefits.
Downloadable PDF
Online tool
You can apply online instead of filling out and sending us the paper form.
Related forms and instructions
VA Form 21-0779
Form name: Request for Nursing Home Information in Connection with Claim for Aid and Attendance
Use this form if you’re a nursing home official to verify a Veteran or someone connected to a Veteran is a patient in a qualifying extended care facility.
Helpful links related to VA Form 21-2680
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If you need help with daily activities, or you’re housebound, learn about these benefits and if you qualify.