Attachments to forms

Discussion in 'General Discussion' started by Deg9, Sep 11, 2010.

  1. Deg9

    Deg9 Newbie

    These are my first of many questions I am sure. I am busy filling in the VA Form 21-534 for my 88 year old mother.
    - My mother will be entering an assisted living facility in January 2011. I plan to submit to the VA a notebook with the following completed forms: VA Form 21-534; Form SSA-24; VA Form 21-4142; VA Form 21-0845. Are there other forms I should include?
    - Where do I attach my Veteran father's death certificate, my parents' marriage certificate, and my mother's first marriage divorce decree prior to marrying my Veteran father? Immediately after the referenced item or as tabbed pages at the back of the notebook?
    Thank you so much for existing!! There is absolutely no one else out there that I can find who knows anything about this benefit. You are appreciated! deg9
  2. AnnieN

    AnnieN Newbie

    Hi. I submitted a successful application for my Mom, the veteran, earlier this year. From my experience I used the notebook method and put everything in there. The attachments were 3-hole punched and put in the notebook. I didn't send any original documents and I had the copy of her military records certified by the County. I used a Form 21-4138, Statement in Support of Claim, for the cover letter listing all forms and attachments. My Mom signed all forms as the veteran in a barely legible scratch, except the 21-4138. Since my Mom lives in an Assisted Living Facility (which is her main cost) I got a typed, signed statement on their letterhead saying,

    "Ms. ___ moved into our facility on 01/12/09. She receives assistance with dressing, medication management, hygiene and all other activities of daily living. She currently pays $5,000.00 per month for her care. This amount could change as her care needs increase of decrease. Please call me at the number listed below if you need further assistance. Signed, Director of Business Services"

    I don't know what you would write if your Mom hasn't moved in yet. Perhaps Vetadmin or others can help with that question. Good luck to you.
  3. vetadmin

    vetadmin Administrator Staff Member

    Take the advice of Annie and how she submitted her application.

    I have a question on the SSA-24 and 21-4142 you mentioned. Not sure what these forms are.

    You need 21-534
    Dr/medical statement
    All supporting documentation ie; marriage license, death certificate, DD-214, banking info etc. You should look at the list on the website.

    If she is already in an ALF, include the statement of occupancy from the facility.
  4. Deg9

    Deg9 Newbie

    Thank you both for replying so quickly. I'll submit the "Application Notebook" after my Mom has moved to her ALF. Annie, I think your idea of using the Form 21-4138 as a cover letter is a better idea too. I'll ask Mom's ALF to do the same letterhead statement as well. Vetadmin, the SSA-24 is "Social Security Administration Application For Survivors Benefits" that was attached to the VA 21-534 when I printed it out. The VA 21-0845 is "Authorization To Disclose Personal Information To A Third Party". Should I leave them out? Mom will be transitioning into her ALF in January and we are keeping our fingers crossed that this will come through for her. Thank you again!
  5. vetadmin

    vetadmin Administrator Staff Member

    You can include the SSA-24. Generally it is just a copy of the most recent SSA statement, but that is fine.

    The 21-0845 is one of the forms I told you need. Without that the VA will not talk to you about the claim.

    Also be sure to send the application Return Receipt and to keep a complete copy of the application for yourself.

    What state does your mom live in? You need to send to the proper office that handles claims for her state.
  6. Deg9

    Deg9 Newbie

    I will definitely include VA 21-0845. Mom lives in Ohio. Thanks V.
  7. Deg9

    Deg9 Newbie

    AnnieN, Did you check "yes" or "no" to question 31 of the VAForm21-534? The question asks "Are you claiming aid and attendance allowance and/or housebound benefits because you need the regular assistnace of another person, are having severe visual lproblems, or are housebound?" I apologize if this is too personal. It's just confusing to me. If answer "yes",the form says to attach a doctor's report. I was going to just have Mom's assisted Living facility write a statement on their letterhead. Did you also include a doctor's report? Thanks.
  8. vetadmin

    vetadmin Administrator Staff Member

    You have to have the Physician's Statement filled out to submit with the application. It is not enough to have just a certificate of occupancy from the ALF. Please look at the home page of the site for all the forms on the right hand side of the home page.
  9. Deg9

    Deg9 Newbie

    Thank you, Debbie. I'm trying so hard to do this right that I'm overlooking the obvious sometimes. Thank you for the advice and for not making me feel stupid for asking. Do I need to contact VA for the address of where to send the whole sha-bang or do you have that info? :)
  10. vetadmin

    vetadmin Administrator Staff Member

    You are welcome.

    For the state of OH you need to send to:

    Milwaukee Pension Maintenance Center
    Veterans Administration
    5400 West National Ave
    Milwaukee, WI 53214
  11. Deg9

    Deg9 Newbie

    Thank you, Debbie. I'll let you know how everything works out.

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