Dad’s admission agreement is not the VA nursing home form. For an Aid and Attendance claim involving nursing home residence, VA identifies Form 21-0779, Request for Nursing Home Information in Connection with Claim for Aid and Attendance. A nursing home official uses it to verify that the claimant is a patient in a qualifying extended care facility.[1]
Treat the form as a handoff between three people: the family supplies Dad’s identifying information, the facility completes its certification, and the person filing the pension claim makes sure the signed form reaches the correct VA file. Do not leave the admission desk assuming the facility automatically sends it.
Before asking the facility to complete it
First identify the claimant. If Dad is the living Veteran, his initial pension application is VA Form 21P-527EZ. If the claimant is a surviving spouse or eligible child, the survivors application is VA Form 21P-534EZ. VA uses Form 21-2680 for the medical examination supporting Aid and Attendance or housebound benefits. Form 21-0779 is additional nursing home evidence, not a replacement for the pension application or every other required form.[2][3][4]
Write the claimant’s full name and VA file number or Social Security number on the family’s working copy before it changes hands. Ask the nursing home which employee is authorized to certify resident information and how completed benefit forms are returned. Record that person’s name, department, telephone number, and the date the form was delivered.
Confirm that the provider is actually a nursing home before using this form. VA describes Form 21-0779 as a form for a nursing home official verifying a patient in a qualifying extended care facility. Assisted living, residential care, adult day care, and in-home attendant arrangements may instead require the applicable worksheet contained in VA Form 21P-8416.[1][5]
What the nursing home must verify
Give the facility the complete current Form 21-0779, including its instructions. Ask the certifying employee to complete every applicable field, sign the certification, and return the whole form. The family should not guess at the facility’s answers or sign as the nursing home official.
Before accepting the form, check it against the admission record. Confirm the claimant’s identity, facility name and address, admission information, level or type of care, Medicaid information requested on the form, and the official’s signature and contact information. If an answer differs from the admission paperwork, ask the facility to resolve the difference before filing. Do not alter a signed facility certification yourself.
Keep a clean copy of the completed Form 21-0779. Also keep the admission agreement, current billing statement, payment ledger, and any document showing who pays the bill. Form 21-0779 verifies nursing home status, while VA Form 21P-8416 reports qualifying medical or dental expenses paid by the claimant or household that were not reimbursed and are not expected to be reimbursed.[1][5]
Match the expense report to money actually paid
Do not copy the facility’s full charge onto an expense report without checking who bears it. Separate the billed amount from insurance payments, Medicaid payments, refunds, credits, and the amount Dad or his household actually paid. VA’s medical expense instructions limit Form 21P-8416 to expenses paid and not reimbursed or expected to be reimbursed.[5]
If the facility cannot yet produce a payment history, ask what document it can provide after the first payment posts. Keep receipts or account statements as private-pay care begins. VA notes that proof may be needed for nursing home, in-home care, or other care facility expenses.[5]
The family does not have to wait for a pension decision before arranging care it can privately afford. But a pending claim is not an award, and the VA sources do not promise a decision date. Build the care budget without treating a possible pension payment as money already available.[6]
Assemble the filing set
For a living Veteran filing an initial pension claim, check the packet for VA Form 21P-527EZ, the completed Form 21-2680 supporting Aid and Attendance, the facility-completed Form 21-0779, and any requested financial or medical-expense forms. VA may direct a claimant to use Form 21P-0969 for income and assets, while Form 21P-8416 reports unreimbursed medical expenses.[2][4][5]
For a surviving spouse or child, begin with VA Form 21P-534EZ rather than the Veteran’s pension application. That application can cover Survivors Pension and increased benefits based on Aid and Attendance or housebound status. The nursing home and medical evidence should identify the survivor as the claimant, not the deceased Veteran.[3]
Number the pages and make a complete copy before submission. Put a short cover sheet on top listing every enclosed form and attachment. If Form 21-0779 arrives after the main claim was filed, label the submission as evidence for the pending pension claim and include the claimant’s identifying number on the cover sheet.
Choose one VA filing door and preserve the receipt
VA permits a Veterans Pension application to be filed online, uploaded through QuickSubmit, mailed to the Pension Intake Center, delivered to a VA regional office, or filed with help from an accredited representative. Aid and Attendance evidence can also be submitted online, by mail, or in person.[2][6]
The second door is the form-specific submission path for Form 21-0779. VA’s form page allows online completion and submission, and the paper form carries its own mailing instructions. Read the current form before mailing rather than copying an address from an old checklist.[1]
Whichever route you use, keep proof tied to the exact pages submitted: an upload confirmation, date-stamped office copy, mailing receipt with tracking, or the accredited representative’s submission confirmation. Then verify that the evidence appears in Dad’s claim record. A delivery confirmation shows that a package reached its destination, not necessarily that every page was associated with the correct claim.
Who can file it free in St. Louis
A VA-accredited Veterans Service Organization representative can help gather evidence, file the claim, and communicate with VA. VA states that an accredited VSO representative’s services on benefit claims are always free. Appointment normally uses VA Form 21-22, and the claimant should ask the representative which organization to name before signing.[7]
Use the site’s Local Help: St. Louis Offices page to identify offices to call. Ask whether the person handling pension claims is currently VA-accredited, whether an appointment is required, what records to bring, and whether the office will provide a submission receipt. VA does not automatically assign a representative.[7]
After filing
VA says decision time depends on the claim and that claims are generally processed in the order received unless priority processing applies. There is no reliable universal wait period to use as a private-pay care budget.[6]
Open every VA letter promptly. Compare any evidence request with the packet copy, identify the exact missing item, and calendar the response deadline printed in the letter. If the facility must correct or update Form 21-0779, return to the same certifying contact and submit the corrected form with the claimant’s identifying information and proof of receipt.
Keep reporting separate events separately. A change in nursing home status, payer, monthly expense, income, assets, or Medicaid participation may affect what VA needs to evaluate. Ask the accredited representative which current form applies before sending an unlabeled stack of bills.
The handoff checklist
Before calling the nursing home form finished, confirm five things: the correct claimant is named, an authorized facility official completed and signed it, the answers match the admission record, the related pension and expense forms are included or already pending, and the family has proof showing exactly what VA received.
For the broader order of work, use Start Here: The Order to Read. This site is independent and is not affiliated with the U.S. Department of Veterans Affairs.
VA.gov footnotes
[1] VA.gov, “VA Form 21-0779.” [2] VA.gov, “How to Apply for a VA Pension as a Veteran,” and “VA Form 21P-527EZ.” [3] VA.gov, “Apply for DIC, Survivors Pension, or Accrued Benefits Online.” [4] VA.gov, “Aid and Attendance Benefits and Housebound Allowance.” [5] VA.gov, “Submit Medical Expenses to Support a Pension or Parents’ DIC Claim.” [6] VA.gov, “Aid and Attendance Benefits and Housebound Allowance,” and “How to Apply for a VA Pension as a Veteran.” [7] VA.gov, “Get Help From a VA Accredited Representative or VSO.” The site’s organized source list is available at Sources.