Fillable 2008 VA Form 21-2680 - Department of Veterans Affairs - vba va
OMB Control No. 2900-0721 Respondent Burden: 30 minutes
EXAMINATION FOR HOUSEBOUND STATUS OR PERMANENT NEED FOR REGULAR AID AND ATTENDANCE
1. FIRST NAME - MIDDLE NAME - LAST NAME OF VETERAN 2. FIRST NAME - MIDDLE NAME - LAST NAME OF CLAIMANT
(If other than veteran)
3. RELATIONSHIP OF CLAIMANT TO VETERAN
4A. VETERAN'S SOCIAL SECURITY NUMBER
4B. CLAIMANT'S SOCIAL SECURITY NUMBER
5. CLAIM NUMBER...
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