Complete the form below and a member of our team will reach out to talk through your family’s situation and next steps. Prefer to talk now? Call 855-380-4400.

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Family Inquiry

Please share as much as you can so we can understand your loved one’s needs. Must be a wartime Veteran or surviving spouse in need of home care.

About the Veteran or Surviving Spouse

Veteran or Surviving Spouse Name*
Who needs care?*

Your Information

Your Name*

Eligibility Questions

Do they already receive home care services?
Do they currently receive any income from the VA?
*If the Veteran is currently receiving income from the VA it cannot be over 70% disability compensation.
1.) Does your loved one need help from another person with daily activities (such as bathing, dressing or eating), or have dementia or legal blindness?
2.) Was the Veteran honorably discharged from their military service?
3.) Are their assets less than $163,699 excluding one house and one car?
4.) Did the Veteran serve at least 90 days of active duty, with at least one day during a wartime period listed below?
*If yes, please select applicable wartime period.

If the answer to questions 1–4 is “yes,” your loved one may be eligible for Pension with Aid & Attendance. VA determines eligibility and benefit amounts.

Please expect a call from VCC within 24 to 48 hours from a 636 area code.

We’ll use the information you share to respond to your inquiry and help coordinate care. See our Privacy Policy.

VA determines benefit requirements, benefit amounts, and authorization for VA programs. This form is not an application for VA benefits and is not a determination of benefits or eligibility.

Healthcare or home care professional? Refer a Veteran.