Veteran Aid Pre-qualification

Choose One
VeteranSurviving SpouseCouple

Was the Veteran honorably discharged?
YesNo

Did the Veteran serve at least 90 consecutive days of active duty, with at least one day during any of the following wartime periods?
Yes*No

*If yes, please select applicable wartime period:
WWII: 12/07/1941 - 12/31/1946Korean War: 6/27/1950 - 01/31/1955Vietnam: 2/28/1961 - 08/05/1964 (must have served in the Republic of Vietnam)Vietnam: 8/05/1964 - 05/07/1975Gulf War: 8/02/1990 - TBD (minimum 2 years active duty)

If Surviving Spouse, were you married to the Veteran at the time of death?
N/AYesNo

If Surviving Spouse, have you remained unmarried after the Veteran’s death?
N/AYesNo

Is there a need for assistance with ADLs or IADLs? (Bathing, Dressing, Transportation, Incontinence, Housekeeping, Laundry Cooking, Shopping, Medication Reminders, Ambulating, or Custodial Care (Supervision due to Mental Health Disorders)
YesNo

Are assets less than $127,061? (Excludes car & home. ex. Cash, Checking, Savings, CDs, etc.)
YesNo

Is a care facility being considered within 60-90 days?
YesNo

Is the Veteran or Surviving Spouse already receiving VA money or other VA benefits?
YesNo

Veteran Aid Pre-qualification

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