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GetFormDetermineyoureligibilityforthisbenefitNote:Youmusthaveaservice-connectedconditiontogetaspeciallyequippedvehicleWorkingwiththisform hasneverbeenObtaintheoriginalcopyofVAFormfromtheveteranorservicememberafterheorshehascompletedSectionIV.Submittheoriginalcopyof VAFormanditemizedinvoicetotheVAregionalofficeshowninItem,SectionIII,Attention:FinancialDivisionYou’llneedtofilloutanApplicationfor AutomobileorOtherConveyanceandAdaptiveEquipment(VAForm)QuicklyaccesstoptasksforfrequentlydownloadedVAformsContactshouldbemade withtheProstheticsServiceatyourlocalVAmedicalcenteroroutpatientclinicpriortoanypurchaseofequipmentCompletealliteminPartIofthisformin duplicateandsigntheformIfyouarerequestingadaptiveequipmentorservices,VAwilldetermineyoureligibilityandcompletePartIIMakesurethatSectionIII ofVAFormiscompletedandsignedbyVADeliverthevehicle,includingVA-approvedadaptiveequipmentprovidedand/orinstalledbythesellerObtainthe originalcopyofVAFormfromtheveteranorservicememberafterheorshehascompletedSectionIVSubmittheoriginalcopyofVAIfyouhaveanyquestions, visittheAskVA(AVA)sitetoaskaquestionelectronicallyTheVAwillmakeaonetimepaymenttoeligibleVeteranstobuyanautomobileorforadaptive equipment,repairorreplacementrequiredduetoadisabilityShowdetailsMailittotheaddresslistedontheformWe’llpaythevehicle’ssellerdirectlyNote: AfteryoucompleteandsubmitSectionIoftheapplication,VAwillcompleteSectionIIandreturntheoriginaltoyouSearchforVAformsbykeyword,form name,orformnumberOpenformfollowtheinstructionsVaFormisaVAformrequestingtheveterantoprovideinformationaboutenrollmentinelementaryor secondaryschoolForSURVIVORSBENEFITStherequiredformsare:VAFormPEZ,LearnhowtoapplyforVAdisabilitybenefitswiththisformthathelps youdetermineyoureligibilityandcompensationforservice-connectedconditions, VAFormPrintable,FillableinPDF–AVAForm,alsoknownasan AuthorizationforAutomobileorOtherConveyanceandAdaptiveUseavaformtemplatetomakeyourdocumentworkflowmorestreamlined.Howitworks.Get VAFormtodownloadLearnmoreaboutForthosewhoalreadyfiledaclaimforVAdisability,useVAForm“ApplicationforAutomobileorOtherConveyance andAdaptiveEquipment”whenapplyingforMakesurethatSectionIIIofVAFormiscompletedandsignedbyVADeliverthevehicle,includingVA-approved adaptiveequipmentprovidedand/or•VAForm,ApplicationforAutomobileorOtherConveyanceandAdaptiveEquipmentIfyouhaven’tMakesurethat SectionIIofVAFormiscompletedandsignedbyVADeliverthevehicle,includingVA-approvedadaptiveequipmentprovidedand/orinstalledbythe sellerObtaintheoriginalcopyofVAFormfromtheveteranorservicepersonafterheorshehascompletedSectionIIITheinstructionsontheVAFormcontaina listofadaptiveequipmentthathasbeenpre-approvedforparticulardisabilities, AnApplicationforAutomobileorOtherConveyanceandAdaptiveEquipment (VAForm)GetVAFormtodownload.