Contact UsStart a Free Consultation Today! Click to Call 1.877.807.1400 Email Us info@unitedveteransassistance.comOr fill out the form below and we will get back to youPlease enable JavaScript in your browser to complete this form.LayoutFirst Name *Email *What timezone are you on?Choose OneEastern Standard TimeMountain Standard TimeCentral Standard TimePacific Standard TimeAlaska Standard TimeHawaii-Aleutian Standard TimeWhich war did the Applicant Serve in?Choose OneVietnam War - 1955-1975World War 2 - 1941-1946Gulf War - 1990+Korean Conflict - 1950-1955OtherLast NamePhone *Applicant is a...Choose OneSurviving SpouseSingle VeteranMarried VeteranTwo Veterans Married to Each OtherIs the Veteran receiving service connected disability compensation? Choose OneVeteran does not receive any disability compensationYes, 100% service connectedYes, but less than a 100% disability ratingNo, Veteran is deceasedUnknown(Not a requirement for Aid and Attendance eligibility)Does the Veteran/ Spouse require the assistance of another person for any of the following activities? Bathing / Dressing Toileting / Personal Hygiene Eating or drinking Transferring in and out of bed No assistance required Has the Veteran/ Spouse been diagnosed with any of the following?Choose OneAlzheimer'sDementiaParkinson'sLegal blindnessNone of the aboveWhat is the Veteran/ Spouses current living situation? Choose OneThey live in an assisted living facility or are considering moving to oneThey live at home with an aidThey live at home with family or friends helping themThey live at home and do not receive assistanceWhat is the household monthly income?Does the Veteran/ Spouse have more than $150,537 in liquid assets? (This does not include their primary residence) Choose OneNoYesThey have between $150,537- $170,000SubmitAvailable Programs: Veterans Pension Aid And Attendance Survivors Pension (Death Pension) Housebound
