Appendix B: Requesting Verification from the Federal Department of Veterans Affairs

VA Pension and Aid and Attendance Rates

Veterans Benefits Effective 1/1/2014
Gross (identifiable) Monthly VA Pension		Aid and Attendance Portion
A		B
2013 2014		2013 2014
$1,704 $1,758		$694 $704
Widows Benefits
$1,113 $1,130 $417 $423
Instructions: If the monthly VA payment (check or direct deposit) is exactly as shown in Column A, then the Aid and Attendance portion is shown in column B. If any other rate is shown, send a benefit verification request to the VA Regional Office.

Veterans Affairs * Regional Office and Insurance Center P.O. Box 8079 Philadelphia, PA 19101 (215) 842-2000 1-800-827-1000
Phone No.: See Chapter 338, Appendix J
* Insert at lower left of envelope (for CAO use only):
Attention: 213 - DO NOT OPEN IN MAILROOM
For the following counties:
Adams Berks Bradford Bucks Cameron Carbon Centre Chester Clinton Columbia	Cumberland Dauphin Delaware Franklin Juniata Lackawanna Lancaster Lebanon Lehigh Luzerne	Lycoming Mifflin Monroe Montgomery Montour Northampton Northumberland Perry Philadelphia Pike	Potter Schuylkill Snyder Sullivan Susquehanna Tioga Union Wayne Wyoming York
Veterans Affairs * Regional Office 1000 Liberty Avenue Pittsburgh, PA 15222 1-800-827-1000
Phone No: See Chapter 338, Appendix J
*Insert at lower left of envelope (for CAO use only):
Attention: CP 21 (A and A) - DO NOT OPEN IN MAILROOM
For the following counties:
Allegheny Armstrong Beaver Bedford Blair Butler Cambria	Clarion Clearfield Crawford Elk Erie Fayette Forest	Fulton Greene Huntingdon Indiana Jefferson Lawrence McKean	Mercer Somerset Venango Warren Washington Westmoreland

The CAO must give the VA the following when asking for confirmation of the benefit amount:

A copy of the signed Authorization for Information (PA 4)
Full name and birth date of the veteran
Full name and birth date of the claimant (the individual making the claim)
Veteran's VA claim or “C” number, military service number, or Social Security number
Relationship of the individual to the veteran (for example, wife, widow, parent, or child)

Please provide monthly VA benefit amounts and the portion attributable to Aid and Attendance for the individual listed below:

Name of recipient:___________________________________________________________

Relationship to Veteran: ___ Veteran ___ Wife/Widow ___ Parent ___ Child

Veteran’s Full Name (print):___________________________________________________

First Middle Last

Veteran's Date of Birth: __________________________________________

Veteran's Service Serial Number: _________________________________

VA Claim Number:______________________________________________

Veteran's Social Security Number:_________________________________

I hereby authorize release of the above information by the Veterans Administration.

______________________________________________________
Signature of VA Recipient

Updated February 27, 2014 Replacing January 10, 2013