Va Automobile Adaptive Equipment Form

All van modifications require prior authorization before purchase.

Va automobile adaptive equipment form.

If va determines you are eligible read the instructions on va form 21 4502 for a list of adaptive equipment preapproved for particular disabilities. Driver s license verification check applicable block 6. Part i to be completed by applicant if more space is needed attach a separate sheet and identify by item number 4. Application for automobile or other conveyance and adaptive equipment fillable file type.

Download va form 10 1394 pdf we may pay you or we may pay the equipment seller directly. Date of va certificate of eligibility. If you qualify for adaptive equipment only you ll need to fill out an application for adaptive equipment motor vehicle va form 10 1394. Obtain the original copy of va form 21 4502 from the veteran or servicemember after he or she has completed section iv.

Purchase a vehicle. If you are unable to find your form here you may want to visit. Veterans are trained through the va driver s rehabilitation program how to safely operate their vehicle on our nation s roadways. Request for dd 214 or other military records nara sf 180.