Va Automobile Adaptive Equipment Form

Part i to be completed by applicant if more space is needed attach a separate sheet and identify by item number 4.

Va automobile adaptive equipment form.

Application for adaptive equipment motor vehicle. If va determines you are eligible read the instructions on va form 21 4502 for a list of adaptive equipment preapproved for particular disabilities. Veterans are trained through the va driver s rehabilitation program how to safely operate their vehicle on our nation s roadways. Driver s license verification check applicable block 6.

Download va form 10 1394 pdf we may pay you or we may pay the equipment seller directly. Request for dd 214 or other military records nara sf 180. If you are unable to find your form here you may want to visit. Obtain the original copy of va form 21 4502 from the veteran or servicemember after he or she has completed section iv.

All van modifications require prior authorization before purchase. The automobile adaptive equipment aae program permits physically challenged persons to enter exit and or operate a motor vehicle or other conveyance. Date of va certificate of eligibility. Deliver the vehicle including va approved adaptive equipment provided and or installed by the seller.