Va Automobile Adaptive Equipment Form

Purchase a vehicle. Deliver the vehicle including va approved adaptive equipment provided and or installed by the seller. Driver s license verification check applicable block 6.

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Application for adaptive equipment motor vehicle.

Va automobile adaptive equipment form.

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. Request for dd 214 or other military records nara sf 180. Date of va certificate of eligibility.

Veterans are trained through the va driver s rehabilitation program how to safely operate their vehicle on our nation s roadways. The automobile adaptive equipment aae program permits physically challenged persons to enter exit and or operate a motor vehicle or other conveyance. 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.

All van modifications require prior authorization before purchase. If va determines you are eligible read the instructions on va form 21 4502 for a list of adaptive equipment preapproved for particular disabilities. Part i to be completed by applicant if more space is needed attach a separate sheet and identify by item number 4. If you are unable to find your form here you may want to visit.