U.S. Department of Veterans Affairs, Veterans Benefits Administration (VBA) Edition VA Form 26-4555, AUG 2026 (OMB No. 2900-0132, expires 08/31/2029) 1 page

VA Form 26-4555 — Application in Acquiring Specially Adapted Housing or Special Home Adaptation Grant

VA's one-page application for the disability housing grants that help adapt a home to a service-connected disability.

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VA Form 26-4555 · Application in Acquiring Specially Adapted Housing or Special Home Adaptation Grant
The official U.S. Department of Veterans Affairs, Veterans Benefits Administration (VBA) form, edition VA Form 26-4555, AUG 2026 (OMB No. 2900-0132, expires 08/31/2029) — blank
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VA Form 26-4555 (2026) Application in Acquiring Specially Adapted Housing or Special Home Adaptation Grant — page 1 of 1
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Fill this form online Blank PDF from U.S. Department of Veterans Affairs, Veterans Benefits Administration (VBA)

What is VA Form 26-4555?

VA Form 26-4555 is the application for VA's Specially Adapted Housing (SAH) grant or Special Home Adaptation (SHA) grant, under 38 U.S.C. 2101(a) or 2101(b). VA's form page says the information helps VA determine or verify your eligibility for these disability housing grants, which help Veterans and service members with certain service-connected disabilities change a home so they can live more independently.

The form is a single page: your name, Social Security number, VA file or claim number, date of birth, email, address and phone numbers; whether you have applied before for specially adapted housing or for a home improvement and structural alteration grant (and when and where); whether you are confined to a nursing home or medical care facility; remarks; and a certification that you are applying because of the nature of your service-connected disability.

FileIt pre-fills your name, date of birth and email from the person's vault record, asks the follow-up questions only when they apply, and prints your answers onto VA's own PDF (AUG 2026 edition). The form asks you to sign your full name in ink, so FileIt leaves the signature line for your pen. FileIt never submits anything to VA.

Who fills it
The Veteran or service member applying for the SAH or SHA grant.
Pages
1
Where it goes
The form says to submit it to the VA regional office where your claim file is located, or to complete it online at va.gov.
Signature
Item 12A, your full name signed in ink.
Edition
VA Form 26-4555, AUG 2026 (OMB No. 2900-0132, expires 08/31/2029)

Who needs to fill out VA Form 26-4555?

  • Veterans and service members with a qualifying service-connected disability who want to adapt a home to it.
  • Applicants who used the paper form before and need the current edition (the AUG 2026 edition replaces MAY 2024).

When to use VA Form 26-4555

  • To apply for a Specially Adapted Housing grant or a Special Home Adaptation grant.
  • When you'd rather send a paper application than use the online application VA's page offers instead.

What you need before you start

  • Your Social Security number (the Privacy Act notice says giving it is mandatory for this application) and your VA file or claim number if you know it.
  • Your current address, email and daytime, evening and cell phone numbers.
  • The date and place of any earlier application for specially adapted housing or for a home improvement and structural alteration grant.
  • The name and address of the nursing home or medical care facility, if you are confined to one.

What’s on VA Form 26-4555

The 2026 edition has 1 page. FileIt asks for it in 4 parts:

  1. ApplicantVeteran or service member
  2. Previous applications and careVeteran or service member
  3. 11. RemarksVeteran or service member
  4. CertificationVeteran or service member

How to fill out VA Form 26-4555, step by step

1 Items 1 to 7: About you

Name, Social Security number, VA file or claim number, date of birth, email, address and phone numbers. FileIt joins your address into the item 6 box and checks it fits.

2 Items 8 and 9: Earlier applications

Yes or no for a previous specially adapted housing application and for a previous home improvement and structural alteration grant application; if yes, the date and place.

3 Item 10: Nursing home or facility

Whether you are confined to a nursing home or medical care facility, and if so its name and address.

4 Item 11: Remarks

Anything else VA should know. FileIt tells you if your remarks won't fit the box.

5 Certification and signature

Sign item 12A with your full name in ink and date it (item 12B).

Common mistakes to avoid

  • Leaving out the date or place of an earlier application after answering Yes to item 8 or 9.
  • Forgetting the facility's name and address after answering Yes to item 10.
  • Typing a name in the signature box: the form asks for your full name signed in ink.
  • Using an old edition: the AUG 2026 form says the MAY 2024 edition will not be used.

After you fill it out

Print the PDF, sign item 12A in ink and date it.

Submit it to the VA regional office where your claim file is located, as the form instructs, or apply online at va.gov instead.

Keep a copy. FileIt files the finished PDF in the person's vault folder.

Fill out VA Form 26-4555 online with FileIt

  1. Pick the person. Choose someone from People and FileIt fills in their name, date of birth, address and other details it already knows.
  2. Answer plain-language questions. One part of the form at a time, with the official help text beside each question — 27 fields in all. Your answers save as you go.
  3. Check the live preview. Watch your answers land on the real U.S. Department of Veterans Affairs, Veterans Benefits Administration (VBA) form, and let FileIt do any worksheet arithmetic.
  4. Generate the official PDF. FileIt prints your answers into the agency’s own PDF and files it in that person’s folder in your vault.

FileIt fills the form — it never files or submits anything for you. Deliver the finished form to whoever asked for it, the way the form’s instructions say.

Start VA Form 26-4555 now — it’s free

VA Form 26-4555: frequently asked questions

What is VA Form 26-4555 for?

It is the application for VA's Specially Adapted Housing grant or Special Home Adaptation grant (38 U.S.C. 2101(a) or 2101(b)) for Veterans and service members with certain service-connected disabilities.

Can I apply online instead?

Yes. VA's form page says you can apply online instead of filling out and sending the paper form, and the form itself says it can be completed online at va.gov.

Where do I send the paper form?

The instructions on the form say to submit it to the VA regional office where your claim file is located.

Can I sign it electronically in FileIt?

No. Item 12A says to sign your full name in ink, so FileIt leaves the signature for your pen.

Do I have to give my Social Security number?

The form's Privacy Act notice says giving your SSN is mandatory and applicants are required to provide it under 38 CFR 3.809, though VA won't deny benefits for refusing unless a federal statute requires the disclosure.

Official sources

FileIt is not affiliated with or endorsed by U.S. Department of Veterans Affairs, Veterans Benefits Administration (VBA) or any government. This page explains the form in general terms and is not legal, tax or immigration advice. Always read the official instructions, and check that you are using the edition the recipient accepts. Page last reviewed 2026-10-25.

Fill out VA Form 26-4555 online