VA Form 26-4555c
Application for Home Improvements and Structural Alterations (HISA) Grant
You need a medically required home modification (wheelchair ramp, grab bars, accessible bathroom) and either don't qualify for SAH/SHA or need a smaller modification.
- Who fills it
- veteran
- Journey phase
- Specialty Benefits
- Estimated time
- 20-30 minutes.
- When to file
- After getting a physician's prescription for the modification and before starting construction.
Official VA form page: https://www.benefits.va.gov/homeloans/adaptedhousing.asp
Gather before you start
- ▸Physician's written prescription specifying the medically required modification
- ▸Contractor estimate for the modification
- ▸Property ownership documentation (own the home)
- ▸VA enrollment information (must be receiving VA health care)
Attach with the form
- ▸Physician's prescription or prescription letter
- ▸Contractor estimate with itemized costs
- ▸Proof of home ownership
Section I - Veteran Identification
Blocks 1-5Name, SSN, VA File Number, addressPII
Your identifying information. HISA is applied through the prosthetics/rehabilitation department at your VA medical center, not through VA Regional Loan Centers. Contact your VAMC first.
(legal name, SSN, VAMC information)
Common mistakes
- ×Contacting the VA loan center about HISA - it is a health care benefit processed through your VAMC prosthetics department, not the loan program.
- ×Not knowing HISA is available for non-SC conditions too - wider eligibility than SAH/SHA.
Section II - Medical Necessity Documentation
Blocks 6-10Physician prescription for the modification and description
Your VA (or VA-approved) physician must write a prescription specifying the medically necessary modification. The prescription must describe: (1) The specific modification needed, (2) The medical reason (which condition requires it), (3) How the modification supports your medical treatment. Examples: wheelchair ramp prescribed for SC spinal cord injury; roll-in shower prescribed for non-SC Parkinson's disease.
e.g., Dr. Smith, VA VAMC Phoenix, prescribed: "Bathroom modifications including roll-in shower and grab bars for patient with bilateral lower extremity weakness (SC condition) to allow safe bathing without caregiver assistance."
Common mistakes
- ×Ordering modifications before getting VA approval - VA must inspect and approve before payment.
- ×Vague physician prescription - must specify the exact modification and the medical reason.
- ×Not knowing both SC and non-SC conditions qualify, but with different grant limits.
Authority
- 38 USC 1710 - Core VA health care eligibility.
Section III - Modification Details and Estimate
Blocks 11-16Specific modifications, estimated cost, and contractor
Describe each modification being requested and attach an itemized contractor estimate. HISA covers medically required structural modifications - not cosmetic improvements.
e.g., Roll-in shower installation: $3,200; grab bars (4): $600; threshold ramp: $800. Total: $4,600. Contractor: ABC Home Modifications.
Common mistakes
- ×Including cosmetic or non-medically-required improvements in the estimate - HISA only covers what the prescription specifies.
- ×Not getting multiple estimates - VA may request a second estimate if the first seems excessive.
Section IV - Certification
Blocks 17-18Veteran signature and datePII
Sign and date. Submit to your VAMC prosthetics department for processing.
(signature/date)
Common mistakes
- ×Mailing to VA Regional Loan Center - HISA goes to the VAMC prosthetics department.
Statutory and regulatory authority
- 38 USC 1710 - Core VA health care eligibility.