VA Form 26-4555c

Application for Home Improvements and Structural Alterations (HISA) Grant

Adapted HousingOfficial VA form on VA.gov

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.

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.

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

1 field

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.

Example

(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

1 field · 1 citation

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.

Example

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

1 field

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.

Example

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

1 field

Blocks 17-18Veteran signature and datePII

Sign and date. Submit to your VAMC prosthetics department for processing.

Example

(signature/date)

Common mistakes

Mailing to VA Regional Loan Center - HISA goes to the VAMC prosthetics department.

Statutory & regulatory authority

38 USC 1710 - Core VA health care eligibility.

VA Form 26-4555c

Application for Home Improvements and Structural Alterations (HISA) Grant

Adapted HousingOfficial VA form on VA.gov

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.

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.

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

1 field

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.

Example

(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

1 field · 1 citation

Blocks 6-10Physician prescription for the modification and description

Example

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

1 field

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.

Example

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

1 field

Blocks 17-18Veteran signature and datePII

Sign and date. Submit to your VAMC prosthetics department for processing.

Example

(signature/date)

Common mistakes

Mailing to VA Regional Loan Center - HISA goes to the VAMC prosthetics department.

Statutory & regulatory authority

38 USC 1710 - Core VA health care eligibility.

VA Form 26-4555c

Application for Home Improvements and Structural Alterations (HISA) Grant

Adapted HousingOfficial VA form on VA.gov

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.

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.

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

1 field

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.

Example

(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

1 field · 1 citation

Blocks 6-10Physician prescription for the modification and description

Example

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

1 field

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.

Example

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

1 field

Blocks 17-18Veteran signature and datePII

Sign and date. Submit to your VAMC prosthetics department for processing.

Example

(signature/date)

Common mistakes

Mailing to VA Regional Loan Center - HISA goes to the VAMC prosthetics department.

Statutory & regulatory authority

38 USC 1710 - Core VA health care eligibility.

VA Form 26-4555c

Application for Home Improvements and Structural Alterations (HISA) Grant

Adapted HousingOfficial VA form on VA.gov

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.

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.

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

1 field

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.

Example

(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

1 field · 1 citation

Blocks 6-10Physician prescription for the modification and description

Example

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

1 field

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.

Example

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

1 field

Blocks 17-18Veteran signature and datePII

Sign and date. Submit to your VAMC prosthetics department for processing.

Example

(signature/date)

Common mistakes

Mailing to VA Regional Loan Center - HISA goes to the VAMC prosthetics department.

Statutory & regulatory authority

38 USC 1710 - Core VA health care eligibility.