Texas veterans who are seeking to file a claim for benefits may need to use the Texas Veterans Commission Form. This form is designed to help veterans collect and submit the necessary information needed to qualify for benefits. The form can be completed either online or through hard copy, and it asks for a variety of details about the veteran's military service. Filing a claim can be a complex process, so it's important to ensure that all the required information is included in the application.
This table features specifics of texas veterans commission form. There, you will locate the information about the PDF you want to fill in, such as the estimated time to fill it out as well as other details.
| Question | Answer |
|---|---|
| Form Name | Texas Veterans Commission Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names |
TEXASVETERANSCOMMISSION
TVC15b
ASSISTEDLIVINGSTATEMENT
EFF. 8/2000
Name of veteran must be provided whether statement is completed for veteranorforwidow.
NameofAssistedLivingFacility
Address
TelephoneNumber
LicenseNumber
RE:
NameofVeteran
Claim#orSSN
NameofClaimant
DateofAdmission
Claimant'sMailingAddress
City State Zip
STATEMENTOFCHARGES
AmountofRecurringGrossDailyChargesforAssistedLivingCare $
Amountpaidandnotreimbursed *$
CLAIMANTCERTIFICATION
*Icertifytheamountasidentifiedaboveisbeingpaidfrompersonalfunds. Theseexpensesarepaidoutofmypocketwithout reimbursementfromanysource. Irequestthisamountbeusedasacontinuingdeductionfrommycountableincome.
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SignatureofWitness** |
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SignatureofClaimant |
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**NOTE: Ifclaimantsignswithhis/hermark,themark |
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SignatureofWitness** |
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mustbewitnessedbytwowitnesses. |
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STATUSOFCLAIMANT: |
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Patientrequiresassistance? |
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oraresidence(needsdwelling)? |
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DisabilitiesRequiringassistance: |
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LevelofCare |
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ADDITIONALREMARKS: |
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IsClaimanteligibleforMedicare?
DateSigned |
SignatureofAssistedLiving |
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FacilityAdministratororAgent |