Va 26 4555C Form PDF Details

The VA 26 4555C form, officially known as the Veteran/Servicemember's Supplemental Application for Assistance in Acquiring Specially Adapted Housing, is a crucial document for veterans or servicemembers who are seeking financial aid to acquire housing that caters to their specific needs due to disabilities. Authorized under the Privacy Act of 1974 and Title 38, CFR 1.576, this form ensures confidentiality and protection of personal information, allowing only authorized disclosures, such as for statistical purposes requested by Congress. The form outlines the respondent's burden, which is an estimated 15-minute time commitment to complete, emphasizing the necessity of this information to establish or confirm eligibility for a specially adapted housing grant pursuant to Title 38, U.S.C. 2101(a) or 2101(b). Additionally, it provides a structured format for applicants to detail their personal information, including contact details, desired grant type, property location, sources of income, household occupancy, and mortgage information. The form also encompasses a certification section to affirm the applicant's commitment to non-discriminatory practices in housing sales or rentals. An essential clause included within the certification is the legal nullity of any racially or otherwise discriminatorily restrictive covenants associated with the property. Finally, a section reserved for VA personnel's use ensures a comprehensive review of the application in relevance to the applicant's financial capabilities and plan specifications for the proposed adaptation or acquisition of housing. This detailed form serves as both a gateway to potential financial aid for home adaptation and a legal document ensuring the applicants' rights and obligations throughout the application process.

QuestionAnswer
Form NameVa 26 4555C Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesveteran application acquiring, 26 specially download, supplemental application specially, 26 supplemental adapted download

Form Preview Example

OMB Approved No. 2900-0031 Respondent Burden: 15 minutes Expiration Date: 1/31/2024

VETERAN/SERVICEMEMBER'S SUPPLEMENTAL APPLICATION FOR

ASSISTANCE IN ACQUIRING SPECIALLY ADAPTED HOUSING

PH NO.

PRIVACY ACT NOTICE: VA will not disclose information collected on this form to any source other than what has been authorized under the Privacy Act of 1974, or Title 38, CFR 1.576

for routine uses (for example: authorized release of information to Congress when requested for statistical purposes) identified in the VA system of records, 55VA26, Loan Guaranty Home, Condominium and Manufactured Home Loan Applicant Records, Specially Adapted Housing Applicant Records, and Vendee Loan Applicant Records - VA, published in the Federal Register. Your obligation to respond is required to in order to determine your eligibility for a Specially Adapted Housing grant.

RESPONDENT BURDEN: We need this information to determine or verify your eligibility for a grant for specially adapted housing. Title 38, U.S.C. 2101(a) or 2101(b), allows us to ask for this information. We estimate that you will need an average of 15 minutes to review the instructions, find the information, and complete this form. VA cannot conduct or sponsor a collection of information unless a valid OMB control number is displayed. Valid OMB control numbers can be located on the OMB Internet Page at www.reginfo.gov/public/do/PRAMain. If desired, you can call 1-800-827-1000 to get information on where to send comments or suggestions about this form.

SECTION I - VETERAN/SERVICEMEMBER'S INFORMATION (To be completed by Veteran/Servicemember)

1. FIRST NAME - MIDDLE INITIAL - LAST NAME OF VETERAN OR SERVICEMEMBER

2. VA FILE NO. OR SOCIAL SECURITY NO.

3A. ADDRESS (Number and street or rural route, city or P.O., State and ZIP Code)

3B. TELEPHONE NUMBERS

DAYTIME (Include Area Code)

EVENING (Include Area Code)

3C. CELL PHONE NO. (Include Area Code)

4. E-MAIL ADDRESS

5. I WISH TO APPLY FOR A GRANT UNDER CHAPTER 21, TITLE 38, U.S.C. FOR (Check one)

 

A. LAND AND HOUSING TO BE ACQUIRED BY VETERAN OR

 

 

B. HOUSING TO BE ERECTED ON LAND NOW OWNED BY VETERAN OR

 

 

 

 

SERVICEMEMBER (PLAN 1)

 

 

SERVICEMEMBER (PLAN 2)

 

 

 

 

C. REMODELING TO BE DONE ON HOUSE NOW OWNED OR TO BE

 

 

D. SUITABLE PROPERTY NOW OWNED OR TO BE ACQUIRED BY VETERAN OR

 

 

 

ACQUIRED BY VETERAN OR SERVICEMEMBER (PLAN 3)

 

 

SERVICEMEMBER NEEDING NO REMODELING (PLAN 4)

 

 

6.LOCATION OF PROPERTY (Include lot and block number, subdivision, or other legal description, city or county and State; also street address if available)

7. SOURCE(S) OF INCOME

8. MONTHLY INCOME

9. WHO WILL OCCUPY YOUR HOUSEHOLD

 

 

A. AGE

B. RELATIONSHIP

 

 

 

 

 

 

A. VA COMPENSATION

$

 

 

 

 

 

 

B. SOCIAL SECURITY

$

 

 

 

 

 

 

C.

$

 

 

 

 

 

 

D.

$

 

 

 

 

 

 

E.

$

 

 

 

 

 

 

F.

$

 

 

 

 

 

 

SECTION II - VETERAN/SERVICEMEMBER MORTGAGE INFORMATION (To be completed by Veteran or Servicemember)

1A. NAME AND ADDRESS OF LENDER/MORTGAGE HOLDER

1B. NAME AND TITLE OF LENDING OFFICIAL

(Only required if new financing)

1C. TELEPHONE NO. OF LENDING OFFICIAL

(If new financing)

 

 

 

 

 

 

2. LOAN DATA

 

 

3. AMOUNT OF MONTHLY INSTALLMENT

 

5. INTEREST RATE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A. TYPE

B. AMOUNT/UNPAID

C. PURCHASE PRICE

$

 

 

 

 

 

 

%

 

 

 

LOAN BALANCE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NEW

 

 

4. REMAINING REPAYMENT PERIOD (Yrs., Mos.)

 

6. AMOUNT OF JUDGEMENTS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EXISTING

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OR OTHER LIENS AGAINST

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PROPERTY

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7. FINANCING BY:

 

 

 

 

 

 

 

 

 

 

8. VETERAN'S CONTRIBUTION

 

 

GUARANTEED LOAN

 

 

CONVENTIONAL LOAN

 

A. TYPE

 

 

 

B. AMOUNT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DIRECT LOAN

 

 

OTHER (Specify)

 

 

 

 

 

CASH

 

EQUITY

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9. ANNUAL COST OF MAINTAINING THE SUBJECT PROPERTY IS ESTIMATED AS FOLLOWS:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A. TAXES

 

 

B. SPECIAL ASSESSMENTS

C. INSURANCE

 

 

 

D. HEAT AND UTILITIES

E. MISC. REPAIRS

 

F. TOTAL

$

 

 

$

 

 

$

 

 

$

 

 

 

$

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CERTIFICATION

Neither I, nor anyone authorized to act for me, will refuse to sell or rent, after the making of a bona fide offer, or refuse to negotiate for the sale or rental of, or otherwise make unavailable or deny the dwelling or property acquired by this benefit to any person because of race, color, religion, sex, or national origin. I recognize that any restrictive covenant on the property relating to race, color, religion, sex, age, handicap status, familial status or national origin is illegal and void and any such covenant is specifically disclaimed. I understand that civil action for preventive relief may be brought by the Attorney General of the United States in any appropriate U.S. District Court against any person responsible for a violation of the applicable law.

10. SIGNATURE OF VETERAN, SERVICEMEMBER, OR FIDUCIARY (Sign in ink)

11.DATE (MM/DD/YYYY)

 

 

 

 

SECTION III - FOR VA USE ONLY

 

 

 

1. I AM OF THE OPINION THAT THE TERMS OF PAYMENT REQUIRED IN THE MORTGAGE PLUS OTHER EXPENSES INCIDENT TO THE OWNERSHIP OF THE

HOUSING UNIT

 

DO

 

DO NOT BEAR A PROPER RELATIONSHIP TO THE VETERAN'S PRESENT AND ANTICIPATED INCOME AND EXPENSES

2. NAME OF BUILDING CONTRACTOR (Attach copy of contract)

3. PLANS AND SPECIFICATIONS ARE ATTACHED FOR:

 

HOUSING TO BE CONSTRUCTED

 

REMODELING TO BE ACCOMPLISHED

 

 

 

 

 

 

 

 

4. SIGNATURE OF VA PERSONNEL (Sign in ink)

 

 

 

 

5. DATE (MM/DD/YYYY)

 

 

 

 

 

 

 

VA FORM

26-4555C

SUPERSEDES VA FORM 26-4555C, MAR 2018,

 

 

 

JAN 2021

 

WHICH WILL NOT BE USED.

 

 

 

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1. When submitting the application assistance acquiring printable, ensure to include all of the essential fields in their associated area. This will help speed up the process, making it possible for your details to be handled promptly and correctly.

Step # 1 of completing supplemental application specially

2. Your next part is usually to submit these fields: SECTION II VETERANSERVICEMEMBER, A NAME AND ADDRESS OF, B NAME AND TITLE OF LENDING, C TELEPHONE NO OF LENDING OFFICIAL, Only required if new financing, If new financing, LOAN DATA, AMOUNT OF MONTHLY INSTALLMENT, INTEREST RATE, A TYPE, NEW, EXISTING, B AMOUNTUNPAID, LOAN BALANCE, and C PURCHASE PRICE.

supplemental application specially completion process shown (stage 2)

3. This next stage will be easy - fill in all of the fields in I AM OF THE OPINION THAT THE, HOUSING UNIT, DO NOT BEAR A PROPER RELATIONSHIP, NAME OF BUILDING CONTRACTOR, SECTION III FOR VA USE ONLY, PLANS AND SPECIFICATIONS ARE, HOUSING TO BE CONSTRUCTED, REMODELING TO BE ACCOMPLISHED, SIGNATURE OF VA PERSONNEL Sign in, DATE MMDDYYYY, VA FORM JAN c, and SUPERSEDES VA FORM C MAR WHICH in order to complete the current step.

Writing section 3 in supplemental application specially

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