Va Automobile Adaptive Equipment Form

Part i to be completed by applicant if more space is needed attach a separate sheet and identify by item number 4.

Va automobile adaptive equipment form.

The automobile adaptive equipment aae program permits physically challenged persons to enter exit and or operate a motor vehicle or other conveyance. If va determines you are eligible read the instructions on va form 21 4502 for a list of adaptive equipment preapproved for particular disabilities. Request for dd 214 or other military records nara sf 180. If you are unable to find your form here you may want to visit.

Deliver the vehicle including va approved adaptive equipment provided and or installed by the seller. Application for automobile or other conveyance and adaptive equipment fillable file type. Driver s license verification check applicable block 6. Download va form 10 1394 pdf we may pay you or we may pay the equipment seller directly.

Obtain the original copy of va form 21 4502 from the veteran or servicemember after he or she has completed section iv. All van modifications require prior authorization before purchase. Date of va certificate of eligibility. Application for adaptive equipment motor vehicle.