Get Wdva 4000 Form

Filling out the Wdva 4000 Form is an essential step for individuals seeking admission to the Wisconsin Veterans Home. This guide provides clear and supportive instructions to help you complete the form easily online.

Follow the steps to fill out the Wdva 4000 Form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by selecting the appropriate Wisconsin Veterans Home location you are applying to by checking one of the options listed.
3. Indicate your seeking admission timeline by choosing between 'Immediate Future,' 'Next 6 Months,' or 'Other.'
4. Provide the applicant's details including their name, date of birth, and social security number in the designated fields.
5. Select the applicant's military status from the provided options: Veteran, Veteran's Spouse, Surviving Spouse, or Gold-Star Parent.
6. Fill in information about the applicant's military service, if applicable, including the nature of any service-connected disabilities and the percentage rated by the VA.
7. Complete the medical and health insurance section by providing details about primary care providers, Medicare coverage, and other health insurance information.
8. In the spouse information section, include the spouse's name, date of birth, and social security number if applicable.
9. Detail the financial information by stating gross monthly income amounts and assets as requested.
10. Review all information for accuracy. Finally, save changes, download the completed form, and/or print it for submission.

Complete your application for admission online to the Wisconsin Veterans Home today!