RI Special Needs Emergency
If you are a resident of Rhode Island it is strongly encouraged that you complete this form and return to the RI Emergency Management Agency so that you will be placed on the registry in the event of a disaster that would cause loss of power or telephone. Having your name on this registry will place you on a priority list to have your services turned on as soon as possible.
Independent Living-Specialty Adapted Housing (SAH)-
VA forms 10-1394/SAH VBA-26-4555/ SAH VBA-26-4555c/ SAH VBA-26-4555d
This is a grant application that is utilized for high end home modifications including but not limited to adding additional rooms, modifying existing property, installing generators or elevators and overall ensuring that your home is a safe and handicap accessible place to reside. This is a lengthy process and is completed through the Manchester division of the VBA.
If you require assistance completing this form, please contact a National Service Organization representative.
Application for Adaptive Equipment- Motor Vehicle –
VA form 10-1394
This is a grant application to assist with the purchase and modification of a vehicle that will accommodate power mobility and facilitate independent driving for as long as possible. This is a rather lengthy process and is facilitated through the Brockton VA. The Prosthetics office at the PVAMC is able to assist you through the process if needed.
If you require assistance completing this form, please contact a National Service Organization representative.
Veterans Application for Assistance in Acquiring Home Improvement Structural Alterations (HISA)- VA form 10-0103
This is a grant application to assist with minor home improvements including bathroom modification and doorway widening. This process is completed locally at the PVAMC and the Chief of Prosthetics and Occupational Therapy can assist you with this process if needed.
Advanced Directives- VA form 10-0137/10-0137A
This document allows you the opportunity to out in writing how you would like your medical care to proceed should you not be able to communicate with your medical providers. This can be changed at any time and should you designate a power of attorney they can always advocate on your behalf. The ALS Clinic Social Worker can assist you with completing these forms or if you have any questions.
Vocational Rehabilitation and Employment Independent Living Program Orientation-
(VA forms 28-0786, 28-0791, 28-1900, 28-1902w)
These forms should be completed fully with as much detail as possible prior to your appointment with the Vocational Rehabilitation & Employment Department at the VBA office on Westminster Street in Providence. If you have any difficulty, bring the forms with you for further assistance. It is imperative to have the forms completed in order for the VR&E department to process your request in a timely fashion.
If you require assistance completing this form, please contact a National Service Organization representative.
Information and Instructions for Completing the Veteran's Application for Compensation and/or Pension- (VA forms 21-526 and 21-4142)
These forms should be completed in its entirety. If the question does not apply, mark it as "n/a" or indicate in some manner that it is not applicable. DO NOT LEAVE ANY BLANKS as the claim will be held up until an answer is received.
This form can be turned in via mail or hand delivered to the VBA office on Westminster Street in Providence.
If you require assistance completing this form, please contact a National Service Organization representative.