07/05/2023                                                                            
                                    
                                                                            
                                            Applying for a HISA Benefit
When applying for the HISA benefit, a completed HISA application package must include the following:
(1) A prescription written or approved by a VA physician which includes:
(a) The beneficiary’s name, address and telephone number;
(b) A description of the prescribed project, including the area of the home to be improved or structurally altered; type of modification and all alternatives to the modifications; and items requiring installation.
(c) The diagnosis and medical justification for the prescribed improvement or structural alteration. The medical justification should demonstrate the project’s clinical appropriateness, that is, the beneficiary’s clinical needs should support the type of home improvement or structural alterations being prescribed.
(2) A completed and signed  VA Form 10-0103, VETERANS APPLICATION FOR ASSISTANCEhttps://www.va.gov/vaforms/medical/pdf/10-0103-fill.pdf In Acquiring Home Improvement and Structural Alterations
If applying for an advanced payment, request on application
(3) FOR RENTERS: A signed and notarized statement from the owner authorizing the improvement or structural alteration
(4) A written itemized estimate of costs for labor, materials, permits, and inspections for the home improvement and structural alteration
(5) A color photograph of the unimproved area