These forms are provided as a courtesy and convenience to those who would like to apply for our Veterans Retirement Homes at the Armed Forces Retirement Homes. The main application, authorization to release medical records, and survey form can be filled in on your computer. The medical examination form and functional assessment forms must be completed by medical professionals, so they can be downloaded to take with you to the doctor’s office. The application process checklist lists everything you need to apply for residence and can either be filled in on your computer or printed and steps checked off manually.
More information on applying for residence can be found on the Armed Forces Retirement Homes website.
- Application Process Checklist
- Admission Application (Fillable)
- Authorization to Release Medical Records (Fillable)
- Medical Examination Form (Manual)
- Functional Assessment Form (Manual)
- Survey Form (Fillable)
You’re close to an affordable retirement.
AFRH Resident Fees (as of January 1, 2019):
- Independent Living: 46.7 % of total current income (not to exceed $1,990 / month)
- Independent Living Plus: 50 % of total current income (not to exceed $2,261 / month)
- Assisted Living: 63 % of total current income (not to exceed $4,729 / month)
- Long Term Care: 70 % of total current income (not to exceed $6,642/ month)
- Memory Support: 70% of total current income (not to exceed $6,713/ month)
Note: fees are computed annually and adjusted for inflation each January. The AFRH Cost of Living Adjustment (COLA) is based on military retirement pay COLA. Fees are computed using the most recently filed tax forms.
Total income for computing monthly fee (includes taxable & non-taxable income from all sources like):
- Defense Finance and Accounting Service
- Department of Veterans Affairs
- Social Security Administration
- All Pension Payments
- Survivor Benefit Payments
- Annuities / IRA distributions & interest
- Rental Income
- Other taxable income
Exclusions from the computation of monthly income:
- Income received by a Resident for Services under the provisions of 24 USC, Section 421
Deductions allowed for computing monthly income:
- Allowable medical & dental insurance premiums paid depending on the Resident’s status:
- Retirees under age 65—TRICARE Prime and dental insurance premiums;
- Retirees over 65 or others eligible for TRICARE for Life—Medicare Part B and dental insurance premiums
- Non-retiree Residents—Medicare Part B & D, supplemental medical insurance and dental insurance premiums
- Court-ordered child / spousal support / alimony
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