(a) Form. An application for the Paralyzed Veterans Pension shall be made on a form prescribed by the Adjutant General. The form is available from the following sources:

1. (1) Department of Military Affairs, Bureau for Veterans’ Affairs, Fort Indiantown Gap, Annville, Pennsylvania 17003-5002 or through the Adjutant General’s Field Offices located in Pittsburgh, Philadelphia and Wilkes-Barre.
2. (2) County Directors of Veterans’ Affairs in each county seat.
3. (3) Governor’s Veterans Outreach and Assistance Centers.
4. (4) Veterans service organizations.
5. (5) American Red Cross.

(c) Documentation. The application shall submit the following documents along with the application form:

1. (1) The appropriate United States Department of Veterans’ Affairs or Department of Defense form requesting and consenting to the release of information from the applicant’s Federal records. The Department will use this form to obtain verification from the United States Department of Veterans’ Affairs or the Department of Defense of the applicant’s disability rating reflecting the loss, or loss of use, of the extremities. The current location of the applicant’s Veterans’ Administration medical records shall be indicated on this form.
2. (2) A copy of the applicant’s Report of Separation from Active Duty in the Armed Forces of the United States covering the period when the applicant sustained the injury or incurred the disease resulting in the loss of, or loss of use of, extremities.
3. (3) An applicant for a pension resulting from loss of, or loss of use of, limbs in peacetime combat-related actions may be required to submit additional documentation to verify the nature of the combat-related action and to verify that the loss of, or loss of use of, extremities resulted from the actions.