An applicant for IVA shall: Have a legitimate interest in the welfare of the individual for whom IVA is sought; Submit an application on the form required by: The Veterans' Administration, if the application is submitted to a Veterans' Administration hospital; or The Administration, if the application is submitted to an inpatient facility other than a Veterans' Administration hospital; Fill out the appropriate form completely; and Sign and date the application form. The Administration shall provide an application form that includes the following: The statutory authority for the application; The form number (MDH34) and revision date; Spaces for the: Name of the inpatient facility to which the application for IVA is submitted; Name of the individual for whom IVA is sought; Name, home or agency address, telephone number, and relationship to the individual or official capacity of the applicant; and Signature of the applicant and the date that the application is made.