ANNEX 2 FORMS COMMONLY USED

 

To obtain VA forms online go to:  http://www.va.gov/vaforms/search_action.asp

 

*VAF 21-526 Veterans Application for Compensation or Pension

          Used to apply for a Service Connected disability or NSC Pension

 

VAF 21-4138 Statement in Support of Claim

Used to reopen an existing claim.

 

VAF 21-8940 Veterans Application for increased Compensation Based on Unemployability

Used to apply for Unemployability based on SC disability.

 

VAF 21-8678 Application for Clothing Allowance

Used to claim clothing allowance based on wear caused by SC disability.

 

VAF 10-10d Civilian Health and Medical Program of the VA (CHAMPVA)

Used to apply for CHAMPVA benefits.

 

VAF 21-534 Application for Dependency and Indemnity Compensation, Death Pension and Accrued Benefits By A surviving Spouse or Child

Used to apply for benefits from SC death.

 

NOTE: A parent who is a dependent files for D.I.C. they use VAF 21-535. Rules on outside income and payment are different for dependent parents as compared to spouses. Checking with Regional Office is strongly recommended.

 

VAF 21-530 Application for Burial Allowance

Used to apply for burial allowance for NSC Veterans

 

VAF 40-1330 Headstone

 

VAF 10-10 Applications for Medical Benefits

Must be submitted at VA medical facility to establish health care eligibility

 

VA Form 22-5490

       Used for dependent children to apply for education benefits (based on veteran's Service Connected disability).

 

VA Form 22-5490 W

     Used for spouses to apply for education benefits (based on veteran's Service Connected disability or SC death).

 

 

OTHER FORMS

 

DD 214 Department of Defense form used to record military discharges. Often used in applying for VA and other benefits.

 

SF 180 Request Pertaining to Military Records

 

Standard Form 180 used in applying for a new copy of a DD 214. Directions how to fill out and where to sent come on the form.

 

* A veteran may include Civilian, DOD, or VA medical records along with a claim.  RO has access to VA records and can request DOD records.  RO may ask you to sign a release of information to request civilian medical records.  You may also use sworn statements from individuals as part of your case.

 

You might choose to have representation from a Service Officer – such as a representative from the DAV or the BVA (see list of service organizations in earlier annex).  The advantage of this is that they can give you advice, help monitor the paperwork coming back from RO, and represent you if there are hearing or appeals.  To work with a Service Officer you must sign what is commonly referred to as a POA, Power of Attorney you have to sign a VA Form 21-22.  This is not an official name for the document, and it is not like the POA’s family members sign.  It only gives an SO the right to see your VA paperwork in regards to your claim.

 

A VBC at RO can also assist you in filing a claim.  But, a VBC cannot represent you at a hearing.  You can now file online.  The downside is that you have to mail in support material.  There is a section of the VA home page devoted to filing online.

 

Use:  www.va.gov to access this option

Return to Table of Contents