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Various VA Forms in PDF Format

Below is a list of the most commonly used forms for senior veterans seeking to apply for pension benefits from the Department of Veterans Affairs. Not all of the forms would be necessary if applicable information is available from other sources or substantiating documents are available in another form.

• VA Form 21-526 -- Veteran’s Application for Pension and/or Compensation
• VA Form 21-534 -- Surviving Spouse or Child's Application for Death Pension, Dependency and Indemnity Compensation (DIC), and/or Accrued Benefits (including death compensation if applicable)
• SF 180 -- Request Pertaining to Military Records (used to obtain DD 214 discharge record)
• VA Form 21-22a -- Appointment of Individual as Claimant's Representative (POA for claim)
• VA Form 21-2680 -- Examination for Housebound Status or Permanent need for Regular Aid and Attendance
• VA Form 21-4142 -- Consent To Release Medical Information To The VA
• VA Form 4138 -- Statement In Support Of Claim
• Form 1 -- Certification of No Fees
• Form 2 -- Care Provider Report (used to provide evidence of recurring medical expenses)
• Form 3 -- Health Insurance Premiums (used to provide evidence of recurring medical expenses)
• Form 4 -- Claimant's Certification (verifies out-of-pocket costs for un reimbursed medical expenses)
• Form 5 -- Fully Developed Claim Certification
• VA Form 21-0779 -- Request for Nursing Home Information in Connection with Claim for Aid and Attendance

IMPORTANT: When applying for Pension, the claimant(s) should supply the VA with an original copy of the veteran's discharge papers. VA also needs proof that the claimant(s) are actually paying for care; supplying the VA with receipts or invoices marked paid for un reimbursed care costs (e.g. home care or assisted living) will provide them with that proof. It is also useful for those applying for death pension to send a copy of their marriage certificate and a copy of the veteran's death certificate along with their application to VA.

These forms are often used for supplemental information or for purposes such as the EVR, application for HISA grants and other reporting requirements.

• VA Form 21-526b -- Change in Existing Compensation
• VA Form 10-10EZ - Application for Health Care
• VA Form 10-0103 - HISA Grant Application
• VA Form 21-527 Change in Income, Net Worth and Employment Statement for Pension
• VA Form 21-4103 Information from Re-Married Widow
• VA Form 21-4165 Pension Claim Questionnaire for Farm Income
• VA Form 21-8049 Request for Details of Expenses
• VA Form 21-8416 Medical Expense Report (Typically used for EVR but can be used for original application)
• VA Form 21-22 Appointment of Veterans Service Organization as Claimant's Representative
• VA Form 21-0510 Eligibility Verification Report Instructions
• VA Form 21-0516 EVR Veteran with No Children
• VA Form 21-0517 EVR Veteran with Children
• VA Form 21-0518 EVR Surviving Spouse with No Children

 

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