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eBenefits Access Your VA & DoDo Benefits 24-7 www.ebenefits.va.gov
 

Benefit Forms

Compensation Forms

 

Veteran's Application for Compensation and/or Pension
VA Form 21-526 | Adobe PDF | Apply Online 
Use this Form: If you currently have a disability that is the result of an injury, disease, or an event in military service.

Supplemental Claim Application
VA Form 21-526B | Adobe PDF
Use this Form: To provide VA information for new claim.

Pre-Discharge Compensation Claim
VA Form 21-526C | Adobe PDF
Use this Form: For Benefits Delivery at Discharge (BDD) or Quick Start Claims.

Fully Developed Claim (Express Compensation Claim)
VA Form 21-526EZ | Adobe PDF
Use this Form: To file expedited claim.

Statement in Support of Claim
VA Form 21-4138 | Adobe PDF| Apply Online 
Use this Form: To provide further evidence in support of your claim.

Application for Benefits for Certain Children with Disabilities born of Vietnam and Certain Korean Service Veterans
VA Form 21-0304 | Adobe PDF
Use this Form: If you are a child of a Women Vietnam Veterans Born with Birth Defects

Award Attachment for Certain Children with Disabilities Born of Vietnam and Certain Korea Service Veterans
VA Form 21-0307 | Adobe PDF
Use this Form: To learn more about benefits for children with disabilities born to Vietnam and certain Korea service Veterans.

Status of Dependents Questionnaire
VA Form 21-0538 | Adobe PDF
Use this Form: To report any changes in your number of dependents.

Request for Nursing Home Information in Connection with Claim for Aid and Attendance
VA Form 21-0779 | Adobe PDF
Use this Form: To provide information for nursing home care. A portion of the form must be filled out by a nursing home official.

Statement in Support of Claim for Service Connection for Post-Traumatic Stress Disorder (PTSD)
VA Form 21-0781 | Adobe PDF
Use this Form: To list the details of incidents that you feel contributed to your PTSD.

Statement in Support of Claim for Service Connection for Post-Traumatic Stress Disorder (PTSD) Secondary to Personal Assault
VA Form 21-0781a | Adobe PDF
Use this Form: To describe behavior that you feel resulted from your PTSD, such as depression, substance abuse, and obsessive behavior.

Information Regarding Apportionment of Beneficiary's Award
VA Form 21-0788 | Adobe PDF
Use this Form: To identify beneficiary's to be paid a portion of the Veteran's benefits.

VA/DOD Joint Disability Evaluation Claim
VA Form 21-0819 | Adobe PDF
Use this Form: To provideinformation to determine eligibility for active duty service members who may be eligible for a DOD Disability Evaluation Board and VA compensation.

Authorization to Disclose Personal Beneficiary/Claimant Information to a Third Party
VA Form 21-0845 | Adobe PDF
Use this Form: To identify people or organizations who can receive information pertaining to your VA record.

Request for Substitution of Claimant upon Death of Claimant
VA Form 21-0847 | Adobe PDF
Use this Form: To continue the claim process after the claimant's death.

Statement of Disappearance
VA Form 21-1775 | Adobe PDF
Use this Form: To provide very detailed information about the missing person, including health, employment and habits.

Appointment of Veterans Service Organization as Claimant's Representative
VA Form 21-22 | Adobe PDF
Use this Form: To see a listing of national, regional, or local organizations recognized by VA in the
preparation, presentation, and prosecution of claims.

Appointment of Individual as Claimant's Representative
VA Form 21-22a | Adobe PDF
Use this Form: To appoint a representative to prepare, present and prosecute claims for benefits from the VA.

Examination for Housebound Status or Permanent Need for Regular Aid and Attendance
VA Form 21-2680 | Adobe PDF
Use this Form: To describe the extent that disease or injury produces physical or mental impairment making the Veteran unable to take care of themselves.

Information from Remarried Widow or Widower
VA Form 21-4103 | Adobe PDF
Use this Form: To apply for death pension on behalf of the children of the Veteran after the spouse has remarried.

Statement in Support of Claim
VA Form 21-4138 | Adobe PDF
Use this Form: To provide further evidence to assist us in processing your claim.

Employment Questionnaire
VA Form 21-4140-1 | Adobe PDF
Use this Form: To provide history of employment for the past 12 months.

Authorization and Consent to Release Information to VA
VA Form 21-4142 | Adobe PDF
Use this Form: To provide history of employment for the past 12 months.

Statement of Marital Relationship
VA Form 21-4170 | Adobe PDF
Use this Form: To provide evidence of the spouse or surviving spouse's marital relationship with the Veteran.

Supporting Statement Regarding Marriage
VA Form 21-4171 | Adobe PDF
Use this Form: As a third party to provide evidence of the claimant and Veterans's marriage.

Report of Accidental Injury in Support of Claim for Compensation or Pension - Statement of Witness to Accident
VA Form 21-4176 | Adobe PDF
Use this Form: To provide details of an accident and provide a witnesses' account.

Report of Income from Property or Business
VA Form 21-4185 | Adobe PDF
Use this Form: To provide rental income less expenses and business income less operating expenses.

Request for Employment Information in Connection with Claim for Disability Benefits
VA Form 21-4192 | Adobe PDF
Use this Form: To enable your employer to provide employment information to the VA.

Application for Automobile or other Conveyance and Adaptive Equipment
VA Form 21-4502 | Adobe PDF
Use this Form: To qualify for a vehicle and adaptive equipment allowance due to physical disability.

Application for Burial Benefits
VA Form 21-530 | Adobe PDF | Apply Online 
Use this Form: To qualify for a vehicle and adaptive equipment allowance due to physical disability.

State Application for Internment Allowance under 38 USC Chapter 23
VA Form 21-530A | Adobe PDF
Use this Form: To provide personal information for interred Veterans, including file number, date of death and burial date.

Application for DIC, Death Pension and Accrued Benefits by a Surviving Spouse or Child
VA Form 21-534 | Adobe PDF
Use this Form: For a surviving spouse or child of a deaceased veteran to apply for benefits they may be entitled to.

Application for Dependency and Indemnity Compensation By a Surviving Spouse or Child-In Service Death Only
VA Form 21-534a | Adobe PDF
Use this Form: For a surviving spouse or child of a veteran who died on active duty to apply for benefits they may be entitled to.

Application for DIC by Parents (Including Accrued Benefits and Death Compensation)
VA Form 21-535 | Adobe PDF
Use this Form: For a surviving parent of a deaceased veteran to apply for benefits they may be entitled to.

Application for Accrued Amounts Due a Deceased Beneficiary
VA Form 21-601 | Adobe PDF
Use this Form: To apply for accrued benefits due the beneficiary but not paid prior to death

Request for Approval of School Attendance
VA Form 21-674 | Adobe PDF
Use this Form:To confirm school attendance of children for whom VA compensation or pension benefits are being paid.

School Attendance Report
VA Form 21-674b | Adobe PDF
Use this Form: To assist in determining entitlement to benefits for a Veteran's child who is between age 18 and 23 and attending school.

Declaration of Status of Dependents
VA Form 21-686c | Adobe PDF| Apply Online 
Use this Form: To indicate marital status and eligibility for an additional allowance for dependents.

Application for Amounts on Deposit for Deceased Veteran
VA Form 21-6898 | Adobe PDF
Use this Form: To provide information to determine who may be entitled to accrued benefits of the deceased Veteran's beneficiaries.

Application of Surviving Spouse or Child for REPS (Restored Entitlement Program for Survivors)Benefits
VA Form 21-8924 | Adobe PDF
Use this Form: For dependents of deceased veterans to make a claim for REPS benefits.

Veteran's Application for Increased Compensation Based on Unemployability
VA Form 21-8940 | Adobe PDF
Use this Form: For Veterans to make a claim for increased VA disability compensation based on unemployability.

REPS Annual Eligibility Report
VA Form 21-8941 | Adobe PDF
Use this Form: For determination of claimant's continued entitlement to Restored Entitlement Program for Survivors (REPS) benefits.

Notice of Waiver of VA Compensation or Pension to Receive Military Pay and Allowances
VA Form 21-8951-2 | Adobe PDF
Use this Form: To waive VA disability benefits in order to receive active or inactive duty training pay.

Application for United States Flag for Burial Purposes
VA Form 27-2008 | Adobe PDF
Use this Form: To apply for a burial flag.

Disability Benefits Questionnaires (DBQs)
DBQ Homepage
DBQs support the Fully Developed Claims (FDC) Program and are valuable for claims processing because they provide medical information that is directly relevant to determining a disability rating.