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Benefit Forms

Pension Forms

 

Eligibility Verification Report Instructions
VAF 21-0510 | Adobe PDF
Use this Form: This report will refer you to the instruction paragraphs that apply to you. You can determine what type of EVR you have by looking at the number in the upper right hand corner on the front of this form.

Old Law and Section 306 Eligibility Verification Report (Surviving Spouse)
VAF 21-0512S-1 | Adobe PDF
Use this Form: This form is used by surviving spouses receiving Old Law or Section 306 Pension. If you have been receiving a fixed rate of pension since 1960, you receive Old Law Pension.

Old Law and Section 306 Eligibility Verification Report (Veteran)
VAF 21-0512V-1 | Adobe PDF
Use this Form: Recipients of Old Law and Section 306 Pension are no longer required to submit annual EVRs unless there is a change in their income.

Old Law and Section 306 Eligibility Verification Report (Children Only)
VAF 21-0513-1 | Adobe PDF
Use this Form: This form is used by children and custodians of children receiving Old Law or Section 306 Pension. If you have been receiving a fixed rate of pension since 1960, you receive Old Law Pension. If you have been receiving a fixed rate of pension since 1978, you receive Section 306 pension.

DIC Parent's Eligibility Verification Report
VAF 21-0514-1 | Adobe PDF
Use this Form: Recipients of Old Law and Section 306 Pension are no longer required to submit annual EVRs unless there is a change in their income.

Improved Pension Eligibility Verification Report (Veteran With No Children)
VAF 21-0516-1 | Adobe PDF
Use this Form: Annual income verification for pension

Improved Pension Eligibility Verification Report (Veteran With Children)
VAF 21-0517-1 | Adobe PDF
Use this Form: Annual income verification for pension

Improved Pension Eligibility Verification Report (Surviving Spouse With No Children)
VAF 21-0518-1 | Adobe PDF
Use this Form: Annual income verification for pension

Improved Pension Eligibility Verification Report (Child or Children)
VAF 21-0519C-1 | Adobe PDF
Use this Form: Annual income verification for pension

Improved Pension Eligibility Verification Report (Surviving Spouse With Children)
VAF 21-0519S-1 | Adobe PDF
Use this Form: Annual income verification for pension

Request for Nursing Home Information in Connect With Claim for Aid and Attendance
VAF 21-0779 | Adobe PDF
Use this Form: To gather the necessary information to determine eligibility for pension and aid and attendance based on being in a nursing home.

Authorization To Disclose Personal Information To a Third Party
VAF 21-0845 | Adobe PDF
Use this Form: To release information in its custody or control in the following circumstances: where the individual identifies the particular information and consents to its use; for the purpose for which it was collected or a consistent purpose (i.e. a purpose which the individual might have reasonably expected).

Request for Substitution of Claimant upon Death of Claimant
VAF 21-0847 | Adobe PDF
Use this Form: To allow claimants to request substitution for a claimant, who passed away, prior to VA processing a claim to completion. This is only allowed when a claimant dies while a claim or appeal for any benefit under a law administered by the VA is pending.

Appointment of Individual As Claimant's Representative
VAF 21-22A | Adobe PDF
Use this Form: To collect the information needed to determine whom claimants have appointed to represent them in the preparation, presentation, and prosecution of claims for VA benefits.

Authorization and Consent to Release Information to the Department of Veterans Affairs
VAF 21-4142 | Adobe PDF
Use this Form: To request medical treatment records from private doctors, hospitals, physicians, etc.

Statement of Marital Relationship
VAF 21-4170 | Adobe PDF
Use this Form: To gather information that is necessary to determine whether a valid common law marriage was established.

Supporting Statement Regarding Marriage
VAF 21-4171 | Adobe PDF
Use this Form: To gather the necessary information from individuals who know, as the result of personal observation, the relationship which existed between the veteran and claimed spouse, when common law marriage is claimed.

Report of Income from Property or Business
VAF 21-4185 | Adobe PDF
Use this Form: to gather information that is necessary to determine a claimant's countable income received from rental property and/or operation of a business.

Fully Developed Claim(Pension)
VAF 21-527EZ | Adobe PDF
Use this Form: For DIC, death pension, and accrued benefit claims claimed under the Fully Developed Claim Program.

Request for Details of Expenses
VAF 21-8049 | Adobe PDF
Use this Form: To gather the necessary information to determine the amounts of any deductible expenses paid by the claimant and/or commercial life insurance received in order to adjust the annual income.

Application for Accrued Amounts Due A Deceased Beneficiary
VAF 21-601 | Adobe PDF
Use this Form: To gather information that is necessary to determine entitlement to accrued benefits.