FORMS

Complete one of the following forms to file for Department of Veterans Affairs Compensation:

VA Form 21-0966

Use this form if you intend to file your claim for compensation and need time to gather relevant evidence to support your application for benefits. You will have one year from the date of your submission of the VA form 21-0966 to submit your application for benefits or risk the loss of your effective date of the claim.

VA Form 21-526 EZ

Use this form if you have never applied for VA compensation due to a disease or injury incurred or aggravated by your military service or are requesting an increase in your current compensation.

VA Form 20-0995

VA form 20-0995-Use this form to request a SUPPLEMENTAL CLAIM of the decision you received that you disagree with. A SUPPLEMENTAL CLAIM is a new review of an issue(s) previously decided by the Department of Veterans Affairs (VA) based on submission of new and relevant evidence. For additional information on the SUPPLEMENTAL CLAIM process or other decision review options such as a higher-level review and appeal to the Board of Veterans’ Appeals, visit https://www.va.gov/decision-reviews/.

VA form 20-0996

USE THIS FORM TO REQUEST A HIGHER-LEVEL REVIEW OF A DECISION YOU RECEIVED. A Higher-Level Review is a new review of an issue(s) previously decided by the Department of Veterans Affairs (VA) based on the evidence of record at the time VA issued notice of the prior decision. The Higher-Level Reviewer will not consider any evidence received after the notification date of the prior decision. A Higher-Level Review may not be requested for the review of a Higher Level Review decision or a Board of Veterans’ Appeals decision. This form must be submitted to VA WITHIN ONE YEAR OF THE DATE VA PROVIDED NOTICE OF OUR DECISION. For additional information on the Higher-Level Review process or a list of review options that allow VA to consider new evidence and how to file, visit www.va.gov/decision-reviews/.

VA form 10182

If you have received a decision from a local VA office or a higher-level adjudicator with which you disagree, and you would like one or more issues to be decided by a Veterans Law Judge, you must fill out and submit a Notice of Disagreement. You can choose to appeal all or only some of the issues previously decided, however, ONLY those issues that you list on your Notice of Disagreement will be considered on appeal. How long do I have to submit my Notice of Disagreement? Your completed Notice of Disagreement must be post-marked or received by the Board within one year (365 days) from the day that your local VA office mailed the notice of the decision. If you do not provide all the information requested in the Notice of Disagreement, VA will consider your form incomplete and will contact you to request clarification and explain your options. Contested Claim: If you are one of multiple people claiming the right to the same benefit, your completed Notice of Disagreement must be post-marked or received by the Board within 60 days from the day that your local VA office mailed the notice of the decision. VA will notify you and provide additional information if you are a party to a contested claim.

VA form 21-686c

Use VA Form 21-686c to submit a claim for additional benefits for a dependent, or to request to remove a dependent from your benefits.

VA form 21-674

Use this VA form when claiming benefits for a Veteran’s child who is at least 18 years old, but under 23, and attending school.

VA Standard form 180-1

The Standard Form 180, Request Pertaining to Military Records (SF180) is used to request information from military records. Certain identifying information is necessary to determine the location of an individual’s record of military service. Please try to answer each item on the SF 180. If you do not have and cannot obtain the information for an item, show “NA,” meaning the information is “not available.” Include as much of the requested information as you can. To determine where to mail this request see Page 2 of the SF180 for record locations and facility addresses. Online requests may be submitted to the National Personnel Records Center (NPRC) by a veteran or deceased veteran’s next of kin using eVetRecs at: http://www.archives.gov/veterans/evetrecs/

VA Form 21-22

VA form 21-22-Use this form to you to appoint representation.

VA Form 21P-527EZ

VA form 21P 527EZ- Use this form to apply for Veterans Pension Benefits or Special Monthly pension due to the need of an aid or attendant.

VA Form 21-2680

VA Form 21-2680-Use this form to support your claim for Special Monthly Pension due to the need of an aid or attendant. (for veterans who are housebound or in need of an attendant) this form must be completed by a licensed physician.

VA form 21P-8416

VA form 21P-8416-Use this form in support of your claim for VA Pension of Special monthly pension. VA may be able to pay you a higher benefit rate if you identify expenses VA can deduct from your income. Your benefit rate is based on your income. Your out-of-pocket payments for medical and dental expenses may be deductible. Report any medical or dental expenses that you paid for yourself or for a relative who is a member of your household (spouse, grandchild, parent, etc.) for which you were not reimbursed and do not expect to be reimbursed. examples of expenses you should include, if applicable:

Hospital expenses • Doctor’s office fees• Dental fees • Prescription/non-prescription drug costs • vision care costs • Medical insurance premiums • Nursing home costs • Hearing aid costs • Home health service expenses • Expenses related to transportation to a hospital, doctor, or other medical facility • Monthly Medicare deduction.

Use the following forms to apply for your education benefits:

VA Form 22-1990

VA Form 22-1990-Use this form to apply for educational assistance under the following benefit programs: • Post- 9/11 GI Bill chapter 33 of title 38, U.S. Code • Montgomery GI Bill (MGIB) chapter 30 of title 38, U.S. Code • Montgomery GI Bill – Selected Reserve (MGIB-SR) chapter 1606 of title 10, U.S. Code • Post-Vietnam Era Veterans’ Educational Assistance Program (VEAP) chapter 32 of title 38, U.S. Code, or section 901 or section 903 of Public Law 96-342.

VA Form 22-1990e

VA form 22-1990e- Use VA Form 22-1990e if your spouse or parent has transferred Post-9/11 GI Bill benefits to you, and you need to apply for a Transfer of Entitlement (TOE).

VA Form 22-1990n

VA Form 22-1990n-Use this form to apply for education benefits under the National Call to Service (NCS) program (section 510 of title 10, U.S. Code). You should apply for this benefit if you first entered the military on or after October 1, 2003, signed an enlistment contract with DoD (Department of Defense) under the NCS program, and you elected one of the two education incentives provided by that program.

CFW Application DVS 40 July 2021

The College Fee Waiver for Veteran Dependents waives mandatory systemwide tuition and fees at a State of California Community College (CCC), California State University (CSU), or University of California (UC) campus. If eligibility criteria are met, use of the California College Fee Waiver for Veteran Dependents may be applied to state-supported programs in the CCC, CSU, and UC systems. Some programs at a CCC, CSU, and UC campus are considered self-supported, commonly referred to as extension courses or extended education, and they are not covered under the college fee waiver. The College Fee Waiver program does not cover the expense of books, parking, room and board, or any other school-specific fees. All applicants must meet California residency requirements. Use this form to apply for your dependents’ College tuition fee waiver offered by the state of California.

Complete one of the following forms to file for veterans burial benefits:

VA form 27-2008

Use this form to apply for a burial flag.

VA form 40-0247

Presidential Memorial Certificate- To apply for a presidential Memorial Certificate use this form.

VA Form 21P 530EZ

BURIAL AND PLOT-INTERMENT ALLOWANCES
USDVA burial allowances are partial reimbursements of an eligible veteran’s burial and funeral costs.

To file for VA Pension, complete the following forms:

VA Form 21-22

VA form 21-22-Use this form to you to appoint representation.

VA Form 21P-527EZ

VA form 21P 527EZ- Use this form to apply for Veterans Pension Benefits or Special Monthly pension due to the need of an aid or attendant.

VA Form 21-2680

VA Form 21-2680-Use this form to support your claim for Special Monthly Pension due to the need of an aid or attendant. (for veterans who are housebound or in need of an attendant) this form must be completed by a licensed physician.

VA form 21P-8416

VA form 21P-8416-Use this form in support of your claim for VA Pension of Special monthly pension. VA may be able to pay you a higher benefit rate if you identify expenses VA can deduct from your income. Your benefit rate is based on your income. Your out-of-pocket payments for medical and dental expenses may be deductible. Report any medical or dental expenses that you paid for yourself or for a relative who is a member of your household (spouse, grandchild, parent, etc.) for which you were not reimbursed and do not expect to be reimbursed. examples of expenses you should include, if applicable:

Hospital expenses • Doctor’s office fees• Dental fees • Prescription/non-prescription drug costs • vision care costs • Medical insurance premiums • Nursing home costs • Hearing aid costs • Home health service expenses • Expenses related to transportation to a hospital, doctor, or other medical facility • Monthly Medicare deduction.

Complete the following form to apply for Dependency Indemnity Compensation, Widows Pension, and Accrued benefits.

VA form 21P 534EZ

Use this notice and the attached application to submit a claim for DIC, Survivors Pension, and/or Accrued Benefits.

CH35-pamphlet-2

VBA 22-5490-ARE

CFW-Application-DVS-40-July2021

Dependents Application for VA education Benefits review pamphlet and complete VA for 22-5490. You may be also eligible for the California Department of Veterans Affairs College tuition fee waiver program, complete the DVS 40 for review and eligibility determination.

CHAMPVA

If you’re the spouse or child of a Veteran with disabilities or the surviving spouse or child of a Veteran who has died, use VA Form 10-10d to apply for health insurance through CHAMPVA (the Civilian Health and Medical Program of the Department of Veterans Affairs).

To file an application for CHAMPVA use the following forms:

VA form 10-10d

Use this form if you’re the spouse or child of a Veteran with disabilities or the surviving spouse or child of a Veteran who has died. 

VA Form 10-7959C

Use VA Form 10-7959C If you’re applying for CHAMPVA (Civilian Health and Medical Program of the Department of Veterans Affairs) and have other health insurance to declare as part of your VA Form 10-10d application. Or you need to report changes in your other non-VA health insurance, such as new beneficiaries or coverage changes.

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