Transcription of VA DATE STAMP (DO NOT WRITE IN THIS SPACE) …
{{id}} {{{paragraph}}}
Example: air traffic controller
VA DATE STAMP (DO NOT WRITE IN THIS SPACE) …
SECTION I: IDENTIFICATION AND CLAIM INFORMATIONPage 8 OMB Control No. 2900-0747 Respondent Burden: 25 minutes Expiration Date: 03/31/2021VA DATE STAMP (DO NOT WRITE IN THIS SPACE) IMPORTANT: Please read the Privacy Act and Respondent Burden on page 12 before completing the VETERAN/SERVICE MEMBER NAME (First, Middle Initial, Last) 3. VETERAN'S SOCIAL SECURITY NUMBER (SSN) 6. DATE OF BIRTH (MM,DD,YYYY) 8. GENDER4. HAVE YOU EVER FILED A CLAIM WITH VA?YESNO(If "Yes," provide your file number in Item 5) 5. VA FILE NUMBER12. EMAIL ADDRESS (Optional) APPLICATION FOR DISABILITY COMPENSATION AND RELATED COMPENSATION BENEFITS11.
SECTION III: SERVICE PAY SECTION II: SERVICE INFORMATION VA Form 21-2680 or, if based on nursing home attendance, VA Form 21-0779 20A. DID/DO YOU RECEIVE ANY TYPE OF SEPARATION/SEVERANCE/RETIRED PAY?
Loading..
Tags:
Information
Domain:
Source:
Link to this page:
Please notify us if you found a problem with this document: