INSIDE THESE INSTRUCTIONS - VA Aid and …

1 GENERAL INSTRUCTIONSFOR VETERAN S APPLICATION FOR COMPENSATION AND/OR PENSION, VA FORM 21-526, PARTS A,B,C, & DWhat s in THESE INSTRUCTIONS ?Ifyouhaveaquestion,calltheS SAtoll-freephonenumberat1-800-772-1213,M ondaythroughFriday, ,recordedinformationandservicesareavaila ble24hoursaday, ,1-800-325-0778, number handy when you call. By Mail: You can locate the address of the closest SSA office in your telephone book blue pages under"UnitedStatesGovernment,SocialSecur ityAdministration" By Internet: ,whichpartstouse,andwhichitemsyouwill need to fill to send your forms after you ve filled them : this form. INSIDE THESE INSTRUCTIONS Pg. 2 Section 1: Preparing your application Pg. 2 Checklist: Which parts of VA Form 21-526 should you use? Pg. 3 Checklist: Things you ll need to prepare for filling out your application Pg. 4 Section 2: Completing your application Pg. 5 Where do you send your application? Pg. 5 Tips for filling out your VA Form 21-526 Pg.

2 6 Section 3: Finding answers to other questions Pg. 7 Section 4: Explanation of the Privacy Act and Respondent BurdenBefore you start ..Where can I get help filling out my application?By telephone:Please call one of the following telephone numbers:1-800-827-10001-800-829-4833(Hea ringImpairedTDDline). ,youshouldhaveallthematerialsthatarelist edonpage3under"Checklist:Thingsyouwillne edtoprepareforfillingoutyourapplication. "Beforeyoucallorgototheregionaloffice, can I contact SSA if I have questions?Ifyouhavequestionsaboutthisfor m,howtofillitout,oraboutbenefits, ServiceOrganizationtohelpyoucompletethef orm, orBy Internet: mail:Youcanlocatetheaddressoftheclosestr egionalofficeinyourtelephonebookbluepage sunder"United States Government, Veterans".General INSTRUCTIONS page 1 SUPERSEDES VA FORM 21-526, APR 2003, WHICHWILL NOT BE FORMJAN 200421-526 Section3 tells you more about other issues that you mayhave questions ,B,C, "GeneralInstructions"consistofthe following four sections:How can I contact VA if I have questions?

3 Social Security ,bothareadministeredbytheSocialSecurityA dministration(SSA)andonlyindividualswhoh aveadisabilityandmeetmedicalcriteriamayq ualifyforbenefits under either 1: PREPARING YOURAPPLICATIONY oushouldapplyforpensionbenefitsifallofth efollowing are true:You are permanently and totally disabled and youbelieve it is because of your military service. CHECK LIST: WHICH PARTS OF VA FORM 21-526 SHOULD YOU USE? Look at the table below to find out which parts of VA Form 21-526 you should use to apply for different income is limited..You were seriously ill while you were in theservice, and you believe you have developed a mental or physical condition thatmay be related to your military ,findoutwhichpartsyouneedtousebyreadingt hroughthechecklistbelowcalled"WhichParts ofVAForm21-526 ShouldYouUse?"You were injured while you were in the are permanently and totally disabled (but notas a result of your military service).You served on active duty during a wartime Only You must fill out:If you are applying for:VA Form 21-526,Part B: CompensationVA Form 21-526,Part D: PensionCompensationand PensionCompensationonlyVA Form 21-526,Part A: GeneralInformationVA Form 21-526,Part C: DependencyWhat can I do to help get my applicationprocessed faster?

4 ,ifyouareclaimingserviceconnectionforace rtaindisability, do I use VA Form 21-526 for?Use VA Form 21-526 to apply for compensation and/orpension following are true:General INSTRUCTIONS page 2 CHECKLIST: THINGS YOU LL NEED TO PREPARE FOR FILLING OUT YOUR APPLICATION When you fill out this VA Form.. You ll need this information ready to answer questions.. 21-526 Part D: Pension Note: If you are a veteran who is age 65 or older you DO NOT have to submit medical evidence with your original or certified copy ofDD214 or other separation papersfor all periods of serviceReserve Duty and National Guard DutyinformationYour nursing home paymentstatus, which is Medicaid coverageor private level of care in the of military benefits you receive and amountsname and address of employersmailing addresses of units you served of disabilities you are claiming, includingInformation about any environmental exposures orevents that caused the disabilities you areclaiming, including dates they happenedCopies of the court records foradoption for each adopted child 21-526 Part A.

5 General InformationActive Duty Informationdates and places you entered and left dutymailing addresses of units you served about children not living with you,including their names, dates and places of birth,Social Security numbers, and amounts that youcontribute in child support for themIf you are in a nursing home, attacha statement signed by an official ofthe nursing home that includes 21-526 Part B: Compensationbeginning and ending datesof employmentname and address of the medical facilitieswhere you have been treated after servicethe date you were admitted to anursing homeCopies of your marriage certificateand all divorce decrees (May berequired in some cases)Current medical evidence telling usabout your disabilitiestreatment dates in servicedates and places you entered and left dutyInformation about your training and employmenthistory for the past year, includingInformation about your current spouse,including his/her Social Security number (andVA file number if he/she is a veteran)Information about you and your spouse sprevious marriages including dates and placesof those marriages and the dates and placesthose marriages endedInformation about the children who live with you,including their names, Social Security numbers,dates and places of INSTRUCTIONS page 3 21-526 Part C.

6 DependencyInformation about income you and yourdependents expect to receive in the next 12monthsInformation about your nursing home, if you livein oneInformation about your net worth and yourdependents net worthInformation about your recurring income andyour dependents recurring incomeMedical records you have indicatingthat the disability was caused by orhappened during your active serviceAn original or copies of all servicemedical records you haveCopies of the public birth records foreach child you claim as a dependent(May be required in some cases)Medical records you have showing youcurrently have this disabilitySECTION 2: COMPLETING YOURAPPLICATIONbe at least 18 but under 23 and pursuing anapproved course of education, ortheserecords, ,privatephysician,oranyotherhealthcarepr ovider,completetheattachedVAForm21-4142, AuthorizationandConsenttoReleaseInformat iontotheDepartmentofVeteransAffairs(VA). We will use this form to request THESE , ,we Form 21-526, Part C: DependencySection IIIW hocanIcountasadependentchild?

7 VArecognizesyourbiologicalchildren,adopt edchildren, and:VA Form 21-526 Part D: PensionSection IV Whatdoyoumeanby"networth"? ,clothing, and :Ifyouareaveteranwhoisage65orolder, INSTRUCTIONS page Form 21-526 Part B: CompensationSection IWhat kind of disabilities should I list? When possible,try to list the actual disease and medical condition that adoctor has diagnosed. Be as specific as you can. Do I have to include any records with this claimform?If you have records that support your claim you shouldattach them to this claim form. If you know of otherrecords that will support your claim, VA will help youby requesting them from the person, company, oragency that has them. On this form you must tell us thename and address of the person, company or agency thathas THESE records, the approximate time frame coveredVA Form 21-526, Part A: General InformationSection IIIW hatistheGulfWarregistry? (suchastheNationalAcademyofSciences). facility to request an VIIS houldIwaivemilitaryretiredpayforVAcompen sation?

8 Ifyoucurrentlyreceivemilitaryretiredpay, , ,ifyouareawardedcompensation, ,youmustsignItem21eof VA Form 21-526, Part A to let us become permanently unable to supportthemselves before reaching the age of do I do when I have finished my application?1. Make sure you sign and date VA Form 21-526, ,Item25 of this form. If you don t sign the form, VA willreturn it for you to sign, and it will take longer for us toprocess Attach any materials that support and explain INSTRUCTIONS to make sure that you have attachedall important pieces of information to your under the age of 18, 2: COMPLETING YOURAPPLICATION (Continued)General INSTRUCTIONS page 5 WhatifIneedtochangeoraddinformationtomya pplication after I give it to VA?Ifyoufindthatyouneedtochangeoraddinfo rmationtoyourapplication, ,make sure you specify: your name, claim number if you know it (or Social Security number if you don t know the claim number), and the item number you want to change or add do I send my application?

9 Mail the original application and your supportingmaterials to the closest VA office. You can find theaddress in your local telephone book or at the VBAinternetwebsite: TIPS FOR FILLING OUT YOUR VA FORM 21-526 ATTACHINGFORMSANDOTHERINFORMATION: Throughout this form, you will be asked to attach certain pieces of information to the form itself. For example, you are asked to attach a DD214 to your Form 21-526, Part A. TheDD214needstobeanoriginalorcertifiedco py, certified copy, you can take your original to the courthouse and have it copied and signed by an official of the court. A VA employee can also "certify" a copy for : Remember that the more questions you answer, the faster your claim can be processed. Try to answer every question that applies to your situation and fill out as much of the form as you can. The list below answers some questions that you might be wondering about:Whatifmyanswertoaquestionis"none"o r"0"? include the name of the country in your , page 5, Item 29 "Remarks" or attach a sheet of paper to your form.

10 Write "Continuation of answers" at the top of the page, your name, and your VA claim number. If this is your first claim, you will not have a VA claim number, so write your Social Security number instead. For each question that you need more room, write "Continuation of Item"and the item number. For example, if you need more room to answer Item 16 on VA Form 21-526, part A, write "Continuation of Item 16, VA Form 21-526, Part A." KEEPING RECORDS: It is important that you keep a copy of all the forms you fill out and give to VA. This way you will have your own complete record to refer to. SIGNING FORMS: Be sure to sign every form you fill out before you send it to ,AuthorizationandConsenttoReleaseInforma tiontotheDepartmentofVeteransAffairs(VA) , ,youauthorizeanydoctors,hospitals, ,medicalfacilities, treatment you received at a VA ,youwillbeprepared if VA has a question about your 3: FINDING ANSWERS TOOTHER QUESTIONSG eneral INSTRUCTIONS page 6 WhatcanyoutellmeaboutVAbenefitsandhowVAd ecides what I will or will not receive?