Va form 21 0518 1-2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering the veteran's and surviving spouse's names, along with their VA file number and complete mailing address. Ensure accuracy for effective communication.
  3. Fill in your Social Security number and the veteran’s Social Security number. Then, provide your date of birth.
  4. Indicate your marital status by checking the appropriate box. This section is crucial for determining eligibility.
  5. Report the number of unmarried dependent children in your custody and any contributions made during the past year for those not in your custody.
  6. If applicable, answer questions regarding nursing home residency and Medicaid coverage, providing dates where necessary.
  7. Detail your monthly and annual income from various sources, ensuring no fields are left blank. This includes wages, benefits, and other income streams.
  8. Complete sections on net worth and family medical expenses as instructed, using additional forms if required.
  9. Finally, sign and date the form, ensuring all information is accurate before submission.

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2021 4.8 Satisfied (78 Votes)
2018 4.4 Satisfied (179 Votes)
2015 4.2 Satisfied (76 Votes)
2012 4.4 Satisfied (162 Votes)
2004 4 Satisfied (23 Votes)
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NOTE: You may complete the form online or by hand. If completed by hand, print the information requested in ink, neatly and legibly, insert one letter per box, and completely fill in each applicable check box to help expedite processing of the form.
You can use this form if youre: A surviving spouse or child of a Veteran who has died. Applying for VA benefits and/or the money that we owe the Veteran but didnt pay prior to their death (accrued benefits)
However, there is an option to complete and sign this form online. This can be accessed by heading to the official VA website and uploading this information. Keep in mind that handwritten signatures as well as e-signatures are considered valid for this purpose.
VA Supplemental Claim Success Rate: While the VA doesnt officially publish Supplemental Claim success rates, it is estimated that approximately 50% of veterans who provide new and relevant evidence experience a favorable decision. This evidence can change the outcome of the claim if properly submitted.
We use this information to determine whether youre eligible to continue receiving additional compensation based on your number of dependents.

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