21p 0518 1: Fill out & sign online

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

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