LexisNexis® Automated Veterans Benefits Forms

LexisNexis Automated Veterans Benefits Forms includes 251 forms and value-added instructions written by National Veteran's Legal Services Program (NVLSP) attorneys. New and revised forms are provided regularly.
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Book Edition: Sep2019

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LexisNexis® Automated Veterans Benefits Forms includes over 251 forms and value-added instructions written by National Veteran's Legal Services Program (NVLSP) attorneys. New and revised forms are provided regularly.

The repetitive typing, cutting, and pasting, and the increased chance of error that plague traditional methods of document preparation all disappear with HotDocs® document-assembly software. Simply enter case- or client-specific information once and HotDocs will insert it where relevant throughout the form. You will produce a signature-ready document in minutes. You can also save the information you have entered and use the saved answers to complete related forms. HotDocs will also compute many of the tax calculations automatically.

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Table of Contents

Veterans' Benefits Forms
Foreword by Ronald Abrams, National Veterans Legal Services Program
Veterans Benefits Manual Advocacy Checklist for Different Types of VA Claims (App17-A) (Word)

Additional Forms
Appeal Cancellation Form
Submission Cover Sheet

VA Compensation and Pension Forms
Application for Accrued Amounts Due a Deceased Beneficiary (21P-601)
Application for Accrued Amounts Due a Deceased Beneficiary (21P-601) (Instructions)
Application for Annual Clothing Allowance (Under 38 U.S.C. 1162) (10-8678)
Application for Automobile or Other Conveyance and Adaptive Equipment (21-4502)
Application for Automobile or Other Conveyance and Adaptive Equipment (21-4502) (Instructions)
Application for Ben. for Certain Children with Disab. Born of Vietnam Vets. (21-0304)
Application for Ben. for Certain Children with Disab. Born of Vietnam Vets. (21-0304) (Instructions)
Application for Burial Benefits (Under 38 U.S.C. Chapter 23) (21P-530)
Application for Burial Benefits (Under 38 U.S.C. Chapter 23) (21P-530) (Instructions)
Application for Dependency and Indemnity Compensation (21-534)
Application for Dependency and Indemnity Compensation (21-534) (Instructions)
Application for Dependency and Indemnity Compensation by a Surviving Spouse or Child (21-534a)
Application for Dependency and Indemnity Compensation by a Surviving Spouse or Child (Instructions)
Application for Dependency and Indemnity Compensation by Parent(s) (21-535)
Application for Dependency and Indemnity Compensation by Parent(s) (21-535) (Instructions)
Application for Exclusion of Children's Income (21-0571)
Application for Pre-Need Determination of Eligibility for Burial in a VA Nat. Cem. (40-10007)
Application for Pre-Need Determination of Eligibility for Burial in a VA Nat. Cem. (40-10007)(Inst.)
Application for United States Flag for Burial Purposes (27-2008)
Application for United States Flag for Burial Purposes (27-2008) (Instructions)
Declaration of Status of Dependents (21-686c)
Decision Review Request: Board Appeal (Notice of Disagreement) (VA 10182)
Decision Review Request: Board Appeal (Notice of Disagreement) (VA 10182) (Instructions)
Decision Review Request: Higher-Level Review (20-0996)
Decision Review Request: Higher-Level Review (20-0996) (Instructions)
Decision Review Request: Supplemental Claim (20-0995)
Decision Review Request: Supplemental Claim (20-0995) (Instructions)
Election of Comp in Lieu of Retired Pay or Waiver of Retirement Pay to Secure Comp from VA (21-651)
Eligibility Verification Report (21-0510) (Instructions)

Fully Developed Claims Process
Application for DIC, Death Pension, and/or Accrued Benefits (21P-534EZ)
Application for DIC, Death Pension, and/or Accrued Benefits (21P-534EZ) (Instructions)
Application for Pension (21P-527EZ)
Application for Pension (21P-527EZ) (Instructions)
Fully Developed Claim Notice (Compensation) (21-526EZ)
Fully Developed Claim Notice (Compensation) (21-526EZ) (Instructions)
Improved Pension Eligibility Verification Report (Child or Children) (21P-0519c-1)
Improved Pension Eligibility Verification Report (Surviving Spouse with Children) (21-0519s-1)
Improved Pension Eligibility Verification Report (Surviving Spouse with No Children) (21-0518-1)
Improved Pension Eligibility Verification Report (Veteran with Children) (21-0517-1)
Improved Pension Eligibility Verification Report (Veteran with No Children) (21-0516-1)
Income-Net Worth and Employment Statement (21P-527)
Income-Net Worth and Employment Statement (21P-527) (Instructions)
Information Regarding Apportionment of Beneficiary's Award (21-0788)
Medical Expense Report (21P-8416)
Medical Expense Report (21P-8416) (Instructions)
Notice of Disagreement (21-0958)
Notice of Disagreement (21-0958) (Instructions)
Old Law and Section 306 Eligibility Verification Report (Children Only) (21-0513-1)
Old Law and Section 306 Eligibility Verification Report (Surviving Spouse) (21-0512s-1)
Old Law and Section 306 Eligibility Verification Report (Veteran) (21-0512v-1)
Old Law Eligibility Verification Report (Veteran) (21-0511v-1)
Parent's DIC Eligibility Verification Report (21-0514-1)
Pension Claim Questionnaire for Farm Income (21P-4165)
Pre-Discharge Compensation Claim (21-526c)
Report of Accidental Injury in Support of Claim for Compensation or Pension (21-4176)
Report of Accidental Injury in Support of Claim for Compensation or Pension (21-4176) (Instructions)
Report of Income from Property or Business (21-4185)
Request for Approval of School Attendance (21-674)
Request for Approval of School Attendance (21-674) (Instructions)
Request for Details of Expenses (21-8049)
Request for Employment Information in Connection with Claim for Disability Benefits (21-4192)
Request for Nursing Home Information in Connection with Claim for Aid and Attendance (21-0779)
Social Security Administration Application For Survivors Benefits (21-534b)
Social Security Administration Application For Survivors Benefits (21-534b) (Instructions)
Statement in Support of Claim (21-4138)
Statement in Support of Claim for Service Connection for Post-Traumatic Stress Disorder (21-0781)
Statement in Support of Claim for Service Connection for Post-Traumatic Stress Disorder (21-0781a)
Statement of Dependency of Parent(s) (21P-509)
Statement of Dependency of Parent(s) (21P-509) (Instructions)
Statement of Marital Relationship (21-4170)
Statement of Person Claiming to Have Stood in Relation of Parent (21P-524)
Supporting Statement Regarding Marriage (21-4171)
Veteran/Beneficiary Claim for Reimbursement of Travel Expenses (10-3542) (Instructions)
Veteran/Beneficiary Claim for Reimbursement of Travel Expenses (10-3542)
Veteran's Application for Compensation and/or Pension (21-526)
Veteran's Application for Compensation and/or Pension (21-526) (Instructions)
Veteran's Application for Increased Compensation Based on Unemployability (21-8940)
Veteran's Supplemental Claim (21-526b)

Department of Defense Forms
Application for Correction of Military Record (DD 149)
Application for Discharge of Member or Survivor of Member of Group... (DD 2168)
Application for the Review of Discharge or Dismissal from the Armed Forces (DD 293)
Application for the Review of Discharge or Dismissal from the Armed Forces (DD 293) (Instructions)
Claim for Combat-Related Special Compensation (CRSC) (DD 2860)
Claim for Combat-Related Special Compensation (CRSC) (DD 2860) (Instructions)
Report of Medical Assessment (DD 2697)
Request for Medical/Dental Records from the National Personnel Records Center (NPRC)(DD 877-1)
Request for Medical/Dental Records or Information (DD 877)
Service Member Pre-Separation/Transition Counseling and Career Readines Standards EForm... (DD 2648)
Service Member's Individual Transition Plan Checklist (DD 2958)
Service Member's Individual Transition Plan Checklist (DD 2958) (Instructions)
Transition Assistance Program (TAP) Checklist for Deactivating/Demobilizing NG/Reserve… (DD 2648-1)

Disability Benefits Questionnaires
Cardiovascular

(21-0960A-1) Ischemic Heart Disease (IHD)
(21-0960A-2) Artery and Vein Conditions (Vascular Diseases Including Varicose Veins)
(21-0960A-3) Hypertension Disability Benefits Questionnaire
(21-0960A-4) Heart Conditions (Including Ischemic and Non-Ischemic Heart Disease...)
Dental and Oral
(21-0960D-1) Oral and Dental Conditions Including Mouth, Lips and Tongue ...
(21-0960M-15) Temporomandibular Joint (TMJ) Conditions Disability Benefits Questionnaire
Dermatological
(21-0960F-1) Scars/Disfigurement Disability Benefits Questionnaire
(21-0960F-2) Skin Diseases Disability Benefits Questionnaire
Ear, Nose and Throat
(21-0960N-1) Ear Conditions (Including Vestibular and Infectious Conditions)
(21-0960N-3) Loss of Sense of Smell and/or Taste Disability Benefits Questionnaire
(21-0960N-4) Sinusitis/Rhinitis and Other Conditions of the Nose, Throat, Larynx and Pharynx ...
Endocrinological
(21-0960E-1) Diabetes Mellitus Disability Benefits Questionnaire
(21-0960E-2) Endocrine Diseases (Other than Thyroid, Parathyroid or Diabetes Mellitus)
(21-0960E-3) Thyroid and Parathyroid Conditions Disability Benefits Questionnaire
Gastrointestinal
(21-0960G-1) Esophageal Conditions (Including gastroesophageal reflux disease (GERD)...)
(21-0960G-2) Gallbladder and Pancreas Conditions Disability Benefits Questionnaire
(21-0960G-3) Intestinal Conditions (Other that Surgical or Infections)...
(21-0960G-4) Intestinal Surgery (Bowel Resection, Colostomy, Ileostomy) Disability Benefits...
(21-0960G-5) Hepatitis, Cirrhosis and Other Liver Conditions Disability Benefits Questionnaire
(21-0960G-6) Peritoneal Adhesions Disability Benefits Questionnaire
(21-0960G-7) Stomach and Duodenal Conditions (Not Including Gerd or Esophageal Disorders)
(21-0960G-8) Infectious Intestinal Disorders, Including Bacterial and Parasitic Infections...
Genitourinary
(21-0960J-1) Kidney Conditions (Nephrology) Disability Benefits Questionnaire
(21-0960J-2) Male Reproductive Organ Conditions Disability Benefits Questionnaire
(21-0960J-3) Prostate Cancer Disability Benefits Questionnaire
(21-0960J-4) Urinary Tract (Including Bladder and Urethra) Conditions
Gynecological
(21-0960K-1) Breast Conditions and Disorders Disability Benefits Questionnaire
(21-0960K-2) Gynecological Conditions Disability Benefits Questionnaire
Hematologic and Lymphatic
(21-0960B-1) Disability Benefits Questionnaire Hairy Cell and Other B-Cell Leukemias
(21-0960B-2) Hematologic and Lymphatic Conditions, Including Leukemia Disability Benefits...
Infectious Diseases
(21-0960I-1) Persian Gulf and Afghanistan Infectious Diseases Disability Benefits Questionnaire
(21-0960I-2) HIV - Related Illnesses Disability Benefits Questionnaire
(21-0960I-3) Infectious Diseases (Other than HIV-Related Illness, Chronic Fatigue, Tuberculosis)...
(21-0960I-4) Systemic Lupus Erythematosus (SLE) and Other Autoimmune Diseases Disability Benefits
(21-0960I-5) Nutritional Deficiencies Disability Benefits Questionnaire
(21-0960I-6) Tuberculosis Disability Benefits Questionnaire
Musculoskeletal
(21-0960M-1) Amputations Disability Benefits Questionnaire
(21-0960M-10) Muscle Injuries Disability Benefits Questionnaire
(21-0960M-11) Osteomyelitis Disability Benefits Questionnaire
(21-0960M-12) Shoulder and Arm Conditions Disability Benefits Questionnaire
(21-0960M-13) Neck (Cervical Spine) Disability Benefits Questionnaire
(21-0960M-14) Back (Thoracolumbar Spine) Conditions Disability Benefits Questionnaire
(21-0960M-16) Wrist Conditions Disability Benefits Questionnaire
(21-0960M-2) Ankle Conditions Disability Benefits Questionnaire
(21-0960M-3) Non-Degenerative Arthritis...
(21-0960M-4) Elbow and Forearm Conditions Disability Benefits Questionnaire
(21-0960M-5) Flatfoot (Pes Planus) Disability Benefits Questionnaire
(21-0960M-6) Foot Miscellaneous (Other Than Flatfoot/PES Planus) Disability Benefits Questionnaire
(21-0960M-7) Hand and Finger Conditions Disability Benefits Questionnaire
(21-0960M-8) Hip and Thigh Conditions Disability Benefits Questionnaire
(21-0960M-9) Knee and Lower Leg Conditions Disability Benefits Questionnaire
Neurological
(21-0960C-1) Parkinson's Disease
(21-0960C-10) Peripheral Nerves Conditions
(21-0960C-11) Seizure Disorders (Epilepsy) Disability Benefits Questionnaire
(21-0960C-2) Amyotrophic Lateral Sclerosis (Lou Gehrig's Disease) Disability Benefits Questionnaire
(21-0960C-3) Cranial Nerve Conditions Disability Benefits Questionnaire
(21-0960C-4) Diabetic Sensory-Motor Peripheral Neuropathy Disability Benefits Questionnaire
(21-0960C-5) Central Nervous System and Neuromuscular Diseases (Except Trau. Brain Injury, etc.)...
(21-0960C-6) Narcolepsy Disability Benefits Questionnaire
(21-0960C-7) Fibromyalgia Disability Benefits Questionnaire
(21-0960C-8) Headaches (Including Migraine Headaches) Disability Benefits Questionnaire
(21-0960C-9) Multiple Sclerosis (MS) Disability Benefits Questionnaire
Ophthalmological
(21-0960N-2) Eye Conditions Disability Benefits Questionnaire
Psychological
(21-0960P-1) Eating Disorders Disability Benefits Questionnaire
(21-0960P-2) Mental Disorders (Other Than PTSD and Eating Disorders) Disability Benefits
(21-0960P-3) Review Post Traumatic Stress Disorder (PTSD) Disability Benefits Questionnaire
Respiratory
(21-0960L-1) Respiratory Conditions (Other than Tuberculosis and Sleep Apnea) Disability Benefits
(21-0960L-2) Sleep Apnea Disability Benefits Questionnaire
Rheumatological
(21-0960Q-1) Chronic Fatigue Syndrome Disability Benefits Questionnaire
Surgery (General)
(21-0960H-1) Hernias (Including Abdominal, Inguinal and Femoral Hernias)...
(21-0960H-2) Rectum and Anus Conditions IIncluding Hemorrhoids) Benefits Questionnaire

Educational Forms
Application and Enrollment Certification for Individualized Tutorial Assistance (22-1990t)
Application and Enrollment Certification for Individualized Tutorial Assistance (22-1990t) (Inst.)
Application for Family Member to use Transferred Benefits (22-1990E)
Application for Family Member to use Transferred Benefits (22-1990E) (Instructions)
Application for Refund of Educational Contributions (22-5281)
Application for Refund of Educational Contributions (22-5281) Instructions
Application for Survivors' and Dependents' Educational Assistance (22-5490)
Application for Survivors' and Dependents' Educational Assistance (22-5490) (Instructions)
Application for VA Education Benefits (22-1990)
Application for VA Education Benefits (22-1990) (Instructions)
Application for Work-Study Allowance (22-8691)
Application for Work-Study Allowance (22-8691) (Instructions)
Certificate of Affirmation of Enrollment Agreement--Correspondence Course (22-1999c)
Dependent’s Request for Change of Program or Place of Training (22-5495)
Dependent’s Request for Change of Program or Place of Training (22-5495) (Instructions)
Request for Change of VA Education Program or Place of Training (22-1995)
Request for Change of VA Education Program or Place of Training (22-1995) (Instructions)
Supplemental Information for Change of Program or Reenrollment (22-8873)
Time Record (Work-Study Program) (22-8690)

Finance Forms
App. for Assump. Approval and/or Release from Personal Liability to Gov't on a Home Loan (26-6381)
Direct Deposit Enrollment (24-0296)

Home Loan Guaranty Forms
Request for a Certificate of Eligibility for VA Home Loan Benefits (26-1880)
Request for a Certificate of Eligibility for VA Home Loan Benefits (26-1880) (Instructions)
Request for Determination of Loan Guaranty Eligibility--Unmarried Surviving Spouses (26-1817)

Insurance Forms
Application for Cash Surrender Value/or
Application for Policy Loan (29-1546)
Application for Service Disabled Veterans Insurance (29-4364)
Application for Service Disabled Veterans Insurance (29-4364) Instructions (29-9)
Application for Service Disabled Veterans Insurance (29-0151)
Application for Supplemental Service Disabled Veterans (RH) Life Insurance (29-0189)
Application for Supplemental Service-Disabled Veterans Insurance (SRH) (29-0188)
Application for Veterans' Group Life Insurance (SGLV 8714)
Application for Veterans' Group Life Insurance (SGLV 8714) (Instructions)
Claim for Death Benefits (SGLV 8283)
Claim for Death Benefits (SGLV 8283) (Instructions)
Claim for Disability Insurance--Government Life (29-357)
Claim for One Sum Payment (29-4125)
Designation of Beneficiary Government Life Insurance (29-336)
Designation of Beneficiary Government Life Insurance (29-336) (Instructions)
Request for Change of Address/Cancellation of Direct Deposit (20-572)
Service-Disabled Veterans Insurance RH Information and Premium Rates VA Pamphlet 29-9

Miscellaneous Forms
Application for 10-Point Veteran Preference(To be Used by Veterans and Relatives of Veterans)(SF 15)
Application for Relief From Court-Martial Findings and/or Sentence... (DA Form 3499)
Presidential Memorial Certificate Request Form (40-0247)

National Archives Forms
Questionnaire about Military Service (NA 13075)
Request For Information Needed To Reconstruct Medical Data (NA 13055)

Other Department of Veterans Affairs Forms
Alternate Signer Certification (21-0972)
Alternate Signer Certification (21-0972) Instructions
Appeal to Board of Veterans' Appeals (9)
Appeal to Board of Veterans' Appeals (9) (Instructions)
Application for Accreditation as a Claims Agent (VA-21A)
Application for Accreditation as a Veterans Organization Representative (VA Form 21)
Application for Adaptive Equipment Motor Vehicle (10-1394)
Application for CHAMPVA Benefits (10-10d)
Application for CHAMPVA Benefits (10-10d) (Instructions)
Application for Comprehensive Assistance for Family Caregivers Program (10-10CG)
Application for Comprehensive Assistance for Family Caregivers Program (10-10CG) (Instructions)
Application for Extended Care Services (10-10EC)
Application for Extended Care Services (10-10EC) (Instructions)
Application for Health Benefits (10-10EZ)
Application for Health Benefits (10-10EZ) (Instructions)
Application for Health Benefits (10-10EZ) (Old Copy)
Application for Health Benefits (10-10EZ) (Old Copy) (Instructions)
Application for Reimbursement of Headstone or Marker Expense (21-8834)
Application for Standard Government Headstone or Marker (40-1330)
Application for Standard Government Headstone or Marker (40-1330) (General Information Sheet)
Application for Survivors Benefits (SSA-24)
Application for Survivors Benefits (SSA-24) (Instructions)
Application of Surviving Spouse or Child for Reps Benefits (21-8924)
Appointment of Individual as Claimant's Representative (21-22a)
Appointment of Veterans Service Organization as Claimant's Representative (21-22)
Appointment of Veterans Service Organization as Claimant's Representative (21-22) (Instructions)
Authorization to Disclose a Record in the Presence of a Third Party (VA Form 5571)
Authorization to Disclose Information to the Department of Veterans Affairs (VA) (21-4142)
Authorization to Disclose Personal Information To a Third Party (21-0845)
Authorization to Disclose Personal Information To a Third Party (21-0845) Instructions
CHAMPVA Other Health Insurance (OHI) Certification (10-7959C)
CHAMPVA Other Health Insurance (OHI) Certification (10-7959C) (Instructions)
Claim for Government Medallion for Placement in a Private Cemetery (40-1330M)
Claim for Government Medallion for Placement in a Private Cemetery (40-1330M) Instructions
Claim for Payment of Cost of Unauthorized Medical Services (10-583)
Examination for Housebound Status or Permanent Need for Regular Aid and Attendance (21-2680)
Financial Status Report (5655)
Foreign Medical Program (FMP) Registration Form (10-7959f-1)
General Release for Medical Provider Information to the Department of VA (21-4142a)
General Release for Medical Provider Information to the Department of VA (21-4142a) Instructions
Health Benefits Renewal Form (10-10EZR)
Health Benefits Renewal Form (10-10EZR) (Instructions)
Individuals' Request for a Copy of Their Own Health Information (10-5345a)
Intent to File a Claim for Compensation or Pension, Survivors Pension, or Other Benefits (21-0966)
Radiation Risk Activity Information Sheet
Rehabilitation Plan (28-8872)
Rehabilitation Plan--Continuation Sheet (28-8872a)
Request for and Authorization to Release Health Information (10-5345)
Request for and Consent to Release of Information from Claimant's Records (3288)
Request for Hardship Determination (10-10HS)
Request for Substitution of Claimant Upon Death of Claimant (21-0847)
Request for Substitution of Claimant Upon Death of Claimant (21-0847) Instructions
School Attendance Report (21-674b)
Statement of Accredited Representation in Appealed Case (1-646)
Veterans Application For Assistance in Acquiring Home Improvement and Structural Alterations
Veteran's Application in Acquiring Specially Adapted Housing or Special Home Adapt. Grant (26-4555)

Standard Forms
Claim for Damage, Injury, or Death Standard Form (SF 95)
Claim for Unpaid Compensation of Deceased member of the Uniformed Serviced (SF 1174)
Records Transmittal and Receipt (SF135)
Request Pertaining to Military Records (SF 180)
Request Pertaining to Military Records (SF 180) (Instructions)

Vocational Rehabilitation and Employment Forms
Counseling Record - Personal Information (28-1902)
Disabled Veterans Application for Vocational Rehabilitation (28-1900)
Disabled Veterans Application for Vocational Rehabilitation (28-1900) (Instructions)
Employment Questionnaire (21-4140-1)
Rehabilitation Needs Inventory (RNI) (28-1902W)

State Specific Forms
California

Calvet Home Loan Program - Prequalification Application Form
Civil Service Preference (SPB 1093)
Civil Service Preference (SPB 1093) (Instructions)
College Fee Waiver for Veteran's Dependents
College Fee Waiver for Veteran's Dependents (DVS-40) (Instructions)
College Fee Waiver for Veteran's Dependents (DVS-40)
Veterans Home Application
Veterans Home Application (Information)
Veterans' Special License Plate (Purple Heart, Medal Of Honor) (Reg 17A)

New York
Application for Alternative Veterans Exemption From Real Property Taxation (RP-458-a)
Application for Alternative Veterans Exemption From Real Property Taxation (RP-458-a) (Instructions)
Application for New York State Civil Service Examination (Form CC-APP)
Application for New York State Civil Service Examination (Form CC-APP) (Instructions)
Application for Veterans Exemption From Real Property Taxation (RP-458)
Application for Veterans Exemption From Real Property Taxation (RP-458) (Instructions)
Form to Register a Vehicle with Former POW or Congressional Medal of Honor Plates (MV-1H)
Form to Register Motor Vehicle Obtained by Disabled Veteran Under Title 38 U.S.C. (MV-1E)
Form to Renew Registration of Motor Vehicle for Disabled Veteran Under Title 38 (MV-1G)

Texas
Application for "Disabled Veteran" License Plate (VTR-615)
Application for Military Service License Plates (VTR-420)
Claims Tracking Form (TVC 18)
Nursing Home Statement (TVC 15a)
Statement of Attending Physician (TVC 16)
Texas State Veterans Home Application for Admission
Texas Veterans Housing Assistance and Home Improvement Programs, Cert of Eligibility Application
Veteran Status / Veteran's Employment Preference Form