Download VA Form 21-526EZ Application for Disability Compensation and Related Compensation Benefits
What Is VA Form 21-526EZ Used for?
The application can be used to claim one of the following benefits:
- Disability Service Connection;
- Compensation Claims Submitted Prior to Discharge;
- Compensation under 38 U.S.C. 1151;
- Automobile Allowance/Adaptive Equipment;
- Secondary Service Compensation;
- Temporary Total Disability Rating;
- Special Monthly Compensation;
- Benefits Based on a Veteran's Seriously Disabled Child;
- Increased Disability Compensation;
- Individual Unemployability especially Adapted Housing/Special Home Adaptation.
VA Form 21-526EZ Instructions
VA Form 21-526EZ consists of twelve pages. The form guidelines are provided on the first seven pages. The instructions for filling out the form are below.
How to Fill out VA Form 21-526EZ?
- Select the Claim program type.
- Section I. Identification information. Include your name, social security number, VA number if any, date of birth, veteran service number, and gender, as well as your contact details. If the form is used for Benefits Delivery at Discharge (BDD), this section should include the date or anticipated date of release from active duty. Indicate your employment if you are a current VA employee.
- Section II. Change of Address information. If you anticipate a change of address, do mention it in this section.
- Section III. Homeless information. This section is filled out if you are homeless or at risk of being homeless. Otherwise, leave it blank.
- Section IV. Claim information. Provide all your current disabilities and treatment facilities, where you received treatment.
- Section V. Service data. Include the branch and component of service, the most recent active service dates, whether you served in reserves or national guard, or are on active duty. If you have served in a combat zone since 9/11/2001 or have ever been a prisoner of war, indicate it in this section.
- Section VI. Service pay information. Provide data about all military payments you receive, and whether you want to receive the VA compensation in lieu of military retired pay or training pay or not.
- Section VII. Direct deposit information.
- Section VIII. Claiming certification and your signature.
- Section IX. Signatures of witnesses.
- Section X. Alternate signer certification and signature.
- Section XI. Power of attorney signature.
VA 21-526EZ Related Forms
VA 21-526EZ Form belongs to VA 21-526 series. The other forms of the series are: