Download VA Form 21-0966 Intent to File a Claim for Compensation and/Or Pension, or Survivors Pension and/Or Dic
VA Form 21-0966 Instructions
VA intent to file a claim form consists of three sections:
- Section I - Claimant/Veteran Identification - the claimant's full name, social security number, and VA file number (if applicable), the veteran's date of birth, the veteran's full name, social security number, sex, and service number, the current mailing address, the telephone number, the email address. The applicant must also state, if the veteran has ever filed a claim with the VA.
- Section II - General Benefit Election. It is required to select one or more of the general benefits - a compensation or a pension. If the boxes remain unchecked, the VA will not be able to use the form to establish an effective date. If the future claimant is a surviving dependent of the veteran, the box «Survivors pension and/or Dependency and Indemnity Compensation (DIC)» must be checked.
- Section III - Declaration of Intent. The claimant indicates the intent to apply for one or more general benefits acknowledging that this form is not a claim for benefits and that the complete application for the benefits must be received within one year from the date the VA receives the form. The claimant or the authorized representative must sign the form and write down the actual date. If the form was completed by a Veteran Service Organization representative, an agent, or an attorney, the form must also contain the individual's name.
How to File VA Form 21-0966?
There are three ways to file the VA 21-0966 form:
- Online through eBenefits. First, it is necessary to initiate a claim. The future claimant completes the personal information page to establish an effective date. This gives an applicant one year to complete the filing process;
- A paper form can be mailed to the VA pension management center. Their mailing addresses are listed below; and
- In person or over the phone. It is allowed to call the VA's National Call Center or visit one of the VA's regional benefit offices, which can be located at eBenefits website.
Where to Send VA Form 21-0966?
There are three VA regional pension management centers:
- Philadelphia VA Regional Office (serves Connecticut, Delaware, Florida, Georgia, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, North Carolina, Pennsylvania, Puerto Rico, Rhode Island, South Carolina, Vermont, Virginia, West Virginia and all foreign countries not included under the St. Paul VA Regional Office);
- Milwaukee VA Pension Center (serves Alabama, Arkansas, Indiana, Illinois, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Ohio, Tennessee, Wisconsin);
- St. Paul VA Regional Office (serves Alaska, Arizona, California, Colorado, Hawaii, Idaho, Iowa, Kansas, Minnesota, Montana, Nebraska, North Dakota, New Mexico, Nevada, Oklahoma, Oregon, South Dakota, Texas, Utah, Washington, Wyoming, Central America, Mexico, South America, and the Caribbean).
The current address for mailing the VA Form 21-0966 is the Department of Veterans Affairs, Claims Intake Center (Attention: Philadelphia Pension Center) PO Box 5206, Janesville, WI 53547-5206.
Milwaukee VA Pension Center: Department of Veterans Affairs, Claims Intake Center Attention: Milwaukee Pension Center, PO Box 5192 Janesville, WI 53547-5192
St. Paul VA Regional Office: Department of Veterans Affairs, Claims Intake Center Attention: St. Paul Pension Center, PO BOX 5365 Janesville, WI 53547-5365