VA Form 21-0538 Mandatory Status of Dependents

What Is VA Form 21-0538?

VA Form 21-0538, Mandatory Status of Dependents is a document issued by the Department of Veterans Affairs (VA). The main purpose of this paper is to collect information necessary to determine veterans' eligibility for additional payments for their dependents (spouse and/or children).

The latest version of the form was released by the VA in April 2013. An up-to-date fillable version of the VA Form 21-0538 is available for download and digital filing below or can be found on the VA website.

Veterans that have dependents are entitled to a higher level of compensation than veterans without dependents. The VA needs to be updated about a reduction or increase in the number of dependents. That is the VA occasionally sends veterans a VA 21-0538 form for completion in order to obtain the most recent information. The VA Status of Dependents Questionnaire is sent to the service members who:

  • receive benefits due to service-connected disabilities;
  • receive additional compensation for their children and/or spouse.

The disabled veterans are responsible for reporting any changes to the number of their dependents. The Questionnaire will be sent if the VA has not received any reports of changes for a long time. The willful submission of any false statements or evidence, as well as fraudulent acceptance of the payments the veteran is not entitled to may lead to a fine and/or imprisonment.

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In Reply Refer To:
The compensation you receive for your service-connected disability includes an additional amount for your spouse and/or
child(ren). You are responsible for reporting any change in the number of your dependents.
To show continued entitlement to this additional amount, you must complete and return the form starting on page 2 of this
letter. You can also provide the information by calling the VA, at 1-800-827-1000. If you use a Telecommunications
Device for the Deaf (TDD), the federal number is 711. If the number of your dependents has not changed, we will
continue your benefits at their present rate. If the number of your dependents has changed due to either the loss or
addition of a dependent, we will adjust your payments accordingly.
If you do not notify us of the status of your dependents within 60 days from the date of this letter, we will reduce your
award by the amount of benefits you are receiving for your dependents.
VA now uses a centralized mail system. If you choose to respond in writing, please put your full name and VA file
number on each page. Send your application and any evidence in support of your claim to the following address:
Department of Veterans Affairs
Evidence Intake Center
P. O. Box 4444
Janesville, WI 53547-4444
If you are unable to mail your application or evidence, please use the following Fax Lines:
(844) 531-7818 (Toll Free)
(248) 524-4260 (Utilized for Foreign Claimants)
You have the right at any time to submit additional information or to have a personal hearing to explain or clarify your
statements. You also have the right to be represented at the hearing by an authorized veteran's service organization.
Veterans Service Center Manager
Enclosure
VA FORM
21-0538
Page 1
DEC 2017
In Reply Refer To:
The compensation you receive for your service-connected disability includes an additional amount for your spouse and/or
child(ren). You are responsible for reporting any change in the number of your dependents.
To show continued entitlement to this additional amount, you must complete and return the form starting on page 2 of this
letter. You can also provide the information by calling the VA, at 1-800-827-1000. If you use a Telecommunications
Device for the Deaf (TDD), the federal number is 711. If the number of your dependents has not changed, we will
continue your benefits at their present rate. If the number of your dependents has changed due to either the loss or
addition of a dependent, we will adjust your payments accordingly.
If you do not notify us of the status of your dependents within 60 days from the date of this letter, we will reduce your
award by the amount of benefits you are receiving for your dependents.
VA now uses a centralized mail system. If you choose to respond in writing, please put your full name and VA file
number on each page. Send your application and any evidence in support of your claim to the following address:
Department of Veterans Affairs
Evidence Intake Center
P. O. Box 4444
Janesville, WI 53547-4444
If you are unable to mail your application or evidence, please use the following Fax Lines:
(844) 531-7818 (Toll Free)
(248) 524-4260 (Utilized for Foreign Claimants)
You have the right at any time to submit additional information or to have a personal hearing to explain or clarify your
statements. You also have the right to be represented at the hearing by an authorized veteran's service organization.
Veterans Service Center Manager
Enclosure
VA FORM
21-0538
Page 1
DEC 2017
OMB Approved No. 2900-0500
Respondent Burden: 10 Minutes
Expiration Date: 12/31/2020
VA DATE STAMP
(DO NOT WRITE IN THIS SPACE)
MANDATORY STATUS OF DEPENDENTS
INSTRUCTIONS: Print all answers clearly. You must sign and date this form (Items
13 and 14). When you have completed this form, mail it to the address in the letter on
Page 1, or fax it, or take it to your local VA regional office.
SECTION I: VETERAN'S IDENTIFICATION INFORMATION
NOTE: You can either complete the form online or by hand. Please print the information requested in ink, neatly and legibly to help process the form.
1. VETERAN'S NAME (First, Middle Initial, Last)
2. VETERAN'S SOCIAL SECURITY NUMBER
4. VETERAN'S DATE OF BIRTH
3. VA FILE NUMBER (If applicable)
Month
Day
Year
5. CURRENT MAILING ADDRESS (Number and street or rural route, P.O. Box, City, State, ZIP Code and Country)
No. &
Street
Apt./Unit Number
City
Country
State/Province
ZIP Code/Postal Code
6A. PRIMARY TELEPHONE NUMBER (Include Area Code)
6B. SECONDARY TELEPHONE NUMBER (Include Area Code)
7. VETERAN'S SERVICE NUMBER (If applicable)
8. PREFERRED E-MAIL ADDRESS (Optional)
SECTION II: SPOUSE INFORMATION
9C. CITY AND STATE, COUNTY AND STATE, or CITY AND
9A. ARE YOU MARRIED?
9B. DATE OF MARRIAGE
COUNTRY OF MARRIAGE
Month
Day
Year
(If "YES," complete Items 9B-9F)
YES
NO
9D. SPOUSE NAME (First, Middle Initial, Last)
9E. SPOUSE SOCIAL SECURITY NUMBER
9F. SPOUSE DATE OF BIRTH
Month
Day
Year
SECTION III: CHILD(REN) INFORMATION
NOTE - Please provide the following information for each child under age 18, over age 18 and under 23 and attending school, or of any age if permanently disabled. If you have more than four
children, list the others in Item 12, "Remarks," giving the information requested in Items 10A through 10F. If you have no children in any of the categories described above, write "None" in
Item 10A.
10C. PLACE OF
10F. NAME AND ADDRESS OF
10B. DATE OF
10D. SOCIAL
10E. CHILD'S
BIRTH
PERSON HAVING CUSTODY
10A. FULL NAME OF
BIRTH
SECURITY
RELATIONSHIP
(City & state,County &
OF THE CHILD
EACH CHILD
(MM/DD/YYYY)
NUMBER
STATUS
(If child is not living with you)
State, or City & Country)
BIOLOGICAL
STEPCHILD
ADOPTED
BIOLOGICAL
STEPCHILD
ADOPTED
BIOLOGICAL
STEPCHILD
ADOPTED
BIOLOGICAL
STEPCHILD
ADOPTED
VA FORM 21-0538, DEC 2017
Page 2
VETERAN'S SOCIAL SECURITY NO.
SECTION III: CHILD(REN) INFORMATION (Continued)
NOTE: Furnish the following information for each terminated dependent.
11B. PROVIDE REASON FOR TERMINATION
11A. FULL NAME OF EACH DEPENDENT
11C. DATE OF TERMINATION
(Death, Divorce, Age)
12. REMARKS
SECTION IV: VETERAN SIGNATURE
I HEREBY CERTIFY THAT the information I have given on this form is true and correct to the best of my knowledge and belief.
13. SIGNATURE OF VETERAN OR GUARDIAN
14. DATE SIGNED (MM/DD/YYYY)
SIGN HERE
IN INK
PENALTY - The law provides severe penalties which include fine or imprisonment, or both, for the willful submission of any statement or evidence of a material
fact, knowing it to be false, or for the fraudulent acceptance of any payment to which you are not entitled.
PRIVACY ACT NOTICE: The VA will not disclose information collected on this form to any source other than what has been authorized under the Privacy Act of 1974 or Title 5, Code
of Federal Regulations 1.526 for routine uses (i.e., civil or criminal law enforcement, congressional communications, epidemiological ore research studies, the collection of money owed
to the United States, litigation in which the United States is a party or has an interest, the administration of VA programs and delivery of VA benefits, verification of identity and status,
and personnel administration) as identified in the VA system of records, 58VA21/22/28 Compensation, Pension, Education, Vocational Rehabilitation and Employment Records - VA,
published in the Federal Register. Your obligation to respond is required to obtain or retain benefits. You must give us your and your dependents SSN account information. Applicants are
required to provide their SSN and the SSN of any dependents for whom benefits are claimed under Title 38 U.S.C. 5101 (c) (1). The VA will not deny an individual benefits for refusing
to provide his or her SSN unless the disclosure of the SSN is required by Federal Statute of law in effect prior to January 1, 1975, and still in effect. Information that you furnish may be
utilized in computer matching programs with other Federal or state agencies for the purpose of determining your eligibility to receive VA benefits, as well as to collect any amount owed
to the United States by virtue of your participation in any benefit program administered by the Department of Veterans Affairs.
RESPONDENT BURDEN: We need this information to determine continued eligibility for an additional allowance for your spouse and/or child(ren). 38 U.S.C. 1115, Title 38, United
States Code, allows us to ask for this information. We estimate that you will need an average of 10 minutes to review the instructions, find the information and complete this form.
VA cannot conduct or sponsor a collection of information unless a valid OMB control number is displayed. Valid OMB control numbers can be located on the OMB Internet page at
www.reginfo.gov/public/do/PRAMain
If desired, you may call 1-800-827-1000 to get information on where to send comments or suggestions about this form.
Page 3
VA FORM 21-0538, DEC 2017

Download VA Form 21-0538 Mandatory Status of Dependents

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VA Form 21-0538 Instructions

The 21-0538 VA Form instructions are as follows:

  • The received form should be completed and returned to the regional VA office within 60 days from the date of the letter. The inability to return the document within a deadline may result in payment delay;
  • The veterans have the right to submit additional information at any time;
  • The veterans have right for personal hearings necessary to clarify their statements;
  • The people qualified as the dependents are: veteran's spouse, children under the age of 18, children under the age of 23 who are attending school, permanently disabled children of any age;
  • No other forms or documents should accompany this questionnaire. However, if a question of proof arises, the veteran must provide all the papers requested;
  • The completed document should be hand signed.

How to Fill out VA Form 21-0538?

The questionnaire is easy to complete. It usually takes about 10 minutes to review the instructions, to find the requested data, and to fill out the paper. The Status of Dependents Questionnaire includes eight items:

  1. Item 1 is for your first, middle, and last name;
  2. Items 2 - 3E are for marriage information. If you are not married, Items 3A through 3E should be left blank;
  3. The information about your dependent children (full name, date, place of birth, and the SSN) should be indicated in items 4A - 4D. If the child is not in your custody, the name and address of a person having custody must be provided in Item 4E;
  4. If you have more than four children, you can list the others in Item 6;
  5. If you have no eligible children, it is required to put "None" in Item 4A;
  6. Items 5A through 5C should contain data about the terminated dependents. The full name of the terminated dependent, reason for termination, and the date they were terminated from you should be provided in the corresponding fields of the table;
  7. Any additional information can be indicated in Item 6;
  8. Items 7A - 7C are for your contact phone numbers;
  9. Signature and date should be provided in Items 8A and 8B correspondingly.

Where to Mail VA Form 21-0538?

Place the completed questionnaire in an enclosed envelope so that the return address indicated on the form is visible through the envelope window. Mail the document to the regional Veterans Service Center.

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