VA Form 21-651 "Election of Compensation in Lieu of Retired Pay or Waiver of Retired Pay to Secure Compensation From Department of Veterans Affairs"

What Is VA Form 21-651?

This is a legal form that was released by the U.S. Department of Veterans Affairs on June 1, 2015 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on June 1, 2015;
  • The latest available edition released by the U.S. Department of Veterans Affairs;
  • Easy to use and ready to print;
  • Yours to fill out and keep for your records;
  • Compatible with most PDF-viewing applications;

Download a fillable version of VA Form 21-651 by clicking the link below or browse more documents and templates provided by the U.S. Department of Veterans Affairs.

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Download VA Form 21-651 "Election of Compensation in Lieu of Retired Pay or Waiver of Retired Pay to Secure Compensation From Department of Veterans Affairs"

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ELECTION OF COMPENSATION IN LIEU OF RETIRED PAY OR WAIVER OF RETIRED PAY
TO SECURE COMPENSATION FROM DEPARTMENT OF VETERANS AFFAIRS
(38 U.S.C. 5304(a)-5305)
SECTION I - To Be Completed by VA.
1. ADDRESS OF VA OFFICE
2. NAME OF VETERAN
3. VA FILE NUMBER
4. SERVICE NUMBER
5. SOCIAL SECURITY NUMBER
SECTION II - To Be Completed by Veteran.
INSTRUCTIONS: Please sign and date this form and return to the VA office shown in Item 1. If you have any questions about
completing this form, call VA toll-free at 1-800-827-1000 (Hearing Impaired TDD federal relay number is 711).
I hereby elect to receive compensation from the Department of Veterans Affairs in lieu of the total amount of retired pay, or waive that
portion of my retired pay which is equal in amount to the compensation which may be awarded by the Department of Veterans
Affairs.
7. DATE
6. SIGNATURE OF VETERAN
SUPERSEDES VA FORM 21-651, MAR 2005,
VA FORM
21-651
WHICH WILL NOT BE USED.
JUN 2015
ELECTION OF COMPENSATION IN LIEU OF RETIRED PAY OR WAIVER OF RETIRED PAY
TO SECURE COMPENSATION FROM DEPARTMENT OF VETERANS AFFAIRS
(38 U.S.C. 5304(a)-5305)
SECTION I - To Be Completed by VA.
1. ADDRESS OF VA OFFICE
2. NAME OF VETERAN
3. VA FILE NUMBER
4. SERVICE NUMBER
5. SOCIAL SECURITY NUMBER
SECTION II - To Be Completed by Veteran.
INSTRUCTIONS: Please sign and date this form and return to the VA office shown in Item 1. If you have any questions about
completing this form, call VA toll-free at 1-800-827-1000 (Hearing Impaired TDD federal relay number is 711).
I hereby elect to receive compensation from the Department of Veterans Affairs in lieu of the total amount of retired pay, or waive that
portion of my retired pay which is equal in amount to the compensation which may be awarded by the Department of Veterans
Affairs.
7. DATE
6. SIGNATURE OF VETERAN
SUPERSEDES VA FORM 21-651, MAR 2005,
VA FORM
21-651
WHICH WILL NOT BE USED.
JUN 2015