VA FORMS

VA
FORMS

Loan

26-1880 Request For Determination of Eligibility and Available Loan Guaranty Entitlement

Use this form to request VA to determine your eligibility for Loan Guaranty benefits, and the amount of entitlement available.

261880p1 PDF GIF
261880p2 PDF GIF
261880p3 PDF GIF

Burial

21-530 Application For Burial Benefits

Use this form to apply for assistance in meeting the funeral and burial costs of a deceased veteran.

Detailed Instruction-p1 PDF GIF
Detailed Instruction-p2 PDF GIF
21530p3 PDF GIF
21530p4 PDF GIF

40-1330 Application For Standard Government Headstone Or Marker For Installation In A Private Or State Veterans Cemetery

This form is used to request a standard Government headstone or marker for installation in a private or local cemetery (which are furnished for unmarked graves).

General Information-p1 PDF GIF
401330p2 PDF GIF
401330p3 PDF GIF
401330p4 PDF GIF

40-4951 Order For Flat Bronze Marker

This form is used for ordering of flat marker.

40-4951 PDF is the only format at this time

40-4960 Temporary Grave Marker

This form is used for ordering a temporary marker.

40-4960 PDF is the only format at this time

40-4987 Agreement For Burial Of Cremated Remains

This form is used for information requested to permit a burial in a nationl cemetery.

40-4987 PDF is the only format at this time

4931Instruction For Processing Request For Replacement Of Headstone Or Marker

This form is used for for processing request for replacement of headstone or marker.

4931 PDF is the only format at this time

4962 Verification Of Eligibilty For Burial In A National Cemetery

This form is used for eligibilty for burial in a national cemetery. (2 pages)

4962 PDF is the only format at this time

VA-2008 Application For United States Flag For Burial Purpose

The next of kin (or close associate if there is no next of kin) of a deceased veteran can use this form to request a burial flag.

2008p1 PDF GIF
2008p2 PDF GIF
2008p3 PDF GIF

Insurance

8286 Servicemen's Group Life Insurance Election And Certificate

This form is for use by ACTIVE DUTY and RESERVE MEMBERS. This form does not apply to and cannot be used for any other Government Life Insurance. This form requires three copies.

8286p1 PDF GIF
8286p2 PDF GIF
8286p3 PDF GIF
8286p4 PDF GIF
8286p5 PDF GIF

29-0188 Application For Supplemental Service Disabled Veterans (RH) LIfe Insurance

This form is used by the insured to pay life insurance premiums.

290532-1p1 PDF is the only format at this time
290532-1p2 PDF is the only format at this time

29-0165 VA Matic Change

This form is used for making any changes to your automatic VA deduction insurance premiums.

29-0165 PDF is the only format at this time

29-0532-1 VA Matic Authorization

This form is used by the insured to authorize VA to make automatic deductions from the insured's bankaccounk to pay insurance premiums.

290532-1p1 PDF is the only format at this time
290532-1p2 PDF is the only format at this time

29-1546 Application For Cash Surrender Value/Policy Loan

This form is used by the insured to apply for cash surrender or policy loan.

291546p1 PDF is the only format at this time
291546p2 PDF is the only format at this time

29-1549 Application For Change Of Permanent Plan (Medical)

This form is used by the insured to apply for change of insurance plan from a higher reserve value to one with a lower reserve value.

291549p1 PDF is the only format at this time
291549p2 PDF is the only format at this time

29-336 Designation Of Beneficiary

Use this form to designate a beneficary for your life insurance.

29336p1 PDF is the only format at this time
29336p2 PDF is the only format at this time

29-352 Application For Reinstatement

This form is used to apply for reinstatement of their Government Life Insurance and/or Total Disability Income Provision which has lapsed more than six months.

29352p1 PDF is the only format at this time
29352p2 PDF is the only format at this time

29-357 Claim For Disability Insurance Benefits

This form is used by the insured to apply for disability insurance benefits.

29357p1 PDF is the only format at this time
29357p2 PDF is the only format at this time
29357p3 PDF is the only format at this time

29-4125 Claim For One Sum Payment

This form is used by beneficiaries applying for the proceeds of Government Life Insurance policies.

294125 PDF is the only format at this time

29-4125A Claim For One Sum Payment

This form is used by beneficiaries applying for the proceeds of Government Life Insurance policies.

294125Ap1 PDF is the only format at this time
294125Ap2 PDF is the only format at this time

29-4125K Claim For One Sum Payment

This form is used by beneficiaries applying for the proceeds of Government Life Insurance policies.

294125Kp1 PDF is the only format at this time
294125Ap2 PDF is the only format at this time

29-4364 Application For Service- Disable Insurance

This form is used by veterans to apply for service - disable veterans insurance, to designate a beneficary and to select an optional settlement.

294364p1 PDF is the only format at this time
294364p2 PDF is the only format at this time

29-538 Assignment - Government Life Insurance Benefits

This form is used for the insurer to designate a beneficary for life insurance.

29538 PDF is the only format at this time

29-541 Certificate Showing Residence And Heirs Of Deceased Veteran Or Beneficary

This form is used to solicit information to establish entitlement to government life insurance proceeds.

29541p1 PDF is the only format at this time
29541p2 PDF is the only format at this time

29-888 Insurance Deduction Authorization

This form is used to authorized VA to make deductions from benefits payment to pay premiums, loans and/or liens on the veteran's insurance.

29888 PDF is the only format at this time

Compensation

21-526 Veteran's Application For Compensation Or Pension

Compensation is a monthly payment made because of disability resulting from an injury or disease incurred in active service. Pension is a benefit paid to a veteran because of permanent and total disability not due to service. Basic eligibility is based on wartime service, and recipients must meet specific income and net worth limits.

21526p1 PDF GIF
21526p2 PDF GIF
21526p3 PDF GIF
21526p4 PDF GIF
21526p5 PDF GIF
21526p6 PDF GIF
21526p7 PDF GIF
21526p8 PDF GIF
21526p9 PDF GIF
21526p10 PDF GIF
21526p11 PDF GIF

21-534 Application For Dependency And Indemnity Compensation, Death Pension And Accrued By A Surviving Spouse Or Child (Including Death Compensation If Applicable

This form is used for the surviving spouse and/or children to apply for benefits based upon the service-connected death of a veteran, or to a surviving spouse or child because of a veteran’s non-service connected death. For non-service connected deaths, recipients must meet specific income and net worth limits.

21534p1 PDF GIF
21534p2 PDF GIF
21534p3 PDF GIF
21534p4 PDF GIF
21534p5 PDF GIF
21534p6 PDF GIF
21534p7 PDF GIF
21534p8 PDF GIF
21534p9 PDF GIF
21534p10 PDF GIF

21-4138 Statement In Support Of Claim

This form is used to provide information to VA relating to benefit claims. This form is in PDF format and GIF format.

Education

21-674b School Attendance Report

This form is used to verify school attendance of children of veterans and survivors receiving disability and death benefits. This form is in PDF format and GIF format.

21-686c Declaration Of Status Of Dependents

The purpose of this form is to declare the status of dependents.

21686cp1 PDF GIF
21686cp2 PDF GIF

22-1990 Application For Education Benefits

This form is used by servicepersons, veterans, and reservists to apply for VA education benefits.

221990p1 PDF GIF
221990p2 PDF GIF
221990p3 PDF GIF
Instructionp4 PDF GIF

22-1990t Application And Enrollment Certification For Individualized Tutorial Assistance

This form is use for appkication and enrollment certification.

221990tp1 PDF is the only format at this time
221990tp2 PDF is the only format at this time

22-1995 Request For Change Of Program Or Place Of Training

This form is use for servicepersons and selected reservits receiving education benefits to reaqest a change of program or place of training.

221995p1 PDF is the only format at this time
221995p2 PDF is the only format at this time

22-1999B Notice Of Change In Student Status

This form is used for servicepersons, veterans, and reservists in school to notify VA of enrollment changes.

221999Bp1 PDF GIF
Instruction-p2 PDF GIF
221999Bp3 PDF GIF
Instruction-p4 PDF GIF

22-1999C Certificate Of Affirmation Of Enrollment Agreement Correspondence

The purpose of this form is to allow a veteran an opportunity to reconsider his/her enrollment in a correspondence course. It allows a veteran 10 days to change his/her mind and not enroll in the correspondence course.

221999Cp1 PDF GIF
221999Cp2 PDF GIF
221999Cp3 PDF GIF

22-5490 Application For Survivor's And Dependent's Educational Assistance

This form is use for survivor's and dependent's request of education benefits.

225490p1 PDF is the only format at this time
225490p2 PDF is the only format at this time
225490p3 PDF is the only format at this time
225490p4 PDF is the only format at this time

22-8873 Supplemental Information For Change Of Program Or Reenrollment After unsatisfactory Attendence, Conduct Or Progress

The purpose of this form is to supplement information changes in school enrollments.

228873p1 PDF GIF
228873p2 PDF GIF

5281 Application For Refund Of Educational Contributions

This form is used for requesting refunds of education contributions. (Three copies required) This form is in PDF format only at this time.

Appeals

4107 Notice Of Procedural And Appellate Rights

This form is informational, notifying you of your rights to appeal and the procedure you need to follow. This form is in PDF format and GIF format.

Military Records

Sf 180 Request Pertaining To Military Records

This form is used to request a person’s military records from non-VA sources. (See address blocks on reverse side.)

SF 180 PDF GIF
Detailed Instructions PDF GIF

DD 149 Application For Correction Of Military Records

This form is used for making corrections to military records.

DD 149p1 PDF is the only format at this time
DD 149p2 PDF is the only format at this time

DD 293 Application For Discharge Or Dismissal From The Armed Forces Of The United States

This form is use for requesting of discharge or dismissal records from the armed forces.

DD 293p1 PDF is the only format at this time
DD 293p2 PDF is the only format at this time
DD 293p3 PDF is the only format at this time
DD 293p4 PDF is the only format at this time

Vocational Rehabilitation

28-1900 Disabled Veterans Application For Vocational Rehabilitation

The purpose of this form is to apply for VA’s vocational rehabilitation program for service-connected disabled veterans.

281900p1 PDF GIF
Instruction-p2 PDF GIF

28-1902 Counseling Record- Personal Information

The purpose of this form is to collect personal information on the veteran as it relates to VA's vocational rehabilitation program.

281902p1 PDF GIF
281902p2 PDF GIF