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

1. Section I ("Claimant/Veteran Identification") requires the claimant's full name, Social Security Number (SSN), 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. State if a previous claim has ever been filed with the VA.
2. One or more of the general benefits should be selected in Section II ("General Benefit Election"). If the boxes remain unchecked, the VA will not be able to use the form to establish an effective date. If the claimant is a surviving dependent of the veteran, the box labeled "Survivors Pension and/or Dependency and Indemnity Compensation (DIC)" must be checked.
3. The claimant indicates the intent to apply for one or more general benefits in Section III ("Declaration of Intent"). This section provides acknowledgment of the fact 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 benefits offices, which can be located at the eBenefits website.

Where to Send VA Form 21-0966?

The 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. Mail forms to the Department of Veterans Affairs, Claims Intake Center (Attention: Philadelphia Pension Center) PO Box 5206, Janesville, Wisconsin 53547-5206.

The Milwaukee VA Pension Center serves Alabama, Arkansas, Indiana, Illinois, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Ohio, Tennessee, Wisconsin. Mail forms to the Department of Veterans Affairs, Claims Intake Center Attention: Milwaukee Pension Center, PO Box 5192 Janesville, Wisconsin 53547-5192.

The 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. Mail forms to the Department of Veterans Affairs, Claims Intake Center Attention: St. Paul Pension Center, PO BOX 5365 Janesville, Wisconsin 53547-5365.