DAV PDF Forms

Claim Info

Claim Originator

DAV Member

DAV#

%disabled Must be Numeric!

Claimant

Claim Writer

Title

Veteran Info

First Name

Last Name

Birth Sex

Self-Identified Gender

Date of Birth (MM/DD/YYYY)

SSN (numbers only) Must be Numeric!

VA File#

Date Entered AD (MM/DD/YYYY)

Date Released AD (MM/DD/YYYY)

Branch of Service

Day Phone (numbers only)

Cell/Work Phone (numbers only)

Email Address

Address Line 1

Apt#

City

State

Zip

Form Preparer (if not Veteran)

Preparer SSN (numbers only) Must be Numeric!

Form Selection

   DAV Contact Brief
   VA Form 10-0485 Request Authorization to Release Health Info to Exchanges
   VA Form 10182 Descision Review Request: Board Appeal (Notice of Disagreement)
   VA Fomr 10-10d Application for CHAMPVA Benefits
   VA Form 10-10EZ Application for Health Benefits
   VA Form 10-7959a CHAMPVA Claim Form
   VA Form 20-0995 Decision Review Reqeust: Supplemental Claim
   VA Form 20-0996 Decision Review Reqeust: Higher-Level Review
   VA Form 20-572 Address/Direct Deposit
   VA Form 40-0247 Presidential Memorial Certificate Request
   VA Form 40-1330 Headstone
   VA Form 40-1330M Medallion
   VA Form 21-22
   VA Form 21-526EZ Application for Disability Compensation
   VA Form 21P-527EZ Application for Pension
   VA Form 21-686c Application Request to Add and/or Remove Dependants
   VA Form 21-0779
   VA Form 21-0781 Statement in Support of Claim for Service Connection for PTSD
   VA Form 21-0781a Statement in Support of Claim for Service Connection for PTSD Secondary to Personal Assault
   VA Form 21-0845 Information and Instruction to help complete Authorization to Discolse Personal Information to 3rd party
   VA Form 21-0966 Claim for Compensation/Pension
   VA Form 21-2680 Exam for Housebound Status
   VA Form 21-4138 Statement in support of claim
   VA Form 21-4142 Authorization to Disclose Information to VA
   VA Form 21-4142a Release for Medical Provider Information to VA
   VA Form 21-4192 Request for Employment Information in Connection with Claim for Disablity Benefits
   VA Form 21-8940 Unemployability
   VA Form 21p-534EZ Notice to Survivor of Evidence Necessary to Substantiate a Claim for Dependency
   VA Form 21P-530EZ Application for Burial Benefits
   VBA-21P-0969-ARE Income and Asset Statement in Support of Claim for Pension or Parents Dependancy and Indemnity Compensation