Va Form 21-0966 Printable Pdf Download

The VA Form 21-0966 is a crucial document for veterans seeking to claim benefits for service-connected disabilities. As a veteran, it's essential to understand the importance of this form and how to complete it accurately to ensure a smooth claims process. In this article, we will delve into the details of the VA Form 21-0966, its purpose, and provide guidance on how to fill it out correctly.

What is the VA Form 21-0966?

The VA Form 21-0966, also known as the "Request for Information Regarding My Disability Claim," is a document used by the United States Department of Veterans Affairs (VA) to gather information from veterans regarding their disability claims. The form is typically used when a veteran files a claim for compensation or pension benefits and requires additional information to support their claim.

Why is the VA Form 21-0966 Important?

The VA Form 21-0966 is a critical component of the disability claims process. By completing this form, veterans provide essential information that helps the VA determine the severity of their disability and make an informed decision regarding their benefits. The form allows veterans to:

Describe their medical condition and how it affects their daily life
List their medical treatment and providers
Report any employment or education changes
Provide information about their dependents

How to Fill Out the VA Form 21-0966

Filling out the VA Form 21-0966 requires careful attention to detail. Here are some steps to help you complete the form accurately:

Section I: Claimant Information
- Enter your name, address, and social security number.
- Provide your VA claim number, if applicable.
Section II: Disability Information
- List all your service-connected disabilities, including the condition and the date it began.
- Describe how each disability affects your daily life and ability to work.
Section III: Medical Treatment
- List all your medical providers, including doctors, hospitals, and clinics.
- Provide the dates of treatment and the conditions treated.
Section IV: Employment and Education
- Report any changes in employment or education, including dates and reasons for changes.
Section V: Dependents
- List all your dependents, including spouses, children, and parents.
- Provide their names, dates of birth, and social security numbers.

VA Form 21-0966 Tips and Reminders

Be thorough and accurate when completing the form.
Use additional sheets if necessary.
Keep a copy of the completed form for your records.
Submit the form to the VA as soon as possible to avoid delays in the claims process.