Forms

VA FormDescriptionClaimant

Non-Service-Connected Disability Pension Benefits

21-22 Appointment of Veterans Service Organization as Claimant's Representative Veteran & Spouse
21-4138 Statement in Support of Claim (Housebound) Veteran
21-4138 Statement in Support of Claim (Housebound) Surviving Spouse
21-4138 Statement in Support of Claim (Nursing Home or Assisted Living) Veteran
21-4138 Statement in Support of Claim (Nursing Home or Assisted Living) Surviving Spouse
21-526 Veteran's Application for Compensation and/or Pension Veteran
21-534 Dependency and Idemnity Compensation and Death Pension Surviving Spouse
21-8416 Medical Expense Report Veteran & Spouse
21-4142 Authorization and Consent to Release Information to the VA Veteran & Spouse
21-2680 Examination For Housebound Status or Permanent Need for Regular A&A Veteran & Spouse
21-0779 Request for Nursing Home Information in Connection with A&A Veteran & Spouse
Military Medals Request
Records Request for Military Medals & Awards Veteran/Next of Kin
     
     
     
     
Note: A veteran or surviving spouse filing for VA pension benefits should provide medical evidence and proof of income. Additionally, the VA requires a certified copy of the veteran's Report of Separation, a copy of the marriage license and death certificate. The Erie County Veterans Service Agency can assist veterans and their family in obtaining any military records.
Service-Connected Disability Compensation Benefits
21-22 Appointment of Veterans Service Organization as Claimant's Representative Veteran
21-4138 Statement in Support of Claim Veteran
21-0781 Statement in Support of Claim for Service Connection for PTSD Veteran
21-0781a Statement in Support of Claim for PTSD Secondary to Personal Trauma Veteran
21-526 Veteran's Application for Compensation and/or Pension Veteran
21-4142 Authorization and Consent to Release Information to the VA Veteran & Spouse
Note: Additionally, a veteran filing for a service-connected disability compensation with the VA should provide a copy of the Report of Separation (DD Form 214) and military medical evidence which supports the claim.
Other VA Forms
10-10EZ VA Form 10-10EZ - Application for Medical Benefits (Enroll) Veteran
10-10EZR VA Form 10-10EZR - Update Your Information Veteran
21-0792 Fiduciary Statement in Support of Appointment Veteran & Spouse
ECVSA-1 Mark/Witness Form - For Pension and Compensation Benefits Veteran & Spouse
SF 180 Request for dd-214/discharge paperwork  
80-11-01 Federal Benefits Guidebook  

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Frequently Requested

Contact

Phone: (716) 858-6363

Veterans Service Agency
Edward A Rath County Office Building
95 Franklin Street, Suite 800
Buffalo, New York 14202