Fillable Va Form 26-8937 - Verification Of Va Benefits printable pdf download

OMB Control No. 2900-0406

Respondent Burden: 5 Minutes

Expiration Date: 06/30/2019

VERIFICATION OF VA BENEFITS

PRIVACY ACT NOTICE: The VA will not disclose information collected on this form to any source other than what has been authorized under the Privacy Act of

1974 or Title 5, Code of Federal Regulations 1.576 for routine uses (i.e., information concerning a veteran's indebtedness to the United States by virtue of a person's

participation in a benefits program administered by VA may be disclosed to any third party, except consumer reporting agencies) as identified in the VA system of

records, 55VA26, Loan Guaranty Home, Condominium and Manufactured Home Loan Applicant Records, Specially Adapted Housing Applicant Records and Vendee

Loan Applicant Records - VA, and published in the Federal Register. Your obligation to respond is required to obtain or retain benefits. Giving us your SSN account

information is voluntary. Refusal to provide your SSN by itself will not result in the denial of benefits. The VA will not deny an individual benefits for refusing to

provide his or her SSN unless the disclosure of the SSN is required by a Federal Statute of law in effect prior to January 1, 1975, and still in effect.

INSTRUCTIONS TO LENDER

(Complete mailing address including ZIP Code)

TO: NAME AND ADDRESS OF LENDER

Complete this form ONLY if the

veteran/applicant:

is receiving VA disability payments; or

has received VA disability payments; or

would receive VA disability payments but

for receipt of retired pay; or

is surviving spouse of a veteran and in

receipt of DIC payments

has filed a claim for VA disability benefits prior

to discharge from active duty service

Complete Items 1 through 10. Send the completed form

to the appropriate VA Regional Loan Center where it

will be processed and returned to the Lender. The

completed form must be retained as part of the lender's

loan origination package.

(First, middle, last)

1. NAME OF VETERAN

2. CURRENT ADDRESS OF VETERAN

3. DATE OF BIRTH

(C-File No., if

(If different from Social Security

4. VA CLAIM FOLDER NUMBER

5. SOCIAL SECURITY NUMBER 6. SERVICE NUMBER

known)

Number)

7. I HEREBY CERTIFY THAT I

DO NOT have a VA benefit-related indebtedness to my knowledge. I authorize VA to furnish the

information listed below.

8. I HEREBY CERTIFY THAT I

HAVE

HAVE NOT filed a claim for VA disability benefits prior to discharge from active duty service

(I am presently still on active duty.)

(Sign in ink)

10. DATE SIGNED

9. SIGNATURE OF VETERAN

FOR VA USE ONLY

(Complete in ink)

The above named veteran does not have a VA benefit-related indebtedness

The veteran has the following VA benefit-related indebtedness

(If any)

VA BENEFIT-RELATED INDEBTEDNESS

AMOUNT OF DEBT(S)

TYPE OF DEBT(S)

(If any)

TERM OF REPAYMENT PLAN

Veteran is exempt from funding fee due to receipt of service-connected disability compensation of $

monthly. (Unless checked,

the funding fee receipt must be remitted to VA with VA Form 26-1820, Report and Certification of Loan Disbursement)

Veteran is exempt from funding fee due to entitlement to VA compensation benefits upon discharge from service.

Veteran is not exempt from funding fee due to receipt of non service-connected-connected pension of $

monthly. LOAN

APPLICATION WILL REQUIRE PRIOR APPROVAL PROCESSING BY VA.

Veteran has been rated incompetent by VA. LOAN APPLICATION WILL REQUIRE PRIOR APPROVAL PROCESSING BY VA.

Insufficient information. VA cannot identify the veteran with the information given. Please furnish more complete information, or a copy of a

DD Form 214 or discharge papers. If on active duty, furnish a statement of service written on official government letterhead, signed by the adjutant,

personnel officer, or commanding officer. The statement should include name, birth date, service number, entry date and time lost.

(Sign in ink)

DATE SIGNED

SIGNATURE OF AUTHORIZED AGENT

RESPONDENT BURDEN: We need this information to determine, establish, or verify your eligibility for VA Loan Guaranty Benefits and to determine if you are

exempt from paying the VA Funding Fee. Title 38, United States Code, allows us to ask for this information. We estimate that you will need an average of 5 minutes to

review the instructions, find the information, and complete this form. VA cannot conduct or sponsor a collection of information unless a valid OMB control number is

displayed. You are not required to respond to a collection of information if this number is not displayed. Valid OMB control numbers can be located on the OMB

Internet Page at If desired, you can call 1-800-827-1000 to get information on where to send comments or suggestions about

this form.

26-8937

VA FORM

SUPERSEDES VA FORM 26-8937, JAN 2013,

JUN 2016

WHICH WILL NOT BE USED.