Va Form 21-0513-1 - Old Law And Section 306 Verification Report - Veterans Benefits Administration
Download a blank fillable Va Form 21-0513-1 - Old Law And Section 306 Verification Report - Veterans Benefits Administration in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Va Form 21-0513-1 - Old Law And Section 306 Verification Report - Veterans Benefits Administration with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2OMB Control No. 2900-0101
Respondent Burden: 30 minutes
FIRST NAME - MIDDLE NAME - LAST NAME OF VETERAN
VETERAN'S SOCIAL SECURITY NUMBER
OLD LAW AND SECTION 306
VERIFICATION REPORT
NAME OF CHILD'S CUSTODIAN
(CHILDREN ONLY)
3
VA FILE NUMBER
COMPLETE MAILING ADDRESS OF CHILD OR CUSTODIAN
VA REGIONAL OFFICE RETURN ADDRESS
IMPORTANT: Please read the enclosed EVR Instructions (VA Form 21-0510) before completing this form. This form is used by children and
custodians of children receiving Old Law or Section 306 Pension. If you have been receiving a fixed rate of pension since 1960, you receive Old Law
Pension. If you have been receiving a fixed rate of pension since 1978, you receive Section 306 pension. If you receive Old Law Pension, do not
complete Item 2G, Net Worth, and Item 3, Family Medical Expenses. If you receive Section 306 Pension, complete all items.
1. CHILD(REN)'S MARITAL AND SCHOOL STATUS
List the children's names, dates of birth, and Social Security numbers, and indicate marital and school status for all children being paid on this award. If
the child does not have a Social Security number, write "No SSN" in the space provided for the child's Social Security number. If other children are on
separate VA awards, they will receive their own EVRs. If additional space is needed, attach a separate sheet of paper.
NOTE: Complete Item 1E only if the child is 18 years of age or older. Complete Item 1F only if the child is between the ages of 18 and 23 and has not
been rated disabled by VA. The child is considered to have attended school continuously if the child attended every regular school term except summer
school or holiday periods. If Block (2), STOPPED SCHOOL, is checked in Item 1E or "NO" is checked in Item 1F, provide the date the child last
attended school in Item 1F.
B. DATE OF
C. SOCIAL
F. ATTENDED SCHOOL
A. FULL NAME OF CHILD
BIRTH
SECURITY
D. MARITAL STATUS
E. SCHOOL STATUS
CONTINUOUSLY SINCE
(First, middle initial, last)
(Mo., day, yr.)
NUMBER
AGE 18
DATE LEFT
(1)
MARRIED
(1)
ATTENDS SCHOOL
YES
SCHOOL
(2)
DIVORCED/WIDOWED
(2)
STOPPED SCHOOL
NO
(3)
NEVER MARRIED
(3)
DISABLED CHILD
(1)
MARRIED
(1)
ATTENDS SCHOOL
DATE LEFT
YES
SCHOOL
(2)
DIVORCED/WIDOWED
(2)
STOPPED SCHOOL
NO
(3)
NEVER MARRIED
(3)
DISABLED CHILD
DATE LEFT
(1)
MARRIED
(1)
ATTENDS SCHOOL
YES
SCHOOL
(2)
DIVORCED/WIDOWED
(2)
STOPPED SCHOOL
NO
(3)
NEVER MARRIED
(3)
DISABLED CHILD
DATE LEFT
(1)
MARRIED
(1)
ATTENDS SCHOOL
YES
SCHOOL
(2)
DIVORCED/WIDOWED
(2)
STOPPED SCHOOL
NO
(3)
NEVER MARRIED
(3)
DISABLED CHILD
(1)
MARRIED
(1)
ATTENDS SCHOOL
DATE LEFT
YES
SCHOOL
(2)
DIVORCED/WIDOWED
(2)
STOPPED SCHOOL
NO
(3)
NEVER MARRIED
(3)
DISABLED CHILD
2. REPORT OF INCOME AND NET WORTH
NOTE: If no income was received from a particular source, write "0" or "none". DO NOT LEAVE ANY ITEMS BLANK.
(Read Paragraphs 2 and 3 of the EVR Instructions)
A. MONTHLY INCOME
CHILD'S NAME:
CHILD'S NAME:
CHILD'S NAME:
SOURCE
SOCIAL SECURITY
$
$
$
U.S. CIVIL SERVICE
U.S. RAILROAD RETIREMENT
BLACK LUNG BENEFITS
SUPPLEMENTAL SECURITY
INCOME (SSI)
(Show source)
OTHER INCOME
(Show source)
OTHER INCOME
VA FORM
SUPERSEDES VA FORM 21-0513-1, JUN 2001,
21-0513-1
(Continued on Reverse)
JUN 2004
WHICH WILL NOT BE USED.
ADVERTISEMENT
0 votes
Related Articles
Related forms
Va Form 21-0512s-1 - Old Law And Section 306 Eligibility Verification Report (surviving Spouse)
Legal
Va Form 21p-0512s-1 - Old Law And Section 306 Eligibility Verification Report (surviving Spouse)
Legal
Related Categories
Parent category: Legal