Va Form 21-527 - Income, Net Worth, And Employment Statement
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8GENERAL INSTRUCTIONS
FOR INCOME, NET WORTH, AND EMPLOYMENT STATEMENT
NOTE: Read these instructions very carefully, detach, and keep for your reference.
Frequently Asked Questions
How can I contact VA if I have a question?
If you have questions about this form, how to complete it, or about benefits, contact your nearest VA regional office. You can
locate the address of the nearest VA regional office on the Internet at , in your telephone book blue
pages under "United States Government, Veterans." For information you may also call 1-877-294-6380 (Hearing Impaired
TDD line 1-800-829-4833). You may also contact VA by the Internet at: https://iris.va.gov.
When do I use VA Form 21-527?
Use VA Form 21-527 to apply for disability pension if you have previously filed a claim for compensation and/or pension. If
you have not filed a claim for compensation or pension previously, you must use VA Form 21-526, Veteran's Application for
Compensation and/or Pension. For expeditious processing, use VA Form 21-527EZ, Fully Developed Claim (Pension). VA
forms are available at
What is disability pension and how does VA decide what I will and will not receive?
You should apply for pension benefits if all of the following are true:
•
Your income is limited
•
You are permanently and totally disabled not necessarily as a result of your military service, or are age 65 or older
•
At least part of your active duty was during a wartime period
VA pays disability pension based on the amount of income that the veteran and his/her family receive and the number of
dependents in the family. VA must include all sources of income that Federal law specifies. You can find out what the current
income limitations and rates of benefits are by contacting your nearest VA office.
VA may pay benefits from the date of receipt of your application unless severe disability prevented you from filing a claim for
a period of at least 30 days. If you want this claim considered for retroactive payment, indicate so in Item 37, "Remarks," and
identify the specific disability which prevented you from filing.
What is special monthly pension?
VA may pay a higher rate of disability pension to a veteran who is blind, a patient in a nursing home, otherwise needs regular
aid and attendance, or who is permanently confined to his or her home because of a disability. If you wish to apply for this
benefit, check "Yes" in Item 22A.
What medical evidence should I submit?
If you are age 65 or older or determined to be disabled by the Social Security Administration, you do not have to submit
medical evidence with your application unless you are claiming special monthly pension. Otherwise, provide only those
medical records that are related to the disabilities that prevent you from working.
If you wish to claim special monthly pension and are not in a nursing home, furnish a statement from your doctor showing the
extent of your disabilities. If you are in a nursing home, attach a statement, signed by an official of the nursing home showing
the date you were admitted to the nursing home, the level of care you receive, and whether Medicaid covers all or part of
your nursing home costs.
If you want help getting medical records related to this claim, you may complete VA Form 21-4142, Authorization and
Consent to Release Information to the Department of Veterans Affairs (VA) or VA Form 21-0779, Request for Nursing Home
Information in Connection with Claim for Aid and Attendance. By signing VA Form 21-4142, you authorize any doctors,
hospitals, or caregivers that have treated you to release information about your treatment to VA. You do not need to
complete this form for any treatment you received at a VA facility. If you need a copy of the VA Form 21-4142 or VA Form
21-0779, you may contact VA as shown in "How can I contact VA if I have a question?" or download the forms from the VA
web site
21-527
VA FORM
SUPERSEDES VA FORM 21-527, JUN 2004,
Page 1
MAR 2012
WHICH WILL NOT BE USED.
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