Important - Form 21-526B
Posted 01 October 2010 - 11:15 AM
It is highly recommended to use a Veteran's Supplemental Claim - VA Form 21-526b only for new additional, increase, appeal, or secondary claims. It is a special cover sheet which the RO will use to quickly route the claim to the appropriate department, instead of someone having to read and interpret the entire 21-4138.
You can go to Hadit's Homepage - click on Forms -
click here: http://www4.va.gov/vaforms/
enter 21-526b and a fillable copy of the form will download and open up.
OMB Control No. 2900-0001 Respondent Burden: 15 minutes
VA DATE STAMP DO NOT WRITE IN THIS SPACE
VETERAN'S SUPPLEMENTAL CLAIM FOR COMPENSATION
IMPORTANT: PLEASE READ THE PRIVACY ACT NOTICE AND RESPONDENT BURDEN INFORMATION BELOW BEFORE COMPLETING THIS FORM.
PART I - VETERAN'S IDENTIFYING INFORMATION
1. NAME OF VETERAN (First, Middle, Last)
2. VETERAN'S SOCIAL SECURITY NUMBER
3. VA FILE NUMBER
4. VETERAN'S ADDRESS (Number, street or rural route, City or P.O., State and ZIP Code)
5. TELEPHONE NUMBER(S)
6. E-MAIL ADDRESS (If applicable)
A. DAYTIME (Include Area Code)
B. EVENING (Include Area Code)
PART II - INFORMATION ABOUT CLAIM
7. I WOULD LIKE TO FILE A CLAIM FOR: (Check all that apply)
INCREASED EVALUATION OF THE DISABILITY(IES) FOR WHICH I AM ALREADY SERVICE CONNECTED (Provide the name of the disability(ies))
SERVICE CONNECTION FOR NEW DISABILITY(IES) (List your new disability(ies))
REOPENING OF PREVIOUSLY DENIED DISABILITY(IES) (List your previously denied disability(ies))
DISABILITY(IES) SECONDARY TO MY EXISTING SERVICE CONNECTED DISABILITY(IES) (Provide the name of the disability(ies) and your service connected condition(s))
8A. NAME AND LOCATION OF VA MEDICAL CENTER THAT HAS MY RELEVANT TREATMENT RECORDS
8B. NAME AND ADDRESS OF MILITARY FACILITY THAT HAS MY RELEVANT TREATMENT RECORDS
8C. DO YOU HAVE PRIVATE TREATMENT RECORDS?
(If "Yes," please attach the treatment records to this form. If you would like to have VA request your private treatment records, please attach a VA Form 21-4142, Authorization and Consent to Release Information to the Department of Veterans Affairs, for each private treatment provider. The form is available at www.va.gov/vaforms.)
9. I WOULD LIKE TO FILE A CLAIM FOR OTHER VA BENEFITS (Check appropriate box) AID AND ATTENDANCE OTHER (Specify benefit) AUTOMOBILE ALLOWANCE
10. I WOULD LIKE TO FILE A CLAIM FOR ADDITIONAL BENEFITS BECAUSE MY SPOUSE IS SERIOUSLY DISABLED (Please provide spouse's name and social security number in Items 10A & 10B)
A. SPOUSE'S NAME
B. SPOUSE'S SOCIAL SECURITY NO.
11A. VETERAN'S SIGNATURE (Do NOT print)
11B. DATE SIGNED
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 38, Code of Federal Regulations 1.576 for routine uses (i.e. civil or criminal law enforcement, congressional communications, epidemiological or research studies, the collection of money owed to the United States, litigation in which the United States is a party or has an interest, the administration of VA programs and delivery of VA benefits, verification of identity and status, and personnel administration) as identified in the VA system of records, 58VA21/22/28 Compensation, Pension, Education and Vocational Rehabilitation and Employment Records - VA, published in the Federal Register. Your obligation to respond is required to obtain or retain benefits. Giving us your SSN account information is mandatory. Applicants are required to provide their SSN under Title 38 USC 5101 © (1). 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 Federal Statute of law in effect prior to January 1, 1975, and still in effect. The requested information is considered relevant and necessary to determine maximum benefits under the law. The responses you submit are considered confidential (38 U.S.C. 5701). Information that you furnish may be utilized in computer matching programs with other Federal or state agencies for the purpose of determining your eligibility to receive VA benefits, as well as to collect any amount owed to the United States by virtue of your participation in any benefit program administered by the Department of Veterans Affairs.
RESPONDENT BURDEN: We need this information to make an eligibility determination for veterans' filing supplemental compensation claims (38 U.S.C. 5101). Title 38, United States Code, allows us to ask for this information. We estimate that you will need an average of 15 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 www.whitehouse.gov/omb/library/OMBINV.VA.EPA.html#VA. If desired, you can call 1-800-827-1000 to get information on where to send comments or suggestions about this form.
VA FORM SUPERSEDES VA FORM 21-526B, JUL 2009, MAY 2010 21- 526b WHICH WILL NOT BE USED.
Posted 01 October 2010 - 06:39 PM
Posted 01 October 2010 - 10:01 PM
Thanks. Great info. I can see why they prefer this one.
Posted 01 October 2010 - 11:04 PM