AGENCY |
FORM # |
FORM NAME |
TYPE |
REVISED |
VHA
|
10
0137
|
VA Advance Directive; Living Will and Durable Power of Attorney for Health Care
|
Form Only
|
|
VHA
|
10
0143
|
Certification Regarding Drug-Free Workplace Requirements Other Than Individuals
|
Form Only
|
|
VHA
|
10
0143a
|
Statement of Assurance of Compliance with Section 504 of Rehabilitation Act of 1973
|
Form Only
|
|
VHA
|
10
0144
|
Certification Regarding Lobbying
|
Both Form and Instructions
|
|
VHA
|
10
0144a
|
Statement of Assurance of Compliance with Equal Opportunity Laws
|
Both Form and Instructions
|
|
VHA
|
10
0376a
|
Credentialing Transfer Brief
|
Form Only
|
|
VHA
|
10
0379
|
Eccleastical Endorsing Organization Verification/Reverification
|
Both Form and Instructions
|
|
VA
|
10-0439
|
Learner's Perception survey
|
Form Only
|
|
VHA
|
VA
10-7959
A
|
CHAMPVA Claim Form
|
Both Form and Instructions
|
|
VHA
|
10
10EC
|
Application for Extended Care
|
Both Form and Instructions
|
|
VHA
|
10
10EZ
|
Application for Medical Benefits
|
Both Form and Instructions
|
|
VHA
|
10
10EZR
|
Health Benefits Renewal Form
|
Both Form and Instructions
|
|
VHA
|
10
10d
|
Application for Medical Benefits for Dependents or Survivors (CHAMPVA)
|
Both Form and Instructions
|
|
VHA
|
10
10sh
|
State Home Program Application for Veteran Care Medical Certification
|
Form Only
|
|
VBA
|
20-8734
|
Equal Opportunity Compliance Review Report
|
Both Form and Instructions
|
|
VBA
|
20-8734a
|
Supplement To Equal Opportunity Compliance Review Report
|
Both Form and Instructions
|
|
VHA
|
10
2065
|
Funeral Arrangements
|
Form Only
|
|
VBA
|
21-0304
|
Benefits for Certain Children with Disabilities Born of Vietnam Veterans
|
Both Form and Instructions
|
|
VBA
|
21-0307
|
Award Attachment for Certain Children with Disabilities Born of Vietnam Veterans
|
Both Form and Instructions
|
|
VBA
|
21-0510
|
Eligibility Verification Report Instructions
|
Both Form and Instructions
|
|
VBA
|
21-0513-1
|
Old Law and Section 306 Eligibility Verification Report (Children Only)
|
Both Form and Instructions
|
|
VBA
|
21-0514-1
|
Parent's DIC Eligibility Verification Report
|
Both Form and Instructions
|
|
VBA
|
21-0516-1
|
Improved Pension Eligibility Verification Report (Veteran With No Children)
|
Both Form and Instructions
|
|
VBA
|
21-0517-1
|
Improved Pension Eligibility Verification Report (Veteran with Children)
|
Both Form and Instructions
|
|
VBA
|
21-0571
|
Application for Exclusion of Children's Income
|
Both Form and Instructions
|
|
VBA
|
21-1775
|
Statement of Disappearance
|
Both Form and Instructions
|
|
VBA
|
21-1995
|
Request for Change of Program or Place of Training
|
Both Form and Instructions
|
|
VBA
|
21-2008
|
Application for United States Flag for Burial Purposes
|
Both Form and Instructions
|
|
VBA
|
21-22
|
Appointment of Veterans Service Organization as Claimant's Representative
|
Both Form and Instructions
|
|
VBA
|
21-4103
|
Information From Remarried Widow/er
|
Both Form and Instructions
|
|
VBA
|
21-4138
|
Statement in Support of Claim
|
Both Form and Instructions
|
|
VBA
|
21-4165
|
Pension Claim Questionnaire for Farm Income
|
Both Form and Instructions
|
|
VBA
|
21-4171
|
Supporting Statement Regarding Marriage
|
Both Form and Instructions
|
|
VBA
|
21-4176
|
General Instructions for Report of Accidental Injury in Support of Claim for Compensation and Pension
|
Both Form and Instructions
|
|
VBA
|
21-4192
|
Request for Employment Info in Connection with Claim for Disability Benefits
|
Both Form and Instructions
|
|
VBA
|
21-4502
|
Application for Automobile or Other Conveyance and Adaptive Equipment (Under 38 U.S.C. 3901 - 3904)
|
Both Form and Instructions
|
|
VBA
|
21-4706b
|
Federal Fiduciary's Account
|
Both Form and Instructions
|
|
VBA
|
21-4706c
|
Court Appointed Fiduciary's Account
|
Both Form and Instructions
|
|
VBA
|
21-4709
|
Certificate as to Assets
|
Both Form and Instructions
|
|
VBA
|
21-4718a
|
Certificate of Balance on Deposit and Authorization to Disclose Financial Record
|
Both Form and Instructions
|
|
VBA
|
21-509
|
Statement of Dependency of Parent(s)
|
Both Form and Instructions
|
|
VBA
|
21-524
|
STATEMENT OF PERSON CLAIMING TO HAVE STOOD IN RELATION OF PARENT
|
Both Form and Instructions
|
|
VBA
|
21-526
|
Vet's Application for Compensation and/or Pension-Part A
|
Both Form and Instructions
|
|
VBA
|
21-527
|
Income-Net Worth And Employment Statement
|
Both Form and Instructions
|
|
VBA
|
21-530
|
Application for Burial Benefits
|
Both Form and Instructions
|
|
VBA
|
21-534
|
Part 1 Application for Dependency and Indemnity Compensation, Death Pension and
|
Both Form and Instructions
|
|
VBA
|
21-535
|
Application for Dependency and Indemnity Compensation by Parent(s)
|
Both Form and Instructions
|
|
VBA
|
21-551
|
Application for Accrued Benefits by Veteran's Surviving Spouse, Child, or Depend
|
Both Form and Instructions
|
|
VBA
|
21-601
|
Application for Reimbursement From Accrued Amounts Due a Deceased Beneficiary
|
Both Form and Instructions
|
|
VBA
|
21-609
|
Application for Amounts Due Estates of Person Entitled to Benefits
|
Both Form and Instructions
|
|
VBA
|
21-614
|
Application for Accrued Amounts of Veteran's Benefits Payable to Surviving Spous
|
Both Form and Instructions
|
|
VBA
|
21-674
|
Request for Approval of School Attendance
|
Both Form and Instructions
|
|
VBA
|
21-686c
|
Declaration Of Status Of Dependents
|
Both Form and Instructions
|
|
VBA
|
21-8049
|
Request for Details of Expenses
|
Both Form and Instructions
|
|
VBA
|
21-8416
|
Medical Expense Report
|
Both Form and Instructions
|
|
VBA
|
21-8416b
|
Report of Medical, Legal, and Other Expenses Incident to Recovery for Injury or Death
|
Both Form and Instructions
|
|
VBA
|
21-8924
|
Application of Surviving Spouse or Child for REPS Benefits
|
Both Form and Instructions
|
|
VBA
|
21-8940
|
Veteran's Application for Increased Compensation Based on Unemployability
|
Both Form and Instructions
|
|
VBA
|
21-8951-2
|
Notice of Waiver of VA Comp or Pension to Receive Military Pay and Allowance
|
Both Form and Instructions
|
|
VBA
|
22-1990
|
Application for VA Education Benefits
|
Both Form and Instructions
|
|
VBA
|
22-1995
|
Request for Change of Program or Place of Training
|
Both Form and Instructions
|
|
VBA
|
22-5495
|
Request for Change of Program or Place of Training Survivors' and Dependents' Education Assistance (Under Provisions of Chapter 35, Title 38 U.S.C.)
|
Both Form and Instructions
|
|
VBA
|
22-8691
|
Application for Work-Study Allowance
|
Both Form and Instructions
|
|
VBA
|
22-8692
|
Student Work Study Agreement (Student Services)
|
Both Form and Instructions
|
|
VBA
|
22-8864
|
Other On-The-Job Training and Apprenticeship Training Agreement and Standards
|
Both Form and Instructions
|
|
VBA
|
22-8865
|
Employer's Application to Provide Job Training
|
Both Form and Instructions
|
|
VBA
|
22-8889
|
Application for Educational Assistance Test Program Benefits
|
Both Form and Instructions
|
|
VBA
|
24-0296
|
Direct Deposit Enrollment
|
Both Form and Instructions
|
|
VBA
|
24-5281
|
Application for Refund of Education Contributions
|
Both Form and Instructions
|
|
VHA
|
10
2421
|
Prosthetic Authorization for Items or Services
|
Both Form and Instructions
|
|
VHA
|
10
2511
|
Authority and Invoice for Travel by Ambulance or Other Hired Vehicle
|
Form Only
|
|
VHA
|
10
2520
|
Prosthetic Service Card Invoice
|
Both Form and Instructions
|
|
VHA
|
10
2570d
|
Dental Record Authorization and Invoice for Outpatient Service
|
Both Form and Instructions
|
|
VBA
|
26-1805
|
Request for Determination of Reasonable Value
|
Both Form and Instructions
|
|
VBA
|
26-1817
|
Determination of Loan Guaranty Eligibility-Unremarried Surviving Spouses 1 Jan 3 2002
|
Both Form and Instructions
|
|
VBA
|
26-1820
|
Report of Certification of Loan Disbursement
|
Both Form and Instructions
|
|
VBA
|
26-1839
|
Compliance Inspection Report
|
Both Form and Instructions
|
|
VBA
|
26-1849
|
Escrow Agreement for Postponed Exterior Onsite Improvements
|
Both Form and Instructions
|
|
VBA
|
26-1874
|
Claim Under Loan Guaranty
|
Both Form and Instructions
|
|
VBA
|
26-1874a
|
Claim Form Addendum - Adjustable Rate Mortgage
|
Both Form and Instructions
|
|
VBA
|
26-1880
|
Request for A Certificate of Eligibility
|
Both Form and Instructions
|
|
VBA
|
26-4555
|
Veteran's Application in Acquiring Specially Adapted Housing or Special Home Adaption
|
Both Form and Instructions
|
|
VBA
|
26-4555c
|
Veteran's Supplemental Application For Assistance in Acquiring Specially Adapted Housing
|
Both Form and Instructions
|
|
VBA
|
26-4555d
|
Veteran's Application for Assistance in Acquiring Special Housing Adaptations
|
Both Form and Instructions
|
|
VBA
|
26-6381
|
Application for Assumption Approval and/or Release from Personal Liability
|
Both Form and Instructions
|
|
VBA
|
26-6382
|
Statement of Purchaser Or Owner Assuming Seller's Loan
|
Both Form and Instructions
|
|
VBA
|
26-6393
|
Loan Analysis
|
Both Form and Instructions
|
|
VBA
|
26-6681
|
Fee or Roster Designation - Application for Fee Personnel Designation
|
Both Form and Instructions
|
|
VBA
|
26-6705
|
Offer to Purchase and Contract of Sale
|
Both Form and Instructions
|
|
VBA
|
26-6705b
|
Credit Statement of Prospective Purchaser
|
Both Form and Instructions
|
|
VBA
|
26-6705d
|
Addendum to Offer to Purchase and Contract of Sale
|
Both Form and Instructions
|
|
VBA
|
26-6807
|
Financial Statement
|
Both Form and Instructions
|
|
VBA
|
26-6850
|
Notice of Default
|
Both Form and Instructions
|
|
VBA
|
26-6850a
|
Notice of Default and Intention to Foreclose
|
Both Form and Instructions
|
|
VBA
|
26-6851
|
Notice of Intention to Foreclose
|
Both Form and Instructions
|
|
VBA
|
26-8084
|
Claim for Repurchase of Loan
|
Both Form and Instructions
|
|
VBA
|
26-8497
|
Request for Verification of Employment
|
Both Form and Instructions
|
|
VBA
|
26-8497a
|
Request for Verification of Deposit
|
Both Form and Instructions
|
|
VBA
|
26-8630
|
Manufactured Home Loan Claim Under Loan Guaranty
|
Both Form and Instructions
|
|
VBA
|
26-8736
|
Application For Authority to Close on an Automatic Basis Nonsupervised Lenders
|
Both Form and Instructions
|
|
VBA
|
26-8736a
|
Nonsupervised Lender's Nomination and Recommendation of Credit Underwriter
|
Both Form and Instructions
|
|
VBA
|
26-8778
|
Present Status of Loan
|
Both Form and Instructions
|
|
VBA
|
26-8923
|
Interest Rate Reduction Refinancing Loan Worksheet
|
Both Form and Instructions
|
|
VBA
|
26-8937
|
Verification of VA Benefit - Related Indebtedness
|
Both Form and Instructions
|
|
VBA
|
28-1900
|
Disabled Veterans Application for Vocational Rehabilitation
|
Both Form and Instructions
|
|
VBA
|
28-1902
|
Counseling Record - Personal Information
|
Both Form and Instructions
|
|
VBA
|
28-1905
|
Authorization And Certification Of Entrance Or Reentrance Into Rehabilitation And Certificate of Status
|
Both Form and Instructions
|
|
VBA
|
28-1905m
|
Request for Supplies (Chapter 31 - Vocational Rehabilitation)
|
Both Form and Instructions
|
|
VBA
|
28-1917
|
Monthly Statement of Wages Paid to Trainee
(Chapter 31, Title 38, U.S.C.)
|
Both Form and Instructions
|
|
VBA
|
28-8832
|
Application for Counseling
|
Both Form and Instructions
|
|
VHA
|
10
2850
|
Application for Physicians, Dentists, Podiatrists and Ophthalmolgists
|
Both Form and Instructions
|
Jul 01, 2006
|
VHA
|
10
2850a
|
Application for Nurses and Nurse Anesthetists
|
Both Form and Instructions
|
Jul 01, 2006
|
VHA
|
10
2850b
|
Application for Residency
|
Both Form and Instructions
|
Jul 01, 2006
|
VHA
|
10
2850c
|
Application for Associated Health Occupations
|
Both Form and Instructions
|
Jul 01, 2006
|
VBA
|
29-0165
|
VA Matic Change
|
Both Form and Instructions
|
|
VBA
|
29-0188
|
Application for Supplemental Service Disabled Veterans (RH) Life Insurance
|
Both Form and Instructions
|
|
VBA
|
29-0543
|
Veteran Mortgage Life Insurance Inquiry
|
Both Form and Instructions
|
|
VBA
|
29-0563
|
Veteran Mortgage Life Insurance - Change of Address Statement
|
Both Form and Instructions
|
|
VA
|
29-1546
|
Application for Cash Surrender and/or Policy Loan
|
Form Only
|
|
VA
|
VA Form
29-1546-1
|
Application for Policy Loan/Cash Surrender
|
Form Only
|
|
VBA
|
29-1549
|
Application for Change of Permanent Plan (Medical)
|
Both Form and Instructions
|
|
VBA
|
29-336
|
Designation of Beneficiary
|
Both Form and Instructions
|
|
VBA
|
29-352
|
Application for Reinstatement
|
Both Form and Instructions
|
Oct 01, 2003
|
VBA
|
29-357
|
Claim for Disability Insurance (Government Life)
|
Both Form and Instructions
|
|
VBA
|
29-4125
|
Claim for One Sum Payment (Government Life Insurance)
|
Both Form and Instructions
|
|
VBA
|
29-4125a
|
Claim for Monthly Payment - National Service Life Insurance
|
Both Form and Instructions
|
|
VBA
|
29-4125k
|
Claim for Monthly Payment - United States Government Life Insurance (USGLI)
|
Both Form and Instructions
|
|
VBA
|
29-4364
|
Application for Service-Disabled Insurance
|
Both Form and Instructions
|
|
VBA
|
29-4499a
|
Notice - Payment Not Applied - Government Life Insurance
|
Both Form and Instructions
|
|
VBA
|
29-459
|
Claim For Disability Insurance Benefits
|
Both Form and Instructions
|
|
VBA
|
29-551b
|
Reviewing Disability Insurnace Benefits Claim
|
Both Form and Instructions
|
|
VBA
|
29-8146
|
Supplemental Physical Examination Report
|
Both Form and Instructions
|
|
VBA
|
29-8158
|
Attending Physician's Statement
|
Both Form and Instructions
|
|
VBA
|
29-8160
|
Supplemental Physician Examination Report
(Diabetes-Physician's Report)
|
Both Form and Instructions
|
|
VBA
|
29-8313-1
|
Disability Benefits Questionnaire
|
Both Form and Instructions
|
|
VBA
|
29-8485
|
Application for Ordinary Life Insurance Replacement Insurance for Modified Life
|
Both Form and Instructions
|
|
VBA
|
29-8485a
|
Application for Ordinary Life Insurance Replacement Insurance for Modified Life
|
Both Form and Instructions
|
|
VBA
|
29-8636
|
Veterans Mortgage Life Insurance Statement
|
Both Form and Instructions
|
|
VBA
|
29-888
|
Insurance Deduction Authorization
|
Both Form and Instructions
|
|
VHA
|
10
2914
|
Prescription and Authorization for Eyeglasses
|
Form Only
|
|
VHA
|
10
3567
|
State Home Inspection
|
Both Form and Instructions
|
|
VHA
|
10
5345
|
Request for and Authorization to Release Medical Records or Other Health Information
|
Form Only
|
|
VHA
|
10
583
|
Claim for Cost of Unauthorized Medical Benefits
|
Form Only
|
|
VHA
|
10
6131
|
Daily Log - Formal Contract
|
Form Only
|
|
VHA
|
10
6298
|
Architecture Engineer Fee Proposal
|
Form Only
|
|
VHA
|
10
7055
|
Application for Voluntary Service
|
Form Only
|
|
VHA
|
10
7078
|
Authorization and Invoice for Medical and Hospital Services
|
Form Only
|
|
VHA
|
10
7959c
|
Other Health Insurance (OHI) Certification (CHAMPVA)
|
Both Form and Instructions
|
|
VHA
|
10
7959d
|
Potential Liability Claim (CHAMPVA)
|
Both Form and Instructions
|
|
VHA
|
10
7959f
|
Claim Cover Sheet for Foreign Medical Program
|
Both Form and Instructions
|
|
VHA
|
10
8678
|
Application for Annual Clothing Allowance
|
Both Form and Instructions
|
|
VA
|
VA
9
|
APPEAL TO BOARD OF VETERANS' APPEALS
|
Both Form and Instructions
|
|
VBA
|
FL29-551a
|
Report of Treatment in Hospital
|
Both Form and Instructions
|
Oct 01, 2003
|