VA Form 20-10207 Priority Processing Request

PRIORITY PROCESSING REQUEST INSTRUCTIONS

Please complete the attached form to submit a request for priority processing of a claim due to certain circumstances or status as described
below along with any supporting information or evidence.
If you are…
• Experiencing extreme financial
hardship

Then submit the following evidence if available or not already on file with VA…
Documentation to support the assertion of extreme financial hardship, including but not limited
to:
• Copy of an eviction notice or statement of foreclosure
• Copy of notices of past-due utilities bills
• Copy of collection notices from creditors

• Terminally ill

• Copy of medical evidence showing illness that is terminal in nature, and/or
• If you want VA to obtain private treatment records on your behalf, submit a completed VA
Form 21-4142, and VA Form 21-4142a
Note: Additional VA forms are available, here: www.va.gov/vaforms.

• Diagnosed with Amyotrophic Lateral
Sclerosis (ALS) also known as Lou
Gehrig's disease
• Very Seriously Injured/Ill or Seriously

· Copy of medical evidence showing diagnosis of ALS, and/or
· If you want VA to obtain private treatment records on your behalf, submit a completed VA
Form 21-4142 and VA Form 21-4142a
• Copy of military personnel records such as a determination from the Department of Defense

Injured/Ill during military operations

• Medical evidence showing severe disability or injury, and/or

(Defined as a disability resulting from

• If you want VA to obtain private treatment records on your behalf, submit a completed VA

a military operation that will likely

Form 21-4142 and VA Form 21-4142a

result in discharge from military
service.)
• Age 85 or older

• Date of birth

• Former Prisoner of War

• Copy of military personnel records such as DD Form 214, Certificate of Release or Discharge
from Active Duty, or
• Information such as service number, branch and dates of service, dates and location of
internment, detaining power, or any other information relevant to the detainment

• Medal of Honor or Purple Heart Award
recipient

• Copy of military personnel records such as DD Form 214, or
• Information showing receipt of Medal of Honor or Purple Heart Award

WHERE TO SEND INFORMATION AND EVIDENCE:
The time it takes your response to reach VA affects how long it takes us to process your request. We recommend calling our National Call
Center at 1-800-827-1000 for immediate assistance whenever possible. If you are not a claimant or representative, we recommend faxing
rather than mailing the information to expedite processing.
Note: You may designate one person or organization as a third-party representative to act on your behalf. A third-party may be a family
member or other designated person who is not a Power of Attorney (POA), agent, or fiduciary. If you designate a third-party to represent
you, a VA Form 21-0845, Authorization to Disclose Personal Information to a Third-Party, must be attached or of record.
VA FORM
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20-10207

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The fastest way to respond to VA is to contact us at 1-800-827-1000.
If you need to fax or mail your correspondence, identify the benefit type; then, use the corresponding fax number or mailing address
below:

FAXING:
Compensation Claims
Toll Free: 1-844-531-7818

Pension & Survivors Benefit Claims
Toll Free: 1-844-655-1604

Board of Veterans' Appeals
Toll Free: 1-844-678-8979

Fiduciary
Toll Free: 1-888-581-6826
MAILING ADDRESSES

Compensation Claims
Department of Veterans Affairs
Compensation Intake Center
P.O. Box 4444
Janesville, WI 53547-4444

Pension & Survivors Benefit Claims
Department of Veterans Affairs
Pension Intake Center
P.O. Box 5365
Janesville, WI 53547-5365

Board of Veterans' Appeals
Department of Veterans Affairs
Board of Veterans' Appeals
P.O. Box 27063
Washington, DC 20038

Fiduciary
Department of Veterans Affairs
Fiduciary Intake Center
P.O. Box 5211
Janesville, WI 53547-5211

These addresses serve all United States and foreign locations.
Attention: If you are currently receiving GI Bill Education benefits and are experiencing any of the reasons listed within Section III:
Reason(s) for Request, please call the 1-888-GIBILL1 (1-888-442-4551) or send an email through Ask A Question at www.gibill.va.gov
for immediate assistance.

IMPORTANT
If you or someone you know is in crisis, call the Veterans Crisis Line at 1-800-273-8255 and press 1,
or visit https://www.VeteransCrisis/line.net/ to chat online, or send a text message to 838255
to receive confidential support 24 hours a day, 7 days a week, 365 days a year.
Support for deaf and hard of hearing individuals is available.

VA FORM
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20-10207

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OMB Approved No. 2900-XXXX
Respondent Burden: 7 Minutes
Expiration Date: XX/XX/XXXX

(DO NOT WRITE IN THIS SPACE)
(VA DATE STAMP)

PRIORITY PROCESSING REQUEST
INSTRUCTIONS: Before completing this form, read the Privacy Act and Respondent Burden on page 5. Use this
form to request priority processing of a claim due to certain status or circumstances. For more information, visit our
website at , contact us at https://iris.custhelp.va.gov, or call us toll-free at 1-800-827-1000.
If you use a Telecommunications Device for the Deaf (TDD), the Federal relay number is 711. VA forms are
available at www.va.gov/vaforms.

SECTION I - VETERAN'S IDENTIFICATION INFORMATION
(This information is required to process your request)

NOTE: You can either complete the form on-line or by hand. If completed by hand, print the information requested in ink, neatly, and legibly and completely fill in each circle to
expedite processing of the form.
1. VETERAN'S NAME (First, Middle Initial, Last)

2. SOCIAL SECURITY NUMBER

3. DATE OF BIRTH (MM-DD-YYYY)

4. VA FILE NUMBER (If applicable)

5. INSURANCE NUMBER (If applicable)

6. CURRENT MAILING ADDRESS (Number and street or rural route, P.O. Box, City, State, ZIP Code and Country)
No. &
Street
Apt./Unit Number
State/Province

City
ZIP Code/Postal Code

Country

8. E-MAIL ADDRESS

7. TELEPHONE NUMBER (Include Area Code)

I agree to receive electronic correspondence from VA in regards to my claim.

Enter International Phone Number
(If applicable)

SECTION II - CLAIMANT'S IDENTIFICATION INFORMATION
(If other than Veteran)
9. CLAIMANTS NAME (First, Middle Initial, Last)

10. SOCIAL SECURITY NUMBER

11. VA FILE NUMBER (If applicable)

12. DATE OF BIRTH (MM-DD-YYYY)

13. CURRENT MAILING ADDRESS (Number and street or rural route, P.O. Box, City, State, ZIP Code and Country)
No. &
Street
Apt./Unit Number
State/Province

City
ZIP Code/Postal Code

Country

14. TELEPHONE NUMBER (Include Area Code)

15. E-MAIL ADDRESS

I agree to receive electronic correspondence from VA in regards to my claim.

Enter International Phone Number
(If applicable)

SECTION III - REASON(S) FOR REQUEST
(This information is required in order to complete your request)
16. HOMELESS INFORMATION (Check all that apply)
16A. ARE YOU CURRENTLY HOMELESS?
YES (If "YES," complete
item 16B regarding your
living situation)
VA FORM
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20-10207

NO (If "NO,"
skip to item
16C)

16B. CHECK THE BOX THAT APPLIES TO YOUR LIVING SITUATION
NOT CURRENTLY IN A SHELTERED
STAYING WITH
LIVING IN A HOMELESS SHELTER
ENVIRONMENT (e.g. living in a car or tent)
ANOTHER PERSON
16A. ARE YOU CURRENTLY
OTHER
HOMELESS? Radio button. YES
(Specify)

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VETERAN'S SSN
16C. ARE YOU CURRENTLY AT RISK OF BECOMING HOMELESS? 16D. CHECK THE BOX THAT APPLIES TO YOUR LIVING SITUATION
YES (If "YES," complete
item 16D regarding your
living situation)

NO (If "NO," skip to item 17)

HOUSING WILL BE LOST IN
30 DAYS

LEAVING PUBLICLY FUNDED SYSTEM OF CARE IN
30 DAYS OR LESS (e.g. homeless shelter)

OTHER (Specify)

17. OTHER REASON(S)/CIRCUMSTANCES FOR REQUEST (Check all that apply)
EXPERIENCING EXTREME FINANCIAL HARDSHIP

TERMINALLY ILL

MEDAL OF HONOR/PURPLE HEART RECIPIENT

DIAGNOSED WITH AMYOTROPHIC LATERAL SCLEROSIS (ALS) ALSO KNOWN AS LOU GEHRIG'S DISEASE

85 YEARS OF AGE OR OLDER

VERY SERIOUSLY INJURED/ILL OR SERIOUSLY ILL/INJURED (VSI/SI) DURING MILITARY SERVICE
FORMER PRISONER OF WAR (Provide date(s) of confinement) (MM-DD-YYYY)
TO

FROM

TO

FROM

SECTION IV - REPORT OF MEDICAL TREATMENT
(If applicable)
18. LIST VA MEDICAL CENTERS (VAMC), DEPARTMENT OF DEFENSE (DoD) MILITARY TREATMENT FACILITIES (MTF), OR
PRIVATE MEDICAL FACILITIES WHERE YOU WERE TREATED FOR THE CIRCUMSTANCE YOU IDENTIFIED IN ITEM 17 AND
PROVIDE APPROXIMATE BEGINNING DATE OF TREATMENT:
NAME/LOCATION OF TREATMENT FACILITY

DATE OF TREATMENT (MM-DD-YYYY)

City
State/Province

Country

NAME/LOCATION OF TREATMENT FACILITY

DATE OF TREATMENT (MM-DD-YYYY)

City
State/Province

Country

NAME/LOCATION OF TREATMENT FACILITY

DATE OF TREATMENT (MM-DD-YYYY)

City
State/Province

Country

NAME/LOCATION OF TREATMENT FACILITY

DATE OF TREATMENT (MM-DD-YYYY)

City
State/Province

Country

VA Form 20-10207, XXX XXXX

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VETERAN'S SSN

SECTION V - CERTIFICATION AND SIGNATURE
I CERTIFY THAT I have completed this form and it is true and correct to the best of my knowledge and belief.
18A.SIGNATURE OF REQUESTER (REQUIRED) (Note: During COVID-19 ink and
electronic signatures are accepted)

14B. DATE SIGNED (MM-DD-YYYY)

SECTION VI - THIRD PARTY SIGNATURE
(Only required if requester has an authorized third party)
I CERTIFY THAT the veteran/claimant has authorized me as the undersigned representative and certifies that the information contained in this document is
true and complete to the best of the veteran/claimant's knowledge.
NOTE: A third-party signature will not be accepted unless a valid VA Form 21-0845, Authorization to Disclose Personal Information to a Third-Party, is of
record or attached to this request. A third-party may be a family member or other designated person who is not a Power of Attorney, agent, or fiduciary.
19A. THIRD-PARTY SIGNATURE (Note: During COVID-19 ink and electronic
signatures are accepted)

19B. DATE SIGNED (MM-DD-YYYY)

SECTION VII - POWER OF ATTORNEY (POA) SIGNATURE
(Required only if requester has an authorized POA representation)
I CERTIFY THAT the veteran/claimant has authorized me as the undersigned representative and certifies that the information contained in this document
is true and complete to the best of the veteran/claimant's knowledge.
NOTE: A POA's signature will not be accepted unless a valid VA Form 21-22, Appointment of Veterans Service Organization as Claimant's
Representative, or VA Form 21-22a, Appointment of Individual as Claimant's Representative, is of record or attached to this request.
20A. POWER OF ATTORNEY (POA) SIGNATURE (Note: During COVID-19 ink
and electronic signatures are accepted)

20B. DATE SIGNED (MM-DD-YYYY)

PENALTY: The law provides severe penalties (including fine and/or imprisonment) for willfully submitting any statement or evidence of a material fact you know to be
false, or for fraudulent receipt of any document you are not entitled to.

PRIVACY ACT NOTICE: 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 voluntary.
RESPONDENT BURDEN: This information will let us help you in support of or response to your claim. Title 38, United States Code,
allows us to ask for this information. It should take you about 7 minutes to review the instructions, find the information, and complete this
form. VA cannot conduct or sponsor a collection of information unless a valid Office of Management and Budget (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.reginfo.gov/public/do/PRAMain. If desired, you can call 1-800-827-1000 to get
information on where to send comments or suggestions about this form.

VA Form 20-10207, XXX XXXX

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