VA Form 21-8951-2 Notice of Waiver of VA Compensation or Pension to Receiv

OMB Approved No. 2900-0463
Respondent Burden: 10 minutes
Expiration Date: 01/31/2023

VA DATE STAMP

(DO NOT WRITE IN THIS SPACE)

NOTICE OF WAIVER OF VA COMPENSATION OR PENSION TO RECEIVE
MILITARY PAY AND ALLOWANCES
IMPORTANT: We need this information to determine whether you choose to waive your VA compensation or
pension or your military pay and allowances for the days for which you received training pay (10 U.S.C. 12316
and 38 U.S.C.5304(c)). If you have any questions about the information contained on this form or if you need
assistance in completing the form, call VA's toll-free number 1-800-827-1000.

NAME AND ADDRESS OF VETERAN

FROM

TO

SECTION I - VETERAN'S IDENTIFICATION INFORMATION

NOTE: You may complete the form online or by hand. If completed by hand, print the information requested in ink, neatly and legibly, insert one letter
per box, and completely fill in each applicable circle to help expedite processing of the form.
1. NAME OF VETERAN (First, Middle Initial, Last)

2. SOCIAL SECURITY NUMBER

4. DATE OF BIRTH (MM/DD/YYYY)

3. VA FILE NUMBER

5. VETERAN'S SERVICE NUMBER (If applicable)

6. TELEPHONE NUMBER (Include Area Code)

7. EMAIL ADDRESS (Optional)

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

Enter International Phone Number (If applicable)

SECTION II - TRAINING PAY INFORMATION
Based on your Social Security Number (SSN), the Defense Manpower Data Center (DMDC) has identified you as having been a reservist or guardsman
during the fiscal year indicated below. Please verify that the Social Security number shown above is your correct Social Security number. If it is not,
please enter the correct number. Also, please enter your telephone number above.
By law, active or inactive duty training pay can't be paid at the same time you're receiving VA disability compensation or pension benefits. You may decide
to keep the training pay you received from your military branch. However, to keep your training pay, you must waive your VA benefits for the same
number of days as the number of days you received training pay. Usually, it's to your advantage to waive benefits and keep your training pay.
Please enter the number of days for which you received training pay below.

FISCAL YEAR

TRAINING DAYS

NOTE: A fiscal year runs from October 1 through September 30. For example, fiscal year 2017 runs from October 1, 2016 through
September 30, 2017.
Please note that the National Guard and Reserves report one full day's duty pay for each 4-hour session of training you attend. That
means they may credit you with 4 days' worth of training for a 2-day drill weekend. The National Guard and Reserves pay most of their
members for about 63 training days during a fiscal year. That included 48 armory drills or training sessions, and 15 days of active
training.
Please fill out this form, sign it, have your unit commander or commander's designee sign it, and return it to one of the 3 addresses listed
on page 3.
VA FORM
JAN 2020

21-8951-2

SUPERSEDES VA FORM 21-8951-2, MAY 2018.

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VETERAN'S SOCIAL SECURITY NO.

SECTION III - ELECTION NOTICE
8.

Complete the appropriate box below, sign this form, secure the signature of your unit commander or designee, and return the completed form to VA
within 60 days. Check one of the following boxes. If you check neither, we will assume that you agree with the number of training pay days shown
on the front of this form.
I agree that the number of training days shown on the front of this form is correct.
The number of training days shown on the front of this form is not correct. The following is the actual number of days for
which I received training pay. (Enter correct information in the boxes below).

TRAINING DAYS

FISCAL YEAR

9.

Check only one of the following boxes:
I elect to waive VA benefits for the days indicated in order to retain my training pay.
I elect to waive military pay and allowances for the days indicated in order to retain my VA compensation or pension.
NOTE: Checking this option will give most veterans LESS money.

I received no military pay and allowances during the fiscal year indicated on page 1 of this form.
SECTION IV - CERTIFICATION AND SIGNATURE
If we do not receive a waiver from you, we will assume that you wish to waive VA compensation or pension for the number of days printed on the front of
the form. However, we will not adjust your award until we have advised you of the specific changes we propose to make.
NOTE: In the past you may have filed a one-time waiver of disability benefits which was to remain in effect until your reserve/guard status changed or you
withdrew the waiver. That waiver is no longer valid. Annual waivers are again required.
10. SIGNATURE OF RESERVIST/GUARDSMAN (REQUIRED)

11. DATE SIGNED (MM/DD/YYYY)

I CERTIFY THAT to the best of my knowledge, the information shown above concerning the member's training days is correct.
12. SIGNATURE OF UNIT COMMANDER OR DESIGNEE (REQUIRED)

13. DATE SIGNED (MM/DD/YYYY)

14. NAME AND MAILING ADDRESS OF RESERVE/GUARD UNIT

15. UNIT TELEPHONE NO. (Include Area Code)

Enter International Phone Number (If applicable)

PENALTY: The law provides severe penalties which include fine or imprisonment, or both, for the willful submission of any statement or evidence of a material fact,
knowing it to be false, or for fraudulent acceptance of any payment to which you are not entitled.
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 Veteran Readiness and Employment Records - VA, published in the Federal
Register. Your obligation to respond is required to obtain or retain benefits. 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 submitted is subject to verification through computer matching programs with other agencies.
RESPONDENT BURDEN: We need this information to determine whether you choose to waive your VA compensation or pension or your military pay and allowances for the days for which
you received training pay (10 U.S.C. 12316 and 38 U.S.C. 5304(c). Title 38, United States Code, allows us to ask for this information. We estimate that you will need an average of 10 minutes
to review the instructions, find the information, and complete the 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.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 21-8951-2, JAN 2020

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WHERE TO SEND WRITTEN CORRESPONDENCE
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
Fiduciary
Department of Veterans Affairs
Fiduciary Intake
P.O. Box 95211
Lakeland, FL 33804-5211

These addresses serve all United States and foreign locations.

VA FORM 21-8951-2, JAN 2020

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