Form 26-8937 Verification of VA Benefits

OMB Approved No. 2900-0406
Respondent Burden: 5 Minutes
Expiration Date: XX/XX/20XX

VERIFICATION OF VA BENEFITS
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 5, Code of
Federal Regulations 1.576 for routine uses (i.e., information concerning a veteran's indebtedness to the United States by virtue of a person's participation in a benefits program administered by
VA may be disclosed to any third party, except consumer reporting agencies) as identified in the VA system of records, 55VA26, Loan Guaranty Home, Condominium and Manufactured
Home Loan Applicant Records, Specially Adapted Housing Applicant Records and Vendee Loan Applicant Records - VA, and published in the Federal Register. You are required to respond
to obtain or retain benefits. Giving us your SSN account information is voluntary. Refusal to provide your SSN by itself will not result in the denial of benefits. 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 a Federal Statute of law in effect prior to January 1, 1975, and still in effect.
TO: NAME AND ADDRESS OF LENDER (Complete mailing address including ZIP Code)

INSTRUCTIONS TO LENDER
The veteran/applicant should complete this form ONLY if he or she:
• is receiving VA disability payments; or
• has received VA disability payments; or
• would receive VA disability payments but for receipt of retired
pay; or
• has filed a claim for VA disability benefits prior to discharge
from active duty service; or
• is surviving spouse of a veteran and in receipt of DIC
payments.
Complete Items 1 through 10. Send the completed form to the
appropriate VA Regional Loan Center where it will be processed and
returned to the Lender. The completed form must be retained as part of
the lender's loan origination package.

1. NAME OF VETERAN (First, middle, last)

2. CURRENT ADDRESS OF VETERAN

3. DATE OF BIRTH (MM/DD/YYYY)
4. VA CLAIM FOLDER NUMBER (C-File No., if known)

7. I HEREBY CERTIFY THAT I

DO

8. I HEREBY CERTIFY THAT I

HAVE

5. SOCIAL SECURITY NUMBER

(999-99-9999)

DO NOT

6. SERVICE NUMBER (If different from Social Security Number)

have a VA benefit-related indebtedness to my knowledge. I authorize VA to furnish the information listed below.

HAVE NOT

filed a claim for VA disability benefits prior to discharge from active duty service.

9. SIGNATURE OF VETERAN (Sign in ink)

10. DATE SIGNED (MM/DD/YYYY)

FOR VA USE ONLY (Complete in ink)
The above named veteran does not have a VA benefit-related indebtedness
The veteran has the following VA benefit-related indebtedness

VA BENEFIT-RELATED INDEBTEDNESS (If any)
TYPE OF DEBT(S)

AMOUNT OF DEBT(S)

TERM OF REPAYMENT PLAN (If any)
Veteran is exempt from funding fee due to receipt of service-connected disability compensation of $

fee receipt must be remitted to VA with VA Form 26-1820, Report and Certification of Loan Disbursement)

monthly. (Unless checked, the funding

Veteran is exempt from funding fee due to entitlement to VA compensation benefits upon discharge from service
Veteran is not exempt from funding fee due to receipt of non service-connected-connected pension of $
REQUIRE PRIOR APPROVAL PROCESSING BY VA.

monthly. LOAN APPLICATION WILL

Veteran has been rated incompetent by VA. LOAN APPLICATION WILL REQUIRE PRIOR APPROVAL PROCESSING BY VA.
Insufficient information. VA cannot identify the veteran with the information given. Please furnish more complete information, or a copy of a DD Form 214 or discharge
papers. If on active duty, furnish a statement of service written on official government letterhead, signed by the adjutant, personnel officer, or commanding officer. The
statement should include name, birth date, service number, entry date and time lost.
SIGNATURE OF AUTHORIZED AGENT (Sign in ink)

DATE SIGNED (MM/DD/YYYY)

RESPONDENT BURDEN: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control
number. The OMB control number for this project is 2900-0406, and it expires XX/XX/20XX. Public reporting burden for this collection of information is estimated to average 5 minutes per
respondent, per year, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. Send comments regarding this burden estimate and any other aspect of this collection of information, including suggestions for reducing the burden, to VA Reports Clearance
Officer at [email protected]. Please refer to OMB Control No. 2900-0406 in any correspondence. Do not send your completed VA Form 26-8937 to this email address.
VA FORM
XXX XXXX

26-8937

SUPERSEDES VA FORM 26-8937, JUN 2022,
WHICH WILL NOT BE USED.

Page 1