OMB control number
Supplement to VA Forms 21-526EZ, 21P-534EZ, and 21P-535 (For Philippine Claims) (VA Form 21-4169)
OMB 2900-0094 · VA.
OMB 2900-0094
VA Form 21-4169 is used to gather the necessary information to determine whether a claimant’s service qualifies as service in the Commonwealth Army of the Philippines or recognized guerrilla organizations. The form is used for the sole purpose of collecting the information needed to determine eligibility for benefits based on such service, including service information, proof of service, place of residence, and membership in pro-Japanese, pro-German, or anti-American Filipino organizations. Without this information, determination of entitlement would not be possible.
The latest form for Supplement to VA Forms 21-526EZ, 21P-534EZ, and 21P-535 (For Philippine Claims) (VA Form 21-4169) expires 2027-08-31 and is listed under ICR 202404-2900-004.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form 21-4169 Supplement to VA Forms 21-526EZ, 21P-534EZ, and 21P-535 (For Philippine Claims)(VA Form 21-4169) | Form |
| 30-DAY FRN 2900-0094.pdf | Supplementary Document |
| 2024-09376, 60-Day FRN (VAF21-4169).pdf | Supplementary Document |
 2900-0094, Supporting Statement (VAF21-4169) v1.docx | Supporting Statement A |
 Supplement to VA Forms 21-526EZ, 21P-534EZ, and 21P-535 (For Philippine Claims)(VA Form 21-4169) |
Form |