Intent to File a Claim for Compensation and/or Pension, or Survivors Pension and/or DIC (VA Form 21-0966)

OMB 2900-0826

VA Form 21-0966 will be used by claimants and/or their authorized representatives to indicate an intent to file a claim for compensation and/or pension, or survivors pension and/or DIC, to establish an effective date for an award granted in association with a complete claim filed within 1 year of such form.

The latest form for Intent to File a Claim for Compensation and/or Pension, or Survivors Pension and/or DIC (VA Form 21-0966) expires 2021-08-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form VA Form 21-0966 Intent to File a Claim for Compensation and/or Pension, or Survivors Pension and/or DIC (VA Form 21-0966) Form
2023-00590.pdf Supplementary Document
2022-24354.pdf Supplementary Document
2900-0826, Supporting Statement (VAF21-0966).docx Supporting Statement A
Intent to File a Claim for Compensation and/or Pension, or Survivors Pension and/or DIC (VA Form 21-0966) Form

All Historical Document Collections

202111-2900-007 Approved without change	Reinstatement with change of a previously approved collection	2023-01-17
201801-2900-004 Approved without change	Extension without change of a currently approved collection	2018-06-21
201501-2900-006 Approved without change	Revision of a currently approved collection	2015-05-22
201407-2900-019 Approved with change	New collection (Request for a new OMB Control Number)	2014-07-30