Follow the steps to successfully complete the form online.

1. Click ‘Get Form’ button to obtain the Section 1151 And FTCA Intake Form and open it in your preferred editor.
2. Begin by entering the date at the top of the form. Ensure that the date is accurate as it may be significant to your claim.
3. Fill out the name of the veteran in the designated fields, including first, middle, and last names.
4. If the veteran used a different name during service, provide that name in the next field.
5. If you are not the veteran, complete the applicant section with the first, middle, and last names of the applicant.
6. Indicate your relationship to the veteran in the corresponding field.
7. Enter the veteran’s home address including number, street, apartment number if applicable, city, state, and zip code.
8. Complete the mailing address section, which may be the same as the home address. If it differs, ensure you provide the correct mailing address.
9. Provide your telephone numbers by filling in the home and work numbers.
10. Enter the date of birth of the veteran in the specified format.
11. Complete the social security number field as this is required for identification.
12. Indicate your marital status by selecting from single, married, separated, divorced, or widowed.
13. Answer the employment status question by indicating if you are currently employed and if so, list your occupation.
14. If you are not employed, answer whether you are able to work.
15. Indicate if your unemployment is related to medical issues from military service or VA treatment.
16. Confirm if you are receiving any government assistance, specifying each type you receive.
17. Indicate if you have dependents and if so, provide their names, relationship to the veteran, dates of birth, and social security numbers.
18. In the service information section, affirm if you are a veteran and provide supportive documentation as necessary.
19. List the branch of service you belonged to and the era during which you served.
20. Provide your dates of service as accurately as possible, including entry and discharge dates.
21. State the type of discharge received from military service.
22. Indicate if you were involved in combat or if you sustained any wounds.
23. If applicable, describe any ongoing medical problems related to wounds.
24. Report if you received treatment for any injury or condition during service.
25. Confirm if you have previously applied for VA benefits and check all applicable types.
26. If applicable, provide the claim number assigned to previous claims.
27. State whether you are currently receiving VA benefits and check the relevant types.
28. Identify the VA regional office where your claim file is located.
29. Disclose if you have been treated at a VA medical center, detailing the treatment provided.
30. Indicate if you have sought help from a Vet Center and provide specifics if applicable.
31. Answer whether an injury was suffered due to VA medical care or rehabilitation.
32. Confirm if you believe the injury was caused by VA medical negligence.
33. Provide details on when and where the injury occurred related to VA medical facilities.
34. Describe the nature of the injury in detail to give context to your claim.
35. If applicable, describe past claims related to the injury including outcomes.
36. Indicate if you were asked to sign an informed consent form prior to the medical care in question.
37. Lastly, disclose if you have consulted with an attorney regarding this injury.
38. Once all fields are completed, review the form for accuracy. Save your changes and you may download, print, or share the form as necessary.

Start your online application today and ensure you submit the necessary documentation for your claim.