Get Dependency And Indemnity Compensation (dic) Intake Form

The Dependency And Indemnity Compensation (DIC) Intake Form is a vital document for those seeking monthly payments following the service-connected death of a veteran. This guide will assist users in filling out the form online, ensuring that all necessary information is supplied accurately and efficiently.

Follow the steps to complete the DIC Intake Form online effectively.

1. Click ‘Get Form’ button to access the DIC Intake Form and open it in an editor.
2. Begin by entering the date at the top of the form, which is essential for record-keeping.
3. In the first section, provide the name of the veteran including their first, middle, and last names.
4. If applicable, fill in the name used by the veteran in service if it differs from the current name.
5. Complete the name of the applicant in the next section, ensuring to include first, middle, and last names.
6. Indicate your relationship to the veteran accurately in the specified field.
7. Fill out your current address, including street, apartment number, city, state, and zip code.
8. Provide a mailing address if different from the permanent address.
9. Enter your contact telephone numbers for home and work, ensuring proper formats are used.
10. State your date of birth in the required format.
11. Insert your Social Security number in the designated area.
12. Select your marital status by marking the appropriate box.
13. Answer whether you are currently employed, and provide your occupation if employed.
14. If not employed, indicate your ability to work.
15. Disclose any government assistance you receive, specifying types if applicable.
16. Indicate whether you have dependents and list their names, relationships to the veteran, dates of birth, and Social Security numbers.
17. Confirm if you are a family member of a veteran and attach the necessary documents such as the veteran's discharge form.
18. Provide information on the branch of service the veteran belonged to.
19. Identify the era during which the veteran served.
20. List the veteran's dates of service accurately.
21. Indicate the type of discharge the veteran received.
22. Answer whether the veteran was in combat, and detail any injuries sustained if applicable.
23. State if the veteran was treated for injuries, disabilities, or diseases during service, providing descriptions as necessary.
24. Confirm if the veteran ever applied for VA benefits, checking relevant boxes.
25. Document if you have previously applied for DIC or another VA benefit.
26. Answer whether you are now receiving any VA benefits and select all that apply.
27. Specify the VA regional office location for the veteran’s claim file.
28. Provide the veteran's date of death and attach a copy of the death certificate.
29. Indicate if a disease or injury incurred in service contributed to the veteran's death.
30. Confirm whether the veteran died from a service-connected disability.
31. State if the veteran was receiving or entitled to 100 percent service-connected benefits at the time of death.
32. If applicable, indicate if the veteran was rated 100 percent disabled for 10 years or more prior to death.
33. Answer regarding the continuity of the veteran's disability rating from the date of discharge.
34. Indicate if the veteran was a former prisoner of war rated at 100 percent disability for at least one year prior to death.
35. If applicable, provide the date of marriage to the veteran and furnish related proof.
36. State if you and the veteran were separated at the time of death.
37. Indicate whether the veteran provided reasonable support during any separation.
38. Answer if the separation was caused by misconduct of the veteran.
39. Confirm if the separation was without fault on the part of the spouse.
40. Indicate whether you have remarried since the veteran's death.
41. If remarried, provide your age at the time of remarriage.
42. State the date of remarriage if applicable.
43. For child applicants, indicate the child's legitimacy status if relevant.
44. Confirm whether the child was a member of the household at the time of the veteran's death.
45. State if the child is currently unmarried.
46. Indicate if the child is under 18 years of age.
47. If over 18, confirm if the child became permanently incapable of self-support before 18.
48. State if the child is currently pursuing education between the ages of 18 and 23.
49. Once all fields are accurately filled out, save changes, and download or print the completed form for sharing.

Start filling out your DIC Intake Form online today to ensure all necessary information is provided.