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Get Election Of Compensation In Lieu Of Retired Pay To Secure Compensation From The Va Form

ELECTION OF COMPENSATION IN LIEU OF RETIRED PAY OR WAIVER OF RETIRED PAY TO SECURE COMPENSATION FROM DEPARTMENT OF VETERANS AFFAIRS 38 U.S.C. 5304 a -5305 1. ADDRESS OF VA OFFICE SECTION I - To Be Completed by VA. 2. NAME OF VETERAN 3. VA FILE NUMBER 4. SERVICE NUMBER 5. SOCIAL SECURITY NUMBER INSTRUCTIONS Please sign and date this form and return to the VA office shown in Item 1. ELECTION OF COMPENSATION IN LIEU OF RETIRED PAY OR WAIVER OF RETIRED PAY TO SECURE COMPENSATION FROM DEPARTMENT OF VETERANS AFFAIRS 38 U*S*C. 5304 a -5305 1. ADDRESS OF VA OFFICE SECTION I - To Be Completed by VA. 2. NAME OF VETERAN 3. VA FILE NUMBER 4. SERVICE NUMBER 5. SOCIAL SECURITY NUMBER INSTRUCTIONS Please sign and date this form and return to the VA office shown in Item 1. If you have any questions about completing this form call VA toll-free at 1-800-827-1000 Hearing Impaired TDD federal relay number is 711. I hereby elect to receive compensation from the Department of Veterans Affairs in lieu of the total amount of retired pay or waive that portion of my retired pay which is equal in amount to the compensation which may be awarded by the Department of Veterans Affairs. 7. DATE 6. SIGNATURE OF VETERAN VA FORM JUN 2015 21-651 SUPERSEDES VA FORM 21-651 MAR 2005 WHICH WILL NOT BE USED. ELECTION OF COMPENSATION IN LIEU OF RETIRED PAY OR WAIVER OF RETIRED PAY TO SECURE COMPENSATION FROM DEPARTMENT OF VETERANS AFFAIRS 38 U*S*C. 5304 a -5305 1. ADDRESS OF VA OFFICE SECTION I - To Be Completed by VA. 2. NAME OF VETERAN 3. VA FILE NUMBER 4. 5304 a -5305 1. ADDRESS OF VA OFFICE SECTION I - To Be Completed by VA. 2. NAME OF VETERAN 3. VA FILE NUMBER 4. SERVICE NUMBER 5. SOCIAL SECURITY NUMBER INSTRUCTIONS Please sign and date this form and return to the VA office shown in Item 1. SERVICE NUMBER 5. SOCIAL SECURITY NUMBER INSTRUCTIONS Please sign and date this form and return to the VA office shown in Item 1. If you have any questions about completing this form call VA toll-free at 1-800-827-1000 Hearing Impaired TDD federal relay number is 711. If you have any questions about completing this form call VA toll-free at 1-800-827-1000 Hearing Impaired TDD federal relay number is 711. I hereby elect to receive compensation from the Department of Veterans Affairs in lieu of the total amount of retired pay or waive that portion of my retired pay which is equal in amount to the compensation which may be awarded by the Department of Veterans Affairs. I hereby elect to receive compensation from the Department of Veterans Affairs in lieu of the total amount of retired pay or waive that portion of my retired pay which is equal in amount to the compensation which may be awarded by the Department of Veterans Affairs. 7. DATE 6. SIGNATURE OF VETERAN VA FORM JUN 2015 21-651 SUPERSEDES VA FORM 21-651 MAR 2005 WHICH WILL NOT BE USED. 5304 a -5305 1. ADDRESS OF VA OFFICE SECTION I - To Be Completed by VA. 2. NAME OF VETERAN 3. VA FILE NUMBER 4. SERVICE NUMBER 5. SOCIAL SECURITY NUMBER INSTRUCTIONS Please sign and date this form and return to the VA office shown in Item 1. If you have any questions about completing this form call VA toll-free at 1-800-827-1000 Hearing Impaired TDD federal relay number is 711.

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