Get Va Voda-01 2017-2025

The VA VODA-01 form is essential for claiming Line of Duty Act benefits in Virginia. It is important to complete this form accurately to ensure timely processing of your claim.

Follow the steps to successfully fill out the VA VODA-01 online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin with Part A: Preparer Information. If you are completing this form on behalf of someone else, provide their details here including name, relationship to the claimant, phone number, and email address.
3. Move to Part B: Claimant Information. Here, you will need to fill in the claimant's details, such as their name, Social Security number, address, gender, marital status at the time of the incident, birth date, phone number, retirement date (if applicable), and email address.
4. Proceed to Part C: Claimant’s Employment Information at Time of Incident. This section requires the employer to provide information about the claimant’s employment, including the employing agency or organization, the contact information for Human Resources, the employment status, and the position held at the time of the incident.
5. In Part D: Report of Incident, document the date of the incident and provide any witnesses' names and addresses if known. Describe the illness or injury that caused the disability or death and list any physicians the claimant has seen related to this condition.
6. Complete Part E: Required Reports and Documentation. Make sure to check off each attached document that is required to process the claim, such as accident reports or death certificates, depending on the type of claim.
7. In Part F: Spouse, Dependent, and Other Beneficiary Information, provide necessary information about the spouse and any dependents. Ensure to include all required documentation for dependents and other beneficiaries.
8. Finally, complete Part G: Certification. Both the employer's representative and the claimant must sign and date this section to validate the claim.
9. Once all sections are completed and all required documents are attached, save your changes, download a copy of the form, and prepare it for submission.

Complete your VA VODA-01 form online today to ensure your claim is processed without delay.