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Husband s Name Designation/ Nature of work done Act omission for which fine imposed Date of Offence Whether workman showed cause against fine Name of person in whose presence employees explanation was heard Wage period and wages payable Amount of fine imposed Date on which fine realized Remarks 1 2 3 4 5 6 7 8 9 10 11 12 v.

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Title: Statement of Marital Relationship (VA Form 21–4170). OMB Control Number: 2900–0114. Type of Review: Revision of an approved collection. Abstract: VA Form 21–4170 is used to gather information that is necessary to determine whether a valid common law marriage was established.

Application for Dependency and Indemnity Compensation, Death Pension and Accrued. Benefits by a Surviving Spouse or Child (Including Death Compensation if Applicable) VA Form 21-534.

Complete VA Form 21-4142, Authorization to Disclose Information to the Department of Veterans Affairs (VA) and VA For 21-4142a, General Release for Medical Provider Information to the Department of Veterans Affairs (VA); submit completed forms with your claim and VA will attempt to obtain your records through our ...

Use this form to determine eligibility for aid and attendance or housebound benefits. For more information, you can contact us online through Ask VA: https://ask.va.gov/. Ask us a question online or call us toll-free at 1-800-827-1000 (TTY: 711). VA forms are available at .va.gov/vaforms.

you are a veteran entitled to disability compensation, and • you are seeking additional benefits for a spouse who requires aid and attendance VA Form 21-2680, Examination for Housebound Status or Permanent Need for Regular Aid and Attendance, or if your spouse resides in a nursing home, use VA Form 21-0779, Request for ...

VA Form 21, APPLICATION FOR ACCREDITATION AS SERVICE ORGANIZATION REPRESENTATIVE.

Veterans and Spouses would require assistance in performing their daily activities of living (ADLs), must have their primary care physician complete this form indicating the need for either Aid and Attendance (A&A) or Housebound status.

Use VA Form 21-22 when you want to have a Veterans Service Organization (VSO) help you with VA benefits or claims.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232