Get VA 21-0966 2017
ION AND/OR DIC (This Form Is Used to Notify VA of Your Intent to File for the General Benefit(s) Checked Below) NOTE: Please read the Privacy Act and Respondent Burden below before completing the form. SECTION I: CLAIMANT/VETERAN IDENTIFICATION NOTE: You can either complete the form online or by hand. If completed by hand, print the information requested in ink, neatly and legibly to expedite processing of the form. 1. CLAIMANT'S NAME (First, Middle Initial, Last) 2. CLAIMANT'S SOCIAL SECURI.
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