We use cookies to improve security, personalize the user experience, enhance our marketing activities (including cooperating with our marketing partners) and for other business use.
Click "here" to read our Cookie Policy. By clicking "Accept" you agree to the use of cookies. Read less
Read more
Accept
Loading
Form preview
  • US Legal Forms
  • Form Library
  • Executive Forms
  • Executive Department Virginia Forms
  • Va Benefits Certain Online

Get Va Benefits Certain Online

Code) A. FATHER (First, middle, last) 7. NAME(S) OF NATURAL PARENT(S) (Please provide information for both) B. MOTHER (First, middle, last) 8. ADDRESS, TELEPHONE NUMBER AND VETERAN STATUS OF NATURAL PARENT(S) A. FATHER (Include number and street or rural route, city or P.O., State and B. MOTHER (Include number and street or rural route, city or P.O., State and C. VIETNAM SERVICE? D. VIETNAM SERVICE? ZIP Code) YES NO (If "Yes", provide dates in 8E) YES E. PLEASE PROVIDE THE DATES THAT.

How it works

  1. Open form

    Open form follow the instructions

  2. Easily sign form

    Easily sign the form with your finger

  3. Share form

    Send filled & signed form or save

How to fill out the VA Benefits Certain Online form

Filling out the VA Benefits Certain Online form is essential for families seeking benefits for children with disabilities related to veterans' service. This guide will walk you through each section of the form, helping you provide accurate and necessary information with ease.

Follow the steps to complete the VA Benefits Certain Online form successfully.

  1. Click ‘Get Form’ button to access the VA Benefits Certain Online form and open it in your preferred editor.
  2. Begin by providing the claimant-child's information. Fill in the child's name (first, middle, last), social security number (if available), date of birth, and place of birth (city and state). Next, enter the child's complete address, including number and street or rural route, city or P.O., state and ZIP code, and their telephone number with area code.
  3. List the names of the natural parents, including their first, middle, and last names. Provide the address and telephone number of each parent, then indicate their veteran status by answering whether they served in Vietnam.
  4. If the claimant-child is under age 18 and has a custodian or guardian other than the natural parent, fill out their name, relationship to the child, and address.
  5. If the claimant-child is 18 or older, indicate whether they have been declared incompetent. If yes, provide the court's name and address that made the finding, as well as the name and address of their guardian.
  6. State the disabilities claimed by the child, along with the name and address of their primary health care provider.
  7. Add dates related to the child’s diagnosis and treatment. Provide the name and place of initial diagnosis, date first diagnosed, and the names and places of any recent treatment, along with the treatment dates.
  8. Fill out the direct deposit information, including selecting the appropriate account type (checking or savings), providing the account number, name of the financial institution, and routing or transit number.
  9. Complete the certification section by having the necessary signatures, including the parent, guardian, or adult child, and the date signed.
  10. Finally, ensure that all information is accurate before saving changes, downloading, or printing the completed form for submission. Mail the finished form to the specified VA Regional Office.

Complete your VA Benefits Certain Online application today to ensure you receive the benefits your family deserves.

Get form

Experience a faster way to fill out and sign forms on the web. Access the most extensive library of templates available.

Related content

VA Form 21-0304 - Veterans Affairs
This site provides public access to all VA forms that are appropriate to be on the web.
Learn more
application for benefits for certain children with...
VA FORM. SEP 2006. 21-0304. 1. NAME OF CLAIMANT - CHILD (First, middle, last). 2. SOCIAL...
Learn more

Related links form

FL Subpoena Ad Testificandum - Leon County 2010 FL Non-Residential Application For Service - Palm Beach County 2019 TX River Mountain Ranch Cattle Company Grazing Lease Agreement 2017 CA Truckee Fire Protection District Self-Inspection Form Business Occupancies 2016

Questions & Answers

Get answers to your most pressing questions about US Legal Forms API.

Contact support

Health Benefits Update Form. Use VA Form 10-10EZR if you already receive VA health care benefits, and you need to update your personal, insurance, or financial information.

If you are requesting VA's help in obtaining these records, you should also fill out VA Form 21-4142a, which gives VA the information needed to locate and contact your providers. If you already have these records or are going to obtain them yourself, you should NOT fill out the form.

VA Form 3288, REQUEST FOR AND CONSENT TO RELEASE OF INFORMATION FROM INDIVIDUAL'S RECORDS.

Use VA Form 21-4142 to give us permission to obtain your personal information from a non-VA source like a private doctor or hospital. Examples of personal information may include your medical treatment, hospitalizations, psychotherapy, or outpatient care.

VA form 20-5455 was an invaluable tool to the veteran and anyone helping the veteran since it showed the following information: (1) All service connected disabilities awarded to the veteran including Diagnostic Code, (2) Dates of original award and each increase, (3) a year-by-year chronology of the veteran's total ...

A VA Form 21-22a is known as an Appointment of Individual as Claimant's Representative form. It will be used by the United States Department of Veterans Affairs. This form is necessary to recognize someone as a representative of a veteran who has a claim with the Department of Veterans Affairs.

A VA Form 21-22a is known as an Appointment of Individual as Claimant's Representative form. It will be used by the United States Department of Veterans Affairs. This form is necessary to recognize someone as a representative of a veteran who has a claim with the Department of Veterans Affairs.

Veterans who were exposed to Agent Orange in Vietnam while on active duty are eligible for disability compensation through the Department of Veterans Affairs (VA) as long as they were discharged under conditions other than dishonorable.

The VA, however, will accept a power of attorney as valid for health care decision-making purposes, even if it is not notarized, if VA Form 10-0137, VA Advance Directive: Durable power of attorney for Health Care and Living Will, is completed. ... A durable power of attorney for health care does not have to be notarized.

Get This Form Now!

Use professional pre-built templates to fill in and sign documents online faster. Get access to thousands of forms.
If you believe that this page should be taken down, please follow our DMCA take down processhere.

Industry-leading security and compliance

US Legal Forms protects your data by complying with industry-specific security standards.
  • In businnes since 1997
    25+ years providing professional legal documents.
  • Accredited business
    Guarantees that a business meets BBB accreditation standards in the US and Canada.
  • Secured by Braintree
    Validated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.
Get Va Benefits Certain Online
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
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
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 WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
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
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
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
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 WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
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
Va Benefits Certain Online
This form is available in several versions.
Select the version you need from the drop-down list below.
2016 VA Form 21-0304 "Application For Benefits For A Qualifying ...
Select form
  • 2016 VA Form 21-0304 "Application For Benefits For A Qualifying ...
  • 2006 VA 21-0304
  • Va Benefits Certain Online
Select form