Header and Item 1: identification
The Veteran's and surviving spouse's names, the VA file number, the surviving spouse's mailing address, a VA regional office return address box, the Veteran's and your Social Security numbers and your date of birth.
21P-0512s-1
Old Law and Section 306 Eligibility Verification Report (Surviving Spouse)
- Agency
- VA
- Revision
- June 2024
- Fillable fields
- 60
- Pages
- 2
- Official source
- VA form page
- Checked
- October 20, 2026
VA Form 21P-0512s-1: Old Law and Section 306 Verification Report (Surviving Spouse)
VA Form 21P-0512s-1 is the U.S. Department of Veterans Affairs Old Law and Section 306 Eligibility Verification Report for a surviving spouse. The form says it is used by surviving spouses receiving Old Law or Section 306 Pension, and it explains the two: a fixed rate of pension received since 1960 is Old Law Pension, and a fixed rate received since 1978 is Section 306 Pension.
The form is two pages. Page 1 covers identification, marital status since the Veteran's death, dependent children, nursing home care, employment, other VA benefits and monthly income. Page 2 holds annual income, income changes, net worth, medical expenses, the signature and phone numbers. The form says to read the enclosed EVR Instructions (VA Form 21P-0510) before completing it. You can fill out the PDF free in your browser on this page and download the result without an account.
What's on VA Form 21P-0512s-1
Item 2: marital status
One box: not remarried since the Veteran died, remarried and still married with the date of the current marriage, or remarried with the latest marriage since ended by death or divorce, with that date.
Items 3 to 6: household and benefits
Unmarried dependent children, contributions to children not in your custody, nursing home status with the entry date, facility and Medicaid coverage, wages or employment in the last 12 months, and any other VA benefits with their VA file number.
Items 7A and 7B: monthly and annual income
Gross monthly amounts from Social Security, U.S. Civil Service, U.S. Railroad Retirement, military retirement, Black Lung benefits, SSI or public assistance and other income, then this year's and last year's wages, interest and dividends and other income.
Items 7C to 8: changes, net worth and medical expenses
Whether income changed in the past 12 months, with what changed, when and how, then net worth from bank accounts, IRAs and Keogh plans, stocks, bonds and mutual funds, real property other than your home and all other property. Item 8 points to VA Form 21P-8416 for medical expenses.
Items 9 and 10: signature and phones
Signature of the claimant, custodian or guardian, the date, daytime and evening phone numbers, and a penalty notice for the willful submission of false statements or evidence.
How to complete VA Form 21P-0512s-1
- 1
Read the EVR Instructions
The form says to read the enclosed EVR Instructions, VA Form 21P-0510, before completing it. Several items point to numbered paragraphs in them.
- 2
Identify your pension type
The form ties Old Law Pension to a fixed rate since 1960 and Section 306 Pension to a fixed rate since 1978. Old Law recipients skip the net worth and family medical expenses items.
- 3
Report income without blanks
The form says to write "0" or "none" when there is no income or net worth from a source, and not to leave any items blank.
- 4
Explain any income change
If income changed in the past 12 months other than a Social Security or VA cost-of-living adjustment, or there was new or one-time income, Items 7D to 7F ask what changed, when and how.
- 5
Sign, date and add phone numbers
Sign Item 9A, enter the date in Item 9B and give daytime and evening phone numbers in Item 10.
- 6
Return it to VA
The form does not print a mailing address. Its first page has a box for the VA regional office return address.
Why fill Form 21P-0512s-1 on indox
You get the real form, filled in a browser tab, with nothing standing between you and the finished PDF.
- Fill the form right in your browser, no software to install
- Free to fill and free to download, with no account
- The official blank straight from the VA, not a copy someone retyped
- Works on a phone, tablet or computer
Where to send it
Return address
The form does not print a mailing address. Its header has a box for the VA regional office return address.
Instructions
The form refers to EVR Instructions, VA Form 21P-0510, enclosed with it.
Online and Spanish
VA's form page offers a downloadable PDF and does not list an online version. VA's forms list names a Spanish version, 21P-0512s-1 (Spanish), as a related form.
Edition
The JUN 2024 edition supersedes the JUL 2021 edition, which the form says will not be used. It carries OMB Approved No. 2900-0101, expiration date 06/30/2027, and a respondent burden of 30 minutes.
Related forms
21P-0512V-1
Old Law and Section 306 Eligibility Verification Report (Veteran)
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21P-0513-1
Old Law and Section 306 Eligibility Verification Report (Children Only)
147 fields, 2 pages
21P-8416
Medical Expense Report
517 fields, 10 pages
21P-0514-1
D.I.C. Parent’s Eligibility Verification Report
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21P-0518-1
Improved Pension Eligibility Verification Report (Surviving Spouse with No Children)
62 fields, 2 pages
21P-0519s-1
Improved Pension Eligibility Verification Report (Surviving Spouse with Children)
152 fields, 2 pages
Who uses VA Form 21P-0512s-1?
The form says it is used by surviving spouses receiving Old Law or Section 306 Pension.
Official sources and the blank
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Questions about Form 21P-0512s-1
What is VA Form 21P-0512s-1 used for?
The form says it is used by surviving spouses receiving Old Law or Section 306 Pension. It asks about marital status, dependents, nursing home care, income and, for Section 306, net worth.
What is the difference between Old Law and Section 306 Pension?
The form says a fixed rate of pension received since 1960 is Old Law Pension, and a fixed rate received since 1978 is Section 306 Pension.
Do Old Law Pension recipients report net worth?
No. The form says Old Law recipients skip net worth and family medical expenses. Its page 1 note calls these Items 2G and 3, while on page 2 they are numbered Items 7G and 8.
What does Item 2 ask about remarriage?
Whether you have not remarried since the Veteran died, remarried and are still married, or remarried and that marriage ended by death or divorce. The last two boxes ask for a date.
Can I leave a line blank if I had no income from it?
The form says to write "0" or "none" when there is no income or net worth from a source, and not to leave any items blank.
How are medical expenses reported?
Item 8 says to use VA Form 21P-8416, Medical Expense Report, if Paragraph 6 of the EVR Instructions indicates that medical expenses should be reported.
Is there a Spanish version?
VA's forms list names 21P-0512s-1 (Spanish) as a related form.