21P-0512V-1
Old Law and Section 306 Eligibility Verification Report (Veteran)
VA Form 21P-0512V-1 is the U.S. Department of Veterans Affairs Old Law and Section 306 Eligibility Verification Report for Veterans. The form says it is used by veterans 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, dependent children, nursing home care, employment and other VA benefits. Page 2 is the report of income and net worth, followed by the signature, phone numbers and a penalty notice. 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.
The Veteran's name, VA file number and mailing address, a VA regional office return address box, Social Security numbers, the spouse's name and date of birth, and one marital status box. A Veteran living apart shows support paid to the spouse in the last 12 months, and dates of a recent separation, divorce or death go here too.
Unmarried dependent children in and not in your custody, amounts contributed to children not in your custody, nursing home status with the entry date, facility and Medicaid coverage, wages or employment in the past 12 months, and any other VA benefits with their VA file number.
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 last year's and this year's wages, interest and dividends and other income.
Whether income changed in the last 12 months, with what changed, when and how, then the Veteran's net worth in bank accounts, IRAs and Keogh plans, stocks, bonds and mutual funds, real property other than the home and all other property.
The form says that if Paragraph 6 of the EVR Instructions indicates medical expenses should be reported, VA Form 21P-8416, Medical Expense Report, is used to report them.
Items 9 and 10 hold the signature, date and daytime and evening phone numbers. Page 2 ends with a penalty notice for false statements, and page 1 has a notice on fees a VA-accredited attorney or agent may charge under Section 5904, Title 38, United States Code.
The form says to read the enclosed EVR Instructions, VA Form 21P-0510, before completing it. Several items point to numbered paragraphs in them.
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 Items 7G and 8.
The form says to write "0" or "none" when no income or net worth came from a source, and not to leave any items blank.
If income changed in the last 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.
Sign Item 9A, enter the date in Item 9B and give daytime and evening phone numbers in Item 10. The form points to Paragraph 9 of the EVR Instructions before signing.
The form does not print a mailing address. Its first page has a box for the VA regional office return address.
You get the real form, filled in a browser tab, with nothing standing between you and the finished PDF.
The form does not print a mailing address. Its header has a box for the VA regional office return address.
The form refers to EVR Instructions, VA Form 21P-0510, enclosed with it.
VA's form page offers a downloadable PDF and does not list an online version of this form.
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.
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The form says it is used by veterans receiving Old Law or Section 306 Pension, and it treats the two groups differently.
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The form says it is used by veterans receiving Old Law or Section 306 Pension. It asks about marital status, dependents, nursing home care, income and, for Section 306, net worth.
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.
No. The form says Old Law Pension recipients do not complete Item 7G, Net Worth, or Item 8, Family Medical Expenses.
The income tables say to report the spouse's income only if you receive Section 306 Pension.
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.
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.
The form does not print a mailing address. Its header has a box for the VA regional office return address.