21P-0514-1
D.I.C. Parent’s Eligibility Verification Report
VA Form 21P-0514-1 is the U.S. Department of Veterans Affairs D.I.C. Parent's Eligibility Verification Report. A parent of a Veteran fills it in and signs it, reporting marital status, nursing home care, employment, other VA benefits and income for the parent and the parent's spouse. VA's page lists it under family member and caregiver benefits.
The form is two pages. Page 1 identifies the Veteran and the parent and asks Items 1 to 6. Page 2 holds monthly and annual income, income changes, a note on medical expenses, the parent's signature and phone numbers. The form says it can be used as the annual Eligibility Verification Report or as a supplement to a pending claim, and says to read the enclosed EVR Instructions (VA Form 21P-0510) first. You can fill out the PDF free in your browser on this page and download the result without an account.
The Veteran's name and Social Security number, the parent's name and address, the VA file number, payee number and stub name, a VA regional office return address box, and Social Security numbers and dates of birth for you and your spouse.
One of four boxes: married and living with the Veteran's other parent, married and living with a spouse who is not the other parent, separated, or not now married, with dates for a separation, divorce or spouse's death in the last 12 months. Item 3 asks if the other parent is living.
Nursing home status with the entry date and the facility's name, address and phone, whether you or your spouse were employed in the 12 months before signing, and any other VA benefits with their VA file number.
Gross monthly amounts for you and your spouse from Social Security, U.S. Civil Service, U.S. Railroad Retirement, Black Lung benefits, military retirement and other sources, then annual wages, interest and dividends and other income with from and thru dates.
Whether income changed in the past 12 months, with what changed, when and how. Item 8 says medical expenses are normally reported at the end of the year and points to VA Form 21P-8416.
Signature of the parent, the date signed, daytime and evening phone numbers, and a penalty notice for the willful submission of false statements or evidence.
The form says to read the enclosed EVR Instructions, VA Form 21P-0510, before completing it. Several items point to numbered paragraphs in them.
Item 2 says to check only one box, and to give the date if a separation, divorce or spouse's death happened in the last 12 months.
The income tables say to write "0" or "none" when no income was received from a source, and that VA will interpret a blank space as none or 0.
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.
Sign Item 9A, enter the date in Item 9B and give daytime and evening phone numbers in Item 9C.
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. VA's forms list names a Spanish version, 21P-0514-1 (Spanish), as a related 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.
21P-8416
517 fields, 10 pages
21P-535
222 fields, 10 pages
21P-0512V-1
85 fields, 2 pages
21P-0512s-1
60 fields, 2 pages
21P-0513-1
147 fields, 2 pages
The form is completed and signed by a parent of the Veteran, with details about the parent's spouse.
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It is the D.I.C. Parent's Eligibility Verification Report. The form says it can be used as the annual Eligibility Verification Report or as a supplement to a pending claim.
The monthly and annual income tables each have a column for you and a column for your spouse.
The income tables say to write "0" or "none" when no income was received from a source, and that VA will interpret a blank space as none or 0.
No. Item 8 says that when the form is used as the annual report and Paragraph 6 of the EVR Instructions says to report medical expenses, they go on VA Form 21P-8416, Medical Expense Report.
The form says a parent using it as a supplement to a pending claim does not need to report medical expenses, and that if entitlement is established there is an opportunity to report them at the end of the year.
VA's forms list names 21P-0514-1 (Spanish) as a related form.