Header and Items 1A to 1D
The Veteran's name, complete mailing address and VA file number, a box for the VA regional office return address, the Veteran's and spouse's Social Security numbers, and the spouse's name and date of birth.
21P-0516-1
Improved Pension Eligibility Verification Report (Veteran with No Children)
- Agency
- VA
- Revision
- June 2024
- Fillable fields
- 96
- Pages
- 2
- Official source
- VA form page
- Checked
- October 20, 2026
VA Form 21P-0516-1: Improved Pension EVR (Veteran with No Children)
VA Form 21P-0516-1 is the U.S. Department of Veterans Affairs Improved Pension Eligibility Verification Report (EVR) for a Veteran with no children. It asks the Veteran about marital status, a spouse, nursing home care, work, other VA benefits, income, net worth and education expenses. The form says to read the enclosed EVR Instructions (VA Form 21P-0510) before completing it, and many items point to a paragraph of those instructions.
The form is two pages. Page 1 covers identification, marital status, dependent children, nursing home and Medicaid questions, wages and other VA benefits. Page 2 holds monthly and annual income, income changes, net worth, a note on medical expenses, the Veteran's education and vocational rehabilitation expenses, and the signature. The medical expense note describes two uses of the form: as the annual Eligibility Verification Report or as a supplement to a pending claim.
VA's form page lists it under pension and offers it as a downloadable PDF. 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-0516-1
Items 2 and 3: marital status and children
One of married and living with spouse, married and not living with spouse, or not married, with support paid to a spouse and any recent separation, divorce or death date. Item 3 asks the number of unmarried, dependent children in and not in your custody and what you contributed to children not in your custody.
Items 4 to 6: nursing home, work and other benefits
Nursing home and Medicaid questions, whether you or your spouse received wages or were employed at any time during the past 12 months, and whether you receive other VA benefits.
Items 7A to 7F: income
Gross monthly amounts 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, for the Veteran and spouse, plus any income change in the past 12 months.
Item 7G: net worth
Cash and non-interest-bearing bank accounts, interest-bearing bank accounts, IRAs and Keogh plans, stocks, bonds and mutual funds, real property other than your home, and all other property, for the Veteran and spouse.
Items 8 to 10: expenses and signature
Item 8 points to VA Form 21P-8416, Medical Expense Report, for medical expenses. Item 9 is the Veteran's educational and vocational rehabilitation expenses paid in the last 12 months. Item 10 holds the signature, date and daytime and evening phone numbers.
How to complete VA Form 21P-0516-1
- 1
Read the EVR Instructions
The form says to read the enclosed EVR Instructions (VA Form 21P-0510) before completing it. Many items name the paragraph of the instructions that applies.
- 2
Answer the page 1 questions
Check only one marital status box and answer the Yes or No questions. The form says which items to skip, for example to go to Item 5 if you are not a nursing home patient.
- 3
Fill in income and net worth
If no income was received from a source, the form says to write "0" or "none", and that VA will interpret a blank space as "none" or "0". If no dates are shown above the annual income columns, the form says to report last calendar year income on the left and current calendar year income on the right.
- 4
Describe any income change
Item 7C asks whether any income changed during the past 12 months. The form says to answer No if the only change was a Social Security or VA cost-of-living adjustment. If Yes, Items 7D to 7F ask what changed, when and how.
- 5
Sign and date it
The form says to read paragraph 9 of the EVR Instructions before signing Item 10A. Enter the date in Item 10B and daytime and evening phone numbers in Item 10C.
Why fill Form 21P-0516-1 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
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- 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 has a box for the VA regional office return address. It does not print a mailing address of its own.
Paper form
VA's form page offers VA Form 21P-0516-1 as a downloadable PDF and lists no online version.
Edition
The June 2024 edition supersedes the July 2021 edition, which the form says will not be used. It carries OMB Control No. 2900-0101, which expires 06/30/2027, and a respondent burden of 30 minutes.
Related forms
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21P-0519s-1
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Questions about Form 21P-0516-1
What is VA Form 21P-0516-1?
It is the Improved Pension Eligibility Verification Report for a Veteran with no children. It asks about marital status, nursing home care, work, other VA benefits, income, net worth and education expenses.
What should I read before filling it out?
The form says to read the enclosed EVR Instructions, VA Form 21P-0510, before completing it. Items on both pages point to specific paragraphs of those instructions.
Do I report medical expenses on this form?
Item 8 says that if you use this form as your annual Eligibility Verification Report and Paragraph 6 of the EVR Instructions says to report medical expenses, you use VA Form 21P-8416, Medical Expense Report. If you use it as a supplement to a pending claim, the form says you do not need to report medical expenses.
What if I had no income from a source?
The form says to write "0" or "none". It also says VA will interpret a blank space as "none" or "0".
Which year's income goes in Item 7B?
The form says to report annual income for the dates shown. If no dates are shown above the columns, report last calendar year (January through December) income in the left-hand column and current calendar year income in the right-hand column.
Can an attorney or agent charge a fee for helping?
The form's fees for claims note says that, generally, a VA-accredited attorney or agent may charge a fee for help seeking further review of a claim only after VA has issued an initial decision on the claim and the attorney or agent has complied with the power-of-attorney and fee agreement requirements.
Is there a version for a Veteran with children?
Yes. VA publishes VA Form 21P-0517-1, the Improved Pension Eligibility Verification Report for a Veteran with children.