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-0517-1
Improved Pension Eligibility Verification Report (Veteran with Children)
- Agency
- VA
- Revision
- June 2024
- Fillable fields
- 160
- Pages
- 2
- Official source
- VA form page
- Checked
- October 20, 2026
VA Form 21P-0517-1: Improved Pension EVR (Veteran with Children)
VA Form 21P-0517-1 is the U.S. Department of Veterans Affairs Improved Pension Eligibility Verification Report (EVR) for a Veteran with children. It asks the Veteran about marital status, a spouse, each unmarried dependent child, nursing home care, work, other VA benefits, income, net worth and 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, the children's names, birth dates and Social Security numbers, children who live elsewhere, nursing home and Medicaid questions, wages and other VA benefits. Page 2 holds income and net worth for the Veteran, spouse and a child, income changes, a note on medical expenses, education expenses, family maintenance (hardship) expenses and the signature.
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-0517-1
Items 2 and 3: marital status and children
One of married and living with spouse, married and not living with spouse, or not married. Item 3A lists the unmarried dependent children, and Item 3B covers children listed in 3A who do not live with you.
Items 4 to 6: nursing home, work and other benefits
Whether you are a nursing home patient, the date you entered, the home's name, address and phone number and whether Medicaid covers all or part of the fees, whether you or your spouse received wages or worked during the past 12 months, and any 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, in VETERAN, SPOUSE and CHILD columns, 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, spouse and child.
Items 8 to 11: expenses and signature
Item 8 points medical expenses to VA Form 21P-8416. Item 9 is the Veteran's educational and vocational rehabilitation expenses, Item 10 is family maintenance (hardship) expenses for the next 12 months, and Item 11 holds the signature, date and phone numbers.
How to complete VA Form 21P-0517-1
- 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
List your children
Enter each unmarried dependent child in Item 3A and check one age or status box for each. Children listed in Item 3A who do not live with you go in Item 3B.
- 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
Check whether Item 10 applies
The form says to complete Item 10, family maintenance (hardship) expenses, only if VA is currently excluding children's income on the grounds of hardship. It asks for total family expenses expected for the next 12 months.
- 6
Sign and date it
The form says to read paragraph 9 of the EVR Instructions before signing Item 11A. Enter the date in Item 11B and daytime and evening phone numbers in Item 11C.
Why fill Form 21P-0517-1 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 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-0517-1 as a downloadable PDF and lists no online version.
Spanish version
VA's forms feed lists a Spanish version of VA Form 21P-0517-1 as a related form.
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 40 minutes.
Related forms
21P-8416
Medical Expense Report
517 fields, 10 pages
21P-0516-1
Improved Pension Eligibility Verification Report (Veteran with No Children)
96 fields, 2 pages
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
21P-0519c-1
Improved Pension Eligibility Verification Report (Child or Children)
147 fields, 2 pages
21P-527EZ
Application for Veterans Pension
477 fields, 17 pages
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Questions about Form 21P-0517-1
What is VA Form 21P-0517-1?
It is the Improved Pension Eligibility Verification Report for a Veteran with children. It asks about marital status, each unmarried dependent child, nursing home care, work, other VA benefits, income, net worth and expenses.
Which children go on the form?
Item 3A asks for unmarried dependent children and refers to Paragraph 1 of the EVR Instructions. Each child is marked as under 18, over 18 and under 23 and attending school, or any age and permanently helpless for mental or physical reasons.
When is Item 10 completed?
The form says to complete Item 10, family maintenance (hardship) expenses, only if VA is currently excluding children's income on the grounds of hardship.
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".
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 no children?
Yes. VA publishes VA Form 21P-0516-1, the Improved Pension Eligibility Verification Report for a Veteran with no children.