21P-0519s-1
Improved Pension Eligibility Verification Report (Surviving Spouse with Children)
VA Form 21P-0519s-1 is the U.S. Department of Veterans Affairs Improved Pension Eligibility Verification Report (EVR) for a surviving spouse with children. It asks the surviving spouse about remarriage, 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 the Veteran's and surviving spouse's names, both Social Security numbers, 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 in SURVIVING SPOUSE and CHILD columns, income changes, a note on family medical expenses, education and family maintenance (hardship) expenses and the payee's signature.
VA's form page lists it under family member and caregiver benefits 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.
The Veteran's name, the surviving spouse's name and complete mailing address, the VA file number, a box for the VA regional office return address, your Social Security number, the Veteran's Social Security number and your date of birth.
One of three remarriage choices. Item 3A lists the unmarried dependent children, and Item 3B covers children listed in 3A who do not live with you.
Nursing home and Medicaid questions, whether you received wages or were employed at any time during the past 12 months, and whether you receive other VA benefits, with that benefit's VA file number.
Gross monthly amounts from Social Security, U.S. Civil Service, U.S. Railroad Retirement, Black Lung Benefits, other retirement and other sources, then annual salary or wages, interest and dividends and other income, in SURVIVING SPOUSE and CHILD columns, plus any income change.
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 surviving spouse and each child column.
Item 8 points family medical expenses to VA Form 21P-8416. Item 9 is your educational and vocational rehabilitation expenses, not children's, Item 10 is family maintenance (hardship) expenses for the next 12 months, and Item 11 is the payee's signature, date and phone numbers.
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.
Check only one box in Item 2, then enter each unmarried dependent child in Item 3A with one age or status box checked. Children who do not live with you go in Item 3B.
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.
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.
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.
Sign Item 11A after reading Paragraph 9 of the EVR Instructions, as the form asks. Enter the date in Item 11B and daytime and evening phone numbers in Item 11C.
You get the real form, filled in a browser tab, with nothing standing between you and the finished PDF.
The form has a box for the VA regional office return address. It does not print a mailing address of its own.
VA's form page offers VA Form 21P-0519s-1 as a downloadable PDF and lists no online version.
VA's forms feed lists a Spanish version of VA Form 21P-0519s-1 as a related form.
The June 2024 edition supersedes the July 2021 edition, which the form says will not be used. It carries OMB Approved No. 2900-0101, which expires 06/30/2027, and a respondent burden of 40 minutes.
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It is the Improved Pension Eligibility Verification Report for a surviving spouse with children. It asks about remarriage, each unmarried dependent child, nursing home care, work, other VA benefits, income, net worth and expenses.
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.
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.
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.
The form says to write "0" or "none". It also says VA will interpret a blank space as "none" or "0".
Yes. VA publishes VA Form 21P-0518-1, the Improved Pension Eligibility Verification Report for a surviving spouse with no children.