Header: Veteran, claimant and missing person
The names of the Veteran, the claimant and the missing person, the file number and the claimant's relationship to the missing person, plus the Privacy Act, burden and fees notices.
21P-1775
Statement of Disappearance
- Agency
- VA
- Revision
- December 2025
- Fillable fields
- 200
- Pages
- 6
- Official source
- VA form page
- Checked
- October 20, 2026
VA Form 21P-1775: Statement of Disappearance
VA Form 21P-1775 is the U.S. Department of Veterans Affairs Statement of Disappearance. It collects detailed information about a person who disappeared, referred to on the form as the "missing person". The form names the Veteran, the claimant and the claimant's relationship to the missing person, then asks about the person completing the form, the missing person's background, their business, legal and social affairs, and the disappearance itself.
The form is six pages in five sections. Its instructions say all questions should be answered in detail and as fully as possible, and to state "unknown" for any question you do not know the answer to.
VA's page lists the form under Family member and caregiver benefits and Pension, with a downloadable PDF and no online version. 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-1775
Section II: the missing person
Items 5 to 30: birth details, parents, nicknames, a physical description, address and household at disappearance, marital history, family, friends, health and any treatment.
Section III: business, legal and social affairs
Items 31 to 56: Social Security number, occupation, ten-year employment history, bonding, life insurance, bank accounts, property, memberships, other benefit claims, court matters, debts, habits and travel.
Section IV: the disappearance
Items 57 to 79: dates and place last seen, circumstances, travel plans, belongings taken, any vehicle, search efforts and police, any contact since, and whether a court was asked to declare the person dead.
Section V: certification and signature
A certification that the statements are true and correct, the date, a signature in ink and the signer's address, then two witness boxes for a signature by mark.
How to complete VA Form 21P-1775
- 1
Read the instructions
The form asks for every question to be answered in detail and as fully as possible, with "unknown" for any answer not known.
- 2
Identify everyone named
Fill in the Veteran, claimant and missing person at the top, then Section I about the person completing the form.
- 3
Work through Sections II to IV
Answer each item about the missing person and the disappearance. Section IV asks for exact dates if possible.
- 4
Attach evidence
Section IV asks for copies of police or other agency reports, newspaper items, letters and notes, and any court proceedings declaring the missing person dead. The form says this evidence will not be returned.
- 5
Sign and mail it
Sign in ink, date it and add your address in Section V, then mail it to the Pension Intake Center.
Why fill Form 21P-1775 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 and getting help
By mail
Department of Veterans Affairs, Pension Intake Center, P.O. Box 5365, Janesville WI 53547-5365.
Questions
The form points to AskVA at https://ask.va.gov/ and the toll-free number 1-800-827-1000 (TTY:711).
Time to complete
The form estimates a respondent burden of 2 hours 45 minutes.
Edition
The DEC 2025 edition supersedes VA Form 21-1775, AUG 2022. It carries OMB Approved No. 2900-0036, which expires 12/31/2028.
Related forms
21-4138
Statement in Support of Claim (VA Form 21-4138)
33 fields, 2 pages
21P-534EZ
Application for D.I.C., Survivors Pension, and/or Accrued Benefits
626 fields, 20 pages
21P-527EZ
Application for Veterans Pension
477 fields, 17 pages
21P-601
Application for Accrued Amounts Due a Deceased Beneficiary
107 fields, 5 pages
Who uses VA Form 21P-1775?
The form names several people. This is who each part is for.
Official sources and the blank
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Questions about Form 21P-1775
What is VA Form 21P-1775?
It is VA's Statement of Disappearance, a six-page form that collects detailed information about a missing person, the claimant and the circumstances of the disappearance.
Who can complete VA Form 21P-1775?
Section I asks for the person completing the form and their relationship to the claimant and to the missing person, with examples such as mother, close friend or casual friend.
What if I do not know an answer?
The instructions say to state "unknown" for any question you do not know the answer to.
What if I need more space?
The instructions say to attach VA Form 21-4138, Statement in Support of Claim, numbering the answers to match the questions.
Will VA return the documents I attach?
No. Section IV says the evidence relating to the disappearance will not be returned.
Where do I mail VA Form 21P-1775?
The form lists Department of Veterans Affairs, Pension Intake Center, P.O. Box 5365, Janesville WI 53547-5365.
Can I file VA Form 21P-1775 online?
VA's form page lists a downloadable PDF and does not list an online version.