21P-527EZ
Application for Veterans Pension
VA Form 21P-527EZ is the U.S. Department of Veterans Affairs Application for Veterans Pension. VA's form page says to use it if you're a wartime Veteran and want to file a pension claim. The PDF opens with seven pages of notice that explain the evidence needed for Veterans Pension, Special Monthly Pension and benefits based on a Veteran's seriously disabled child, followed by the application itself and two care worksheets.
The notice says the application has 14 sections: identification, contact and service information, pension questions, employment history, marital status and prior marriages, dependent children, income and assets, unreimbursed medical expenses, direct deposit, and signatures. It points to other forms for other needs: VA Form 21P-534EZ for survivors benefits, VA Form 20-0995 for a supplemental claim and VA Form 21-0966 to file an intent to file first.
VA's page says you can apply online instead of sending the paper form. You can fill out the PDF free in your browser on this page and download the result without an account.
Name, Social Security number, date of birth, VA file number, address, phone and email, then other names served under, active duty dates, service number, branch, place of last separation and any prisoner of war dates.
Whether you are over 65 or found disabled by the Social Security Administration, are medically incapable of working, live in a nursing home, have Medicaid cover nursing home costs, claim Special Monthly Pension, and VA or federal treatment.
Current and past employment, marital status and spouse details, your and your spouse's prior marriages, and dependent children with their status, such as biological, stepchild, adopted, seriously disabled or 18 to 23 and in school.
Whether you and your dependents have over $75,000.00 in assets, asset transfers in the three calendar years before this year, primary residence lot size, the number of income sources, and up to four income entries.
Up to three in-home care or care facility providers with type of care, dates and amounts, and up to six other medical, last illness or burial expenses with payee, purpose, date and frequency.
Direct deposit, your certification and signature, two witnesses if you sign with an X, an alternate signer certification, and worksheets for a care facility and for in-home attendant expenses.
The notice says to leave items in a section blank if they do not apply to you.
The first seven pages explain the evidence for each claim type, how VA helps get records, the terms used to calculate pension, and a checklist of evidence VA may require. The Section XII certification says you received this notice.
To verify service, the notice lists a copy of your DD Form 214 (or equivalent) for all periods of military service. It asks that original documents not be sent, because they will not be returned.
Questions 9A to 9G say when to add VA Form 21P-0969, for example over $75,000.00 in assets, an asset transfer, or 5 or more income sources. In that case the form asks only for Social Security income in 9H to 9K.
The form names VA Form 21-2680 for Special Monthly Pension, VA Form 21-0779 for a nursing home, VA Form 21-674 for a child 18 to 23 in school, and VA Form 21P-8416 if more medical expense space is needed.
For in-home care, residential care, adult daycare or a similar facility, the form asks for the worksheet on page 16 or 17 for each provider, completed and signed by the facility or the in-home care provider.
Sign Item 12A and date Item 12B, then mail it to the Pension Intake Center in Janesville, Wisconsin, or submit it online at va.gov or by direct upload through access.va.gov.
You get the real form, filled in a browser tab, with nothing standing between you and the finished PDF.
Department of Veterans Affairs, Pension Intake Center, P.O. Box 5365, Janesville, Wisconsin 53547-5365. The notice suggests keeping a photocopy of the application and everything sent with it.
VA's form page says you can apply online instead of sending the paper form. The notice also lists direct upload through access.va.gov.
The notice says you have up to one year from the date VA received the claim to submit information and evidence, and that this still applies if VA decides the claim before the year ends.
The notice says the beginning date of entitlement is generally based on when VA received the claim, or the intent to file for pension if the completed application arrives within a year of it.
Section XI says the Department of the Treasury requires federal benefit payments by electronic funds transfer. It points people without a bank account to the Veterans Benefits Banking Program and 1-800-827-1000.
The notice points to accredited Veterans Service Officers, state offices of Veterans affairs, and VA-accredited attorneys and claims agents. VA Form 21-22 or VA Form 21-22a appoints a representative. The form estimates 30 minutes to complete.
21-0966
49 fields, 2 pages
21-22
63 fields, 4 pages
20-0995
136 fields, 7 pages
21-4138
33 fields, 2 pages
21P-0969
428 fields, 11 pages
21-2680
112 fields, 4 pages
VA's form page and the notice at the front of the form describe these claimants.
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Yes. VA's form page says you can apply online instead of filling out and sending the paper form, and the notice also lists direct upload through access.va.gov. You can fill out the PDF here free and print or download it.
The notice says a Veteran claiming pension who is 65 or older, or found disabled by the Social Security Administration, does not have to submit medical evidence unless claiming Special Monthly Pension. Item 4B asks for medical evidence when you answer yes to being medically incapable of working.
Section IX points to VA Form 21P-0969 if you and your dependents have over $75,000.00 in assets, transferred assets in the three calendar years before this year, have marketable land over 2 acres around the primary residence, or have 5 or more income sources.
The notice suggests VA Form 21-0966 to protect your date of claim. It says that if VA Form 21P-527EZ is completed within one year of filing VA Form 21-0966, the application is considered filed as of the date VA received the VA Form 21-0966.
The notice describes it as an increased amount paid to people who, due to mental or physical disability, need the aid of another person for activities of daily living, are in a nursing home, have severe visual problems, or are substantially confined to their home. Item 4E asks for VA Form 21-2680 with that claim.
Section XIV is for an alternate signer, such as a court-appointed representative, an attorney in fact under a durable power of attorney, or a person or institution responsible for the claimant's care. The form says VA may ask for documents showing that authority.
The notice lists Department of Veterans Affairs, Pension Intake Center, P.O. Box 5365, Janesville, Wisconsin 53547-5365.