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Department of Veterans Affairs

Form 10-0094aMedical Education Affiliation Agreement - School of Medicine11/19/2004
Form 10-0094bMedical Education Affiliation Agreement - Osteopathic Medicine11/19/2004
Form 10-0094cMedical Education Affiliation Agreement - Graduate Medical Education11/19/2004
Form 10-0094dMedical Education Affiliation Agreement - School of Dentistry11/19/2004
Form 10-0094eMedical Education Affiliation Agreement - VA Sponsor - Dentistry11/19/2004
Form 10-0094fDental Education Affiliation Agreement11/19/2004
Form 10-0094gAssociated Health Education Affiliation Agreement11/19/2004
Form 10-0094hEducation Affiliation Agreement - Non-VA Health Care Facility11/19/2004
Form 10-0102CAREER DEVELOPMENT APPLICATION -04/06/2006
Form 10-0103Veterans Application for Assistance in Acquiring Home Improvement-10/31/2007
Form 10-0137VA Advance Directive: Living Will & Durable Power of Attorney for Health Care07/17/2012
Form 10-0137AYour Rights Regarding Advance Directives -09/19/2011
Form 10-0137BWHAT YOU SHOULD KNOW ABOUT ADVANCE DIRECTIVES09/21/2011
Form 10-0137B-lg printWHAT YOU SHOULD KNOW ABOUT ADVANCE DIRECTIVES - large print09/21/2011
Form 10-0143Certification Regarding Drug-Free Workplace-12/06/2006
Form 10-0143aStatement of Assurance of Compliance with Sec. 504 of the Rehabilitation Act12/06/2006
Form 10-0144Certification Regarding Lobbying -12/06/2006
Form 10-0144aStatement of Assurance of Compliance with Equal Opportunity Laws-12/06/2006
Form 10-0246Veterans Patient Statement02/25/2013
Form 10-0376aCredentials Transfer Brief -09/21/2005
Form 10-0379Ecclesiastical Endorsing Organization Request to Designate Ecclesiastical Endorsing Official - fill04/13/2006
Form 10-0381Civil Rights Discrimination Complaint -07/22/2008
Form 10-0388Documents & Information Required for State Home Construction & Acquisition Grant09/08/2005
Form 10-0388-1Initial Application for State Home Construction & Acquisition09/08/2005
Form 10-0388-10Cert. of Compliance with Federal Requirements - State Home Construction Grant09/08/2005
Form 10-0388-11Memorandum of Agreement for a Grant to Construct or Acquire State Veterans Home09/08/2005
Form 10-0388-12Cert Re Debarment, Suspension, Ineligibility, Voluntary Exclusn-Lower Tier Tran09/08/2005
Form 10-0388-13Docs & Info Required for State Home Construction/Acquisition-Post Grant Requir's09/08/2005
Form 10-0388-14Checklist of Major Requirements for State Home Construction/Acquisition Grants12/27/2005
Form 10-0388-2Cert. of Compliance w/ the Provisions of Davis-Bacon Act (40 USC 276a to 276a-7)03/28/2006
Form 10-0388-3State Home Construction Grant Program Space Program Analysis-Nursing Home & Dom09/08/2005
Form 10-0388-4State Home Construction Grant Program-Adult Day Health Care09/08/2005
Form 10-0388-5Add'l. Doc's. & Info. Required-State Home Construction /Acquisition Grants Appl.09/08/2005
Form 10-0388-6Certification of State Matching Funds to Qualify for Group 1 on Priority List09/08/2005
Form 10-0388-7Cert. Re Debarment, Suspension, Other ...-Primary Covered Transactions09/08/2005
Form 10-0388-8Cert. Re Drug-Free Workplace Requirments for Grantees Other than Individuals09/08/2005
Form 10-0388-9Certification Regarding Lobbying09/08/2005
Form 10-0398Research Protocol Safety Survey05/01/2002
Form 10-0400Request for VSO Access to CPRS (Computer Patient Record System)08/05/2002
Form 10-0400aCPRS Read-Only Rules for VSOs08/05/2002
Form 10-0408VHA Fisher House Application04/13/2006
Form 10-0408AVHA FISHER HOUSE OR OTHER TEMPORARY LODGING APPLICATION01/19/2012
Form 10-0415VA Geriatrics and Extended Care (GEC) Referral -04/27/2006
Form 10-0426Meds By Mail Order Form CHAMPVA12/21/2012
Form 10-0430APPLICATION FOR ASSISTANCE FOR HIRING AND RETAINING NURSES AT STATE HOMES04/30/2009
Form 10-0436Application for an Off-site Tissue Banking Waiver -07/14/2011
Form 10-0445OCCUPATIONAL AND ENVIRONMENTAL EXPOSURE HISTORY -01/06/2010
Form 10-0454Military Treatment Facility Referral to VA Liaison -05/07/2009
Form 10-0455Clinical Trial Annual Progress Report07/19/2007
Form 10-0455aClinical Trial Inclusion/Enrollment Report11/13/2008
Form 10-0459Credentialing Release of Information Authorization01/24/2008
Form 10-0460Request for Prescription Drugs from an Eligible Veteran in a State Home06/09/2009
Form 10-0462Political Activities Fact Sheet and Certification09/08/2008
Form 10-0474Application for Biospecimen Storage at a For-Profit Institution07/14/2011
Form 10-0484Revocation for Release of Individually-Identifiable Health Information-01/31/2011
Form 10-0485Request for and Authorization to Release Protected Health Information to Nationwide Health Information Network10/31/2011
Form 10-0490Acknowledgement of Receipt Of Department of Veterans Affairs Protected Health Information By Affiliated Educational Institutions07/14/2010
Form 10-0502Ethics Consultation Feedback Tool08/17/2010
Form 10-1010EZApplication for Health Care Benefits 10-10EZ -07/30/2013
Form 10-1023Information Regarding Possible Claim Against Third Party Stock #F0139911/06/2007
Form 10-1086Research Consent Form -03/22/2006
Form 10-10CGInstructions for Completing Application for Comprehensive Assistance for Family Caregivers Program05/05/2011
Form 10-10dApplication for CHAMPVA Benefits-12/21/2012
Form 10-10ECApplication For Extended Care Services11/21/2006
Form 10-10EZAPPLICATION FOR HEALTH BENEFITS - Print and fill out by hand07/30/2013
Form 10-10EZRHealth Benefits Renewal Form02/10/2011
Form 10-10HSRequest for Hardship Determination12/01/2009
Form 10-10MMedical Certificate10/23/2013
Form 10-10SHState Home Program Application for Veteran Care Medical Certificate-04/16/2009
Form 10-1170Application for Furnishing Nursing Home Care to Beneficiaries of VA-06/04/2007
Form 10-1223Report of Subcommittee on Human Studies01/05/2006
Form 10-1245CVA/Department of Defense Sharing Agreement02/14/2012
Form 10-1313-1Merit Review Application -12/19/2006
Form 10-1313-10Research Advisory Group Summary Statement10/23/2013
Form 10-1313-11Rehab Research & Dev. Svc-Scientific Merit Review Board Summary Statement10/23/2013
Form 10-1313-13VHA Research & Development Letter of Intent Cover Page -10/27/2009
Form 10-1313-2Research and Development Program -12/19/2006
Form 10-1313-3Research & Development Program - Current Funds & First Year Request10/23/2013
Form 10-1313-4Research & Development Program-Estimated08/26/2009
Form 10-1313-5Research & Dev. Program-Investigator's Biographic Sketch12/19/2006
Form 10-1313-6Research & Development Program - Investigator's Biography12/19/2006
Form 10-1313-7VA Research & Development Program-Investigator's VA & Non-VA Research Support10/23/2013
Form 10-1313-8Research & Dev. Program-Investigator's Total VA & Non-VA Research/Dev. Support10/23/2013
Form 10-1313AMerit Review Board Summary Sheet10/23/2013
Form 10-1314HSR&D Carer Development Awardee Annual Progress Report-08/03/2005
Form 10-1394Application for Adaptive Equip - Motor Vehicle -09/10/2008
Form 10-1436Research and Development Information System Project Data Sheet10/23/2013
Form Oct-65Funeral Arrangements -11/09/2010
Form Oct-06Recommendation for Release of Patient in Home Other Than Patient's Own01/26/2005
Form Oct-07Residential Care Home Program - Sponsor Application -06/04/2007
Form Oct-09Patient Agreement with Hospital in Relation to Home Other Than Own10/29/2004
Form Oct-10Agreement to Provide Home Care to Patient10/29/2004
Form Oct-78Veterans Request for Refill of Medication -07/31/2007
Form Oct-11Authority and Invoice for Travel by Ambulance or Other Hired Vehicle03/12/2008
Form 10-2570DDental Record Authorization and Invoice for Outpatient Service -03/17/2008
Form 10-2649AInterfacility Transfer Form -06/05/2013
Form 10-2649BPhysician Certification & Patient Consent for Transfer -10/26/2006
Form Oct-50Application for Physicians, Dentists, Podiatrists, Optometrists & Chiropractors07/24/2006
Form 10-2850AApplication for Nurses and Nurse Anesthetists - -Order from SDC #F0104512/23/2011
Form 10-2850BApplication for Residents07/24/2006
Form 10-2850CApplication for Associated Health Occupations - Order from SDC #F0542810/21/2010
Form 10-2850dAPPLICATION FOR HEALTH PROFESSIONS TRAINEES01/31/2012
Form Oct-03Consent For Use of Picture and/or Voice07/20/2005
Form Oct-67State Home Inspection -12/06/2006
Form 10-4344a-MHVIndividual's Rqst for Med Record from MyHealtheVet -03/28/2012
Form Oct-45Request For and Authorization To Release Medical Records09/13/2013
Form 10-5345aIndividuals' Request for a Copy of Their Own Health Information - fill05/16/2012
Form 10-5345a-MHVIndividual's Rqst for Med Record from MyHealtheVet -05/29/2012
Form Oct-88State Home Report and Statement of Federal Aid Claimed -05/19/2009
Form 10-583Claim for Payment of Cost of Unauthorized Medical Services-01/24/2011
Form 10-6001aContract Progress Report06/05/2012
Form 10-6056ALease09/22/2009
Form Oct-31Daily Log - Formal Contract -12/06/2006
Form Oct-98Architect - Engineer Fee Proposal12/06/2006
Form Oct-55Application for Voluntary Service -03/03/2008
Form Oct-78Authorization and Invoice For Medical and Hospital Services-02/08/2008
Form 10-7959ACHAMPVA Claim Form -07/02/2013
Form 10-7959CCHAMPVA - Other Health Insurance (OHI) Certificate12/21/2012
Form 10-7959DCHAMPVA Potential Liability Claim09/08/2004
Form 10-7959EClaim for Miscellaneous Expenses-12/14/2012
Form 10-7959f-1Foreign Medical Program (FMP) Registration Form - fill12/21/2012
Form 10-7959f-2CLAIM COVER SHEET ? FOREIGN MEDICAL PROGRAM (FMP) - fill12/21/2012
Form Oct-78Application for Annual Clothing Allowance06/25/2012
Form Oct-12Investigational Drug Information Record10/23/2013
Form 20-572Request for Change of Address/Cancellation of Direct Deposit10/20/2009
Form 20-8206VA Statement of Assurance of Compliance with Equal Opportunity Laws10/23/2013
Form 20-8800Request for VA Forms and Publications03/30/2007
Form 21-0304Bene for Certain Children with Disab Born of Viet & Certain Korea Serv Vets (F)03/03/2010
Form 21-0307Award Attachment for Certain Children with Disabilities Born of Vietnam Veterans10/23/2013
Form 21-0501Veterans Benefits Timetable (No -in)06/04/2010
Form 21-0506Due Process Rights (No -in)04/03/2012
Form 21-0510Eligibility Verification Report Instructions (No -in)06/11/2010
Form 21-0512s-1Old Law and Section 306 Eligibility Verification Report (Surviving Spouse)05/23/2011
Form 21-0512V-1Old Law and Section 306 Eligibility Verification Report (Veteran)04/23/2010
Form 21-0513-1Old Law and Section 306 Eligibility Verification Report (Children Only)02/14/2012
Form 21-0514-1DIC Parent's Eligibility Verification Report02/28/2012
Form 21-0516-1Improved Pension Eligibility Verification Report (Veteran With No Children)02/28/2012
Form 21-0517-1Improved Pension Eligibility Verification Report (Veteran With Children)02/28/2012
Form 21-0518-1Improved Pension Eligibility Verification Report (Surviving Spouse With No Children)02/28/2012
Form 21-0519s-1Improved Pension Eligibility Verification Report (Surviving Spouse With Children)02/28/2012
Form 21-0538Status of Dependents Questionnaire10/21/2013
Form 21-0571Application For Exclusion Of Children's Income06/20/2011
Form 21-0760VA Benefits in Brief (No -in)06/07/2010
Form 21-0779Req. for Nursing Home Info. in Connect. with Claim for Aid and Attendance05/03/2010
Form 21-0781aStatement in Support of Claim for Service Connection for Post-Traumatic Stress Disorder (PTSD) Secondary to Personal Assault06/06/2012
Form 21-0788Information Regarding Apportionment of Beneficiary's Award08/25/2009
Form 21-0789Your Rights to Representation and A Hearing (No -in)04/02/2012
Form 21-0790Your Rights to Representation and a Hearing (Possible Overpayment) (No -in)04/11/2009
Form 21-0819VA/DOD Joint Disability Evaluation Board Claim03/08/2010
Form 21-0845Authorization To Disclose Personal Information To a Third Party06/03/2010
Form 21-0847Request for Substitution of Claimant upon Death of Claimant01/20/2010
Form 21-0958Notice of Disagreement08/20/2013
Form 21-0960A-1Ischemic Heart Disease (IHD) Disability Benefits Questionnaire03/01/2013
Form 21-0960A-2Artery and Vein Conditions (Vascular Diseases Including Varicose Veins) Disability Benefits Questionnaire09/11/2013
Form 21-0960A-3Hypertension Disability Benefits Questionnaire09/11/2013
Form 21-0960A-4Heart Conditions (Including Ischemic and Non-Ischemic Heart Disease, Arrhythmias, Valvular Disease and Cardiac Surgery) Disability Benefits Questionnaire03/01/2013
Form 21-0960B-1Hairy Cell and Other B-Cell Leukemias Disability Benefits Questionnaire02/28/2013
Form 21-0960B-2Hematologic and Lymphatic Conditions, Including Leukemia Disability Benefits Questionnaire03/20/2013
Form 21-0960C-1Parkinson's Disease Disability Benefits Questionnaire02/28/2013
Form 21-0960C-10Peripheral Nerves Conditions (Not Including Diabetic Sensory-Motor Peripheral Neuropathy) Disability Benefits Questionnaire04/29/2013
Form 21-0960C-11Seizure Disorders (Epilepsy) Disability Benefits Questionnaire04/03/2013
Form 21-0960C-2Amyotrophic Lateral Sclerosis (Lou Gehrig's Disease) Disability Benefits Questionnaire03/28/2013
Form 21-0960C-3Cranial Nerve Conditions Disability Benefits Questionnaire04/03/2013
Form 21-0960C-4Diabetic Sensory-Motor Peripheral Neuropathy Disability Benefits Questionnaire03/01/2013
Form 21-0960C-5Central Nervous System and Neuromuscular Diseases (Except Trau. Brain Injury, etc.) Disability Benefits Questionnaire04/17/2013
Form 21-0960C-6Narcolepsy Disability Benefits Questionnaire04/03/2013
Form 21-0960C-7Fibromyalgia Disability Benefits Questionnaire04/03/2013
Form 21-0960C-8Headaches (Including Migraine Headaches) Disability Benefits Questionnaire03/15/2013
Form 21-0960C-9Multiple Sclerosis (MS) Disability Benefits Questionnaire03/25/2013
Form 21-0960D-1Oral and Dental Conditions Including Mouth, Lips and Tongue (Other Than Temporomandibular Joint Conditions) Disability Benefits Questionnaire04/03/2013
Form 21-0960E-1Diabetes Mellitus Disability Benefits Questionnaire02/28/2013
Form 21-0960E-2Endocrine Diseases (Other than Thyroid, Parathyroid or Diabetes Mellitus) Disability Benefits Questionnaire03/12/2012
Form 21-0960E-3Thyroid and Parathyroid Conditions Disability Benefits Questionnaire04/03/2013
Form 21-0960F-1Scars/Disfigurement Disability Benefits Questionnaire03/01/2013
Form 21-0960F-2Skin Diseases Disability Benefits Questionnaire03/01/2013
Form 21-0960G-1Esophageal Conditions (Including gastroesophageal reflux disease (GERD), hiatal hernia and other esophageal disorders) Disability Benefits Questionnaire03/18/2013
Form 21-0960G-2Gallbladder and Pancreas Conditions Disability Benefits Questionnaire03/18/2013
Form 21-0960G-3Intestinal Conditions (Other than Surgical or Infectious) (Including Irritable Bowel Syndrome, Crohn's Disease, Ulcerative Colitis, and Diverticulitis) Disability Benefits Questionnaire03/18/2013
Form 21-0960G-4Intestinal Surgery (Bowel Resection, Colostomy, Ileostomy) Disability Benefits Questionnaire03/18/2013
Form 21-0960G-5Hepatitis, Cirrhosis and Other Liver Conditions Disability Benefits Questionnaire03/25/2013
Form 21-0960G-6Peritoneal Adhesions Disability Benefits Questionnaire03/18/2013
Form 21-0960G-7Stomach and Duodenal Conditions (Not Including Gerd or Esophageal Disorders) Disability Benefits Questionnaire03/18/2013
Form 21-0960G-8Infectious Intestinal Disorders, Including Bacterial and Parasitic Infections Disability Benefits Questionnaire03/19/2013
Form 21-0960H-1Hernias (Including Abdominal, Inguinal and Femoral Hernias) Disability Benefits Questionnaire04/03/2013
Form 21-0960H-2Rectum and Anus Conditions (Including Hemorrhoids) Disability Benefits Questionnaire03/18/2013
Form 21-0960I-1Persian Gulf and Afghanistan Infectious Diseases Disability Benefits Questionnaire03/28/2013
Form 21-0960I-2HIV - Related Illnesses Disability Benefits Questionnaire04/03/2013
Form 21-0960I-3Infectious Diseases (Other than HIV-Related Illness, Chronic Fatigue Syndrome, or Tuberculosis) Disability Benefits Questionnaire04/03/2013
Form 21-0960I-4Systemic Lupus Erythematosus (SLE) and Other Autoimmune Diseases Disability Benefits Questionnaire04/03/2013
Form 21-0960I-5Nutritional Deficiencies Disability Benefits Questionnaire04/03/2013
Form 21-0960I-6Tuberculosis Disability Benefits Questionnaire03/28/2013
Form 21-0960J-1Kidney Conditions (Nephrology) Disability Benefits Questionnaire03/28/2013
Form 21-0960J-2Male Reproductive Organ Conditions Disability Benefits Questionnaire03/28/2013
Form 21-0960J-3Prostate Cancer Disability Benefits Questionnaire03/26/2013
Form 21-0960J-4Urinary Tract (Including Bladder and Urethra) Conditions (Excluding Male Reproductive System) Disability Benefits Questionnaire04/03/2013
Form 21-0960K-1Breast Conditions and Disorders Disability Benefits Questionnaire03/19/2013
Form 21-0960K-2Gynecological Conditions Disability Benefits Questionnaire03/25/2013
Form 21-0960L-1Respiratory Conditions (Other than Tuberculosis and Sleep Apnea) Disability Benefits Questionnaire04/04/2013
Form 21-0960L-2Sleep Apnea Disability Benefits Questionnaire03/25/2013
Form 21-0960M-1Amputations Disability Benefits Questionnaire03/01/2013
Form 21-0960M-10Muscle Injuries Disability Benefits Questionnaire03/04/2013
Form 21-0960M-11Osteomyelitis Disability Benefits Questionnaire03/20/2013
Form 21-0960M-12Shoulder and Arm Conditions Disability Benefits Questionnaire03/01/2013
Form 21-0960M-13Neck (Cervical Spine) Disability Benefits Questionnaire03/28/2013
Form 21-0960M-14Back (Thoracolumbar Spine) Conditions Disability Benefits Questionnaire05/02/2013
Form 21-0960M-15Temporomandibular Joint (TMJ) Conditions Disability Benefits Questionnaire03/04/2013
Form 21-0960M-16Wrist Conditions Disability Benefits Questionnaire03/04/2013
Form 21-0960M-2Ankle Conditions Disability Benefits Questionnaire03/01/2013
Form 21-0960M-3Non-Degenerative Arthritis (Including Inflammatory, Autoimmune, Crystalline and Infectious Arthritis) and Dysbaric Osteonecrosis Disability Benefits Questionnaire03/25/2013
Form 21-0960M-4Elbow and Forearm Conditions Disability Benefits Questionnaire03/01/2013
Form 21-0960M-5Flatfoot (Pes Planus) Disability Benefits Questionnaire02/28/2013
Form 21-0960M-6Foot Miscellaneous (Other Than Flatfoot/PES Planus) Disability Benefits Questionnaire02/28/2013
Form 21-0960M-7Hand and Finger Conditions Disability Benefits Questionnaire02/28/2013
Form 21-0960M-8Hip and Thigh Conditions Disability Benefits Questionnaire03/01/2013
Form 21-0960M-9Knee and Lower Leg Conditions Disability Benefits Questionnaire03/01/2013
Form 21-0960N-1Ear Conditions (Including Vestibular and Infectious Conditions) Disability Benefits Questionnaire03/25/2013
Form 21-0960N-2Eye Conditions Disability Benefits Questionnaire03/07/2013
Form 21-0960N-3Loss of Sense of Smell and/or Taste Disability Benefits Questionnaire04/03/2013
Form 21-0960N-4Sinusitis/Rhinitis and Other Conditions of the Nose, Throat, Larynx and Pharynx Disability Benefits Questionnaire04/05/2013
Form 21-0960P-1Eating Disorders Disability Benefits Questionnaire03/28/2013
Form 21-0960P-2Mental Disorders (Other Than PTSD and Eating Disorders) Disability Benefits Questionnaire03/28/2013
Form 21-0960P-3Review Post Traumatic Stress Disorder (PTSD) Disability Benefits Questionnaire03/28/2013
Form 21-0960Q-1Chronic Fatigue Syndrome Disability Benefits Questionnaire04/03/2013
Form 21-1775Statement of Disappearance12/30/2010
Form 21-22Appointment of Veterans Service Organization as Claimant's Representative07/17/2013
Form 21-22aAppointment of Individual As Claimant's Representative01/06/2010
Form 21-2680Exam. for Housebound Status or Permanent Need For Regular Aid and Attend.02/03/2009
Form 21-4103Information From Remarried Widow/er06/20/2011
Form 21-4138Statement in Support of Claim08/22/2011
Form 21-4142Authorization and Consent to Release Information to the Department of Veterans Affairs05/21/2012
Form 21-4165Pension Claim Questionnaire for Farm Income01/12/2011
Form 21-4170Statement of Marital Relationship07/13/2011
Form 21-4171Supporting Statement Regarding Marriage06/20/2011
Form 21-4176Report of Accidental Injury in Support of Claim for Compensation or Pension/Statement of Witness to Accident12/12/2011
Form 21-4185Report of Income from Property or Business12/12/2011
Form 21-4192Request for Employment Information in Connection With Claim for Disability Benefits01/18/2011
Form 21-4502Application for Automobile or Other Conveyance and Adaptive Equipment (Under 38 U.S.C. 3901-3904)06/24/2009
Form 21-4709Certificate as to Assets09/16/2010
Form 21-4718aCertificate of Bal. on Deposit and Auth. to Disclose Financial Record12/10/2009
Form 21-509Statement of Dependency of Parent(s)10/25/2011
Form 21-524Statement of Person Claiming to Have Stood in Relation of Parent02/03/2011
Form 21-526Veterans Application for Compensation and/or Pension07/08/2010
Form 21-526bVeteran's Supplemental Claim for Compensation05/06/2010
Form 21-526cPre-Discharge Compensation Claim01/28/2010
Form 21-526EZApplication for Disability Compensation and Related Compensation Benefits09/16/2013
Form 21-527Income, Net Worth and Employment Statement01/18/2013
Form 21-527EZApplication for Pension11/14/2012
Form 21-530Application for Burial Benefits09/20/2012
Form 21-530aState Application for Interment Allowance under 38 U.S.C. Chapter 2301/24/2012
Form 21-534Appl. for DIC, Death Pension & Accrued Benefits by Surviving Spouse or Child (F)12/10/2009
Form 21-534aApplication for Dependency and Indemnity Compensation by a Surviving Spouse or Child - In-Service Death Only09/29/2011
Form 21-534EZApplication for DIC, Death Pension, and/or Accrued Benefits01/31/2013
Form 21-535Application for Dependency and Indemnity Compensation by Parent(s) (Including Accrued Benefits and Death Compensation When Applicable)01/25/2012
Form 21-601Application for Accrued Amounts Due A Deceased Beneficiary01/03/2011
Form 21-651Election of Compensation in Lieu of Retired Pay or Waiver of Retired Pay to Secure Compensation from Department of Veterans Affairs09/17/2010
Form 21-674Request for Approval of School Attendance01/31/2012
Form 21-674bSchool Attendance Report09/25/2013
Form 21-686cDeclaration of Status of Dependents05/19/2009
Form 21-6898Application for Amounts on Deposit for Deceased Veteran05/17/2011
Form 21-8049Request for Details of Expenses05/08/2009
Form 21-8416bReport of Medical, Legal, and Other Expenses Incident to Recovery for Injury or Death08/23/2011
Form 21-8764Disability Compensation Award Attachment Important Information (F)11/03/2009
Form 21-8764aDisability Compensation Award Under 38 U.S.C. 1151 Important Information (F)11/03/2009
Form 21-8767Death Pension Award Attachment (F)04/27/2009
Form 21-8768Disability Pension Award Attachment06/12/2008
Form 21-8834Application for Reimbursement of Headstone or Marker Expense10/03/2007
Form 21-8924Application of Surviving Spouse or Child for REPS Benefits (Restored Entitlement Program for Survivors)06/20/2011
Form 21-8940Veteran's Application for Increased Compensation Based on Unemployability08/14/2013
Form 21-8941REPS Annual Eligibility Report (Under the Provisions of Section 256, Public Law 97-377)08/22/2011
Form 21-8951-2Notice of Waiver of VA Compensation or Pension to Receive Military Pay and Allowances02/14/2012
Form 21P-0519c-1Improved Pension Eligibility Verification Report (Child or Children)11/14/2012
Form 21P-4706bFederal Fiduciary's Account10/26/2012
Form 21P-4706cCourt Appointed Fiduciary's Account11/14/2012
Form 21P-8416Medical Expense Report02/02/2012
Form 22-0803Application for Reimbursement of Licensing or Certification Test Fees07/17/2012
Form 22-0810Application for Reimbursement of National Exam Fee07/12/2012
Form 22-0839Yellow Ribbon Program Agreement (Under chapter 33 of title 38, U.S.C.)06/11/2012
Form 22-0848Application for Rural Relocation Benefit Under the Post - 9/11 GI Bill07/11/2012
Form 22-1990Application for VA Education Benefits07/12/2012
Form 22-1990eApplication for Family Member to Use Transferred Benefits07/12/2012
Form 22-1990nApplication for VA Education Benefits Under the National Call to Service (NCS) Program (FiIlable)07/12/2012
Form 22-1990RApplication for Veterans Retraining Assistance Program (VRAP)10/23/2013
Form 22-1990tApplication for Individualized Tutorial Assistance07/12/2012
Form 22-1995Request for Change of Program or Place of Training07/12/2012
Form 22-1999cCertificate of Affirmation of Enrollment Agreement Correspondence Course (FILL)03/06/2009
Form 22-5281Application for Refund of Educational Contributions (VEAP, Ch. 32, Title 38, U.S.C.)07/11/2012
Form 22-5490Dependents' Application for VA Education Benefits (Under Provisions of chapters 33 and 35, of title 38, U.S.C.)09/12/2013
Form 22-5495Dependents' Request for Change of Program or Place of Training (Under Provisions of Chapters 33 and 35, Title 38, U.S.C.)07/11/2012
Form 22-6553cMonthly Certification of Flight Training05/17/2011
Form 22-6553d-1Monthly Certification of On-The-Job and Apprenticeship Training07/11/2012
Form 22-8597Fact Sheet on Approval of OJT Programs (F)04/29/2009
Form 22-8691Application for Work-Study Allowance07/11/2012
Form 22-8864Training Agreement for Apprenticeship and Other On-The-Job Training Programs01/20/2011
Form 22-8873Supp Info for Chg of Prog or Reenroll After Unsat Attend, Condt or Progress (F)03/22/2010
Form 22-8889Application for Educational Assistance Test Program Benefits07/13/2012
Form 24-0296Direct Deposit Enrollment11/09/2009
Form 24-0296aDirect Deposit Enrollment - Australia10/26/2009
Form 24-0296bDirect Deposit Enrollment - Canada10/26/2009
Form 24-0296cEFT Enrollment - Germany10/26/2009
Form 24-0296dEFT Enrollment - Ireland10/26/2009
Form 24-0296eEFT Enrollment - United Kingdom10/26/2009
Form 26-0503Federal Collection Policy Notice10/13/2009
Form 26-0551Debt Questionnaire06/14/2005
Form 26-0585VA Advertising Guidelines for Fair Housing12/13/2012
Form 26-0592Counseling Checklist for Military Homebuyers10/23/2013
Form 26-0829Servicer's Staff Appraisal Reviewer (SAR) Application09/16/2011
Form 26-1802aHUD/VA Addendum to Uniform Residential Loan Application07/23/2013
Form 26-1805Request for Determination of Reasonable Value10/21/2008
Form 26-1814Batch Transmittal - Loan Code Sheet10/23/2013
Form 26-1817Request for Determination of Loan Guaranty Eligibility - Unmarried Surviving Spouses04/24/2012
Form 26-1820Report and Certification of Loan Disbursement09/19/2012
Form 26-1833Advice Regarding Indebtedness of Obligors on Guaranteed or Insured Loans03/10/2009
Form 26-1839Compliance Inspection Report10/23/2007
Form 26-1844Request for Acceptance of Changes in Approved Drawings and Specifications04/26/2013
Form 26-1849Escrow Agreement for Postponed Exterior Onsite Improvements01/16/2008
Form 26-1852Description of Materials10/16/2012
Form 26-1859Warranty of Completion of Construction01/15/2008
Form 26-1880Request for A Certificate of Eligibility09/27/2011
Form 26-421Equal Employment Opportunity Certification12/05/2012
Form 26-4555Application in Acquiring Specially Adapted Housing or Special Home Adaptation Grant02/21/2012
Form 26-4555cVeteran/Servicemember's Supplemental Application for Assistance in Acquiring Specially Adapted Housing08/25/2011
Form 26-4555dVeterans Application for Assistance in Acquiring Special Housing Adaptations (F)09/11/2009
Form 26-6363Endorsement to Certificate of Reasonable Value09/10/2008
Form 26-6381Application for Assumption Approval and/or Release Personal Liability to Gov ...10/23/2013
Form 26-6382Statement of Purchaser Or Owner Assuming Seller's Loan09/21/2010
Form 26-6393Loan Analysis11/14/2012
Form 26-6681Application for Fee or Roster Personnel Designation05/07/2013
Form 26-6705Offer to Purchase and Contract of Sale09/19/2008
Form 26-6705bCredit Statement of Prospective Purchaser09/19/2008
Form 26-6705dAddendum to Offer to Purchase and Contract of Sale09/20/2010
Form 26-6807Financial Statement04/11/2008
Form 26-6807aSupplemental Certification for Financial Statement06/29/2007
Form 26-6808Loan Service Report06/17/2010
Form 26-8084Claim for Repurchase of Loan (Chapter 37, Title 38 U.S.C., 38 CFR 36.4600)05/07/2013
Form 26-8106Statement of Veteran Assuming Loan (Substitution of Entitlement)10/23/2013
Form 26-8149Report of Automatic Manufactured Home and/or Lot Loan10/23/2013
Form 26-8261aRequest for Certificate of Veteran Status12/11/2012
Form 26-8497Request for Verification of Employment09/28/2010
Form 26-8497aRequest for Verification of Deposit09/28/2010
Form 26-8599Manufactured Home Warranty (Limited Warranty)10/23/2013
Form 26-8629Manufactured Home Loan Claim Under Loan Guaranty10/23/2008
Form 26-8630Manufactured Home Loan Claim Under Loan Guaranty10/22/2008
Form 26-8641aComputation of Loan Amount for Manufactured Home Unit11/13/2007
Form 26-8644Placement Certificate for Manufactured Home06/29/2007
Form 26-8712Manufactured Home Appraisal Report03/24/2009
Form 26-8730Used Manufactured Home Warranty (Limited Warranty)08/18/2010
Form 26-8731aWater-Plumbing Systems Inspection Report (Manufactured Home)09/14/2007
Form 26-8731bElectrical Systems Inspection Report (Manufactured Home)01/02/2008
Form 26-8731cFuel and Heating Systems Inspection Report (Manufactured Home)11/07/2007
Form 26-8791VA Affirmative Marketing Certification10/23/2013
Form 26-8812VA Equal Opportunity Lender Certification10/23/2013
Form 26-8827Housing Discrimination Complaint06/29/2007
Form 26-8844Financial Counseling Statement02/14/2011
Form 26-8923Interest Rate Reduction Refinancing Loan Worksheet08/18/2010
Form 26-8937Verification of VA Benefits01/24/2013
Form 27-2008Application for United States Flag for Burial Purposes07/24/2012
Form 28-0588VA Vocational Rehabilitation - Getting Ahead After You Get Out04/06/2009
Form 28-1900Disabled Veterans Application for Vocational Rehabilitation06/27/2011
Form 28-1902wRehabilitation Needs Inventory (RNI)10/15/2012
Form 28-8832Education/Vocational Counseling Application09/01/2009
Form 29-0165VA Matic Enrollment/ Change07/09/2013
Form 29-0309Direct Deposit Enrollment/Change (For VA Life Insurance Only)10/23/2013
Form 29-0543Veterans Mortgage Life Insurance (VMLI) Inquiry10/03/2007
Form 29-0563Veterans Mortgage Life Insurance (VMLI) - Change of Address Statement09/19/2011
Form 29-1546Application for Cash Surrender/Application for Policy Loan02/15/2008
Form 29-1549Application for Change of Permanent Plan (Medical)10/17/2008
Form 29-336Designation of Beneficiary - Government Life Insurance03/18/2010
Form 29-353Application for Reinstatement (Non Medical - Comparative Health Statement)11/18/2010
Form 29-357Claim for Disability Insurance - Government Life Insurance08/14/2012
Form 29-389Notice of Lapse and Application for Reinstatement10/25/2010
Form 29-4125Claim for One Sum Payment - Government Life Insurance11/05/2012
Form 29-4125aClaim for Monthly Payments - National Service Life Insurance11/05/2012
Form 29-4125kClaim for Monthly Payments - U. S. Government Life Insurance (USGLI)10/14/2008
Form 29-4364Application for Service-Disabled Veterans Insurance05/09/2011
Form 29-541Certificate Showing Residence and Heirs of Deceased Veteran or Beneficiary06/12/2008
Form 29-586Certification of Change for Correction of Name - Government Life Insurance02/10/2012
Form 29-8485Applic. for Ordin. Life Ins. Replace. Ins. for Modif. Life Reduced at 6510/22/2008
Form 29-8485aApplic. for Ordinary Life Insurance Replacement Insurance for Modified10/22/2008
Form 29-8636Veterans Mortgage Life Insurance Statement09/05/2012
Form 29-888Insurance Deduction Authorization09/23/2008
Form 40-40-0247Presidential Memorial Certificate Request Form10/09/2013
Form 40-40-0895-11Memo of Agreement for a Grant to Const. or Modify State/Tribal Gov't Vet Cem10/03/2013
Form 40-40-0895-12Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Excl.10/09/2013
Form 40-40-0895-8Certification Regarding Drug-Free Workplace Requirements for Grantees10/08/2013
Form 40-40-0895-9Certification Regarding Lobbying09/30/2013
Form 40-40-4970Request for Disinterment10/02/2013
Form FL-1-28Supplemental Statement of the Case10/10/2013
Form FL-1-28aSupplemental Statement of the Case10/10/2013
Form FL-10-341aEmployment Reference for Title 38 Employee -07/24/2006
Form FL-10-341bTrainee Qualification and Credentials Verification Letter (TQCVL) -08/06/2009
Form FL-10-426Temporary Loan Follow-up Letter02/18/2005
Form FL-10-90Request to Firm to Submit Estimate of Cost of Purchase or Repair of Prosthetic D09/23/2009
Form FL-4-437Notice of Approval of Waiver Request10/10/2013
Form FL-70-2Request to Correspondent for Identifying Information Regarding Veteran10/10/2013
Form FL 29-459Req. to Employer for Employment Info in Connect'n w/Claim for Disab. Bene(FILL)09/22/2008
Form OF-306Declaration for Federal Employment06/01/2012
Form SF-144Statement of Prior Federal Service09/29/2011
Form SF-180REQUEST PERTAINING TO MILITARY RECORDS05/12/2012
Form SF-184Request for Employee Medical Folder10/10/2013
Form SF-2801Application for Immediate Retirement (CSRS)09/29/2011
Form SF-2808Designation of Beneficiary - CSRS03/29/2012
Form SF-2809Health Benefits Election Form02/16/2012
Form SF-2819Notice of Conversion Privilege (FEGLI)09/29/2011
Form SF-3112Documentation in Support of Disability Retirement Application02/16/2012
Form SF-50Notification of Personnel Action10/10/2013
Form SF-52Request for Personnel Action08/14/2012
Form SF-85Questionnaire for Non-Sensitive Position09/29/2011
Form SF-85PQuesetionnaire for Public Trust Positions09/29/2011
Form VA-0120VA Police Officer Pre-Employment Screening Checklist09/09/2013
Form VA-0220Your Appellate Rights Relating to our Denial of your Motion for Reconsideration09/03/2013
Form VA-0710Authorization for Release of Information10/03/2013
Form VA-0711Request for Personal Identity Verification Card09/17/2013
Form VA-0730aChild Care Subsidy Application Form09/10/2013
Form VA-0730bChild Care Provider Information09/30/2013
Form VA-0730hVA Child Care Subsidy Program Benefit Payment Request Form10/01/2013
Form VA-0745Board of Veterans' Appeals Hearing Survey10/08/2013
Form VA-0857aWritten Confirmation of Request for Accommodation10/10/2013
Form VA-0857dAuthorization for Limited Release of Medical Information09/30/2013
Form VA-0862Claim for Credit of Annual Leave10/09/2013
Form VA-0877Vetbiz Vendor Information Pages Verification Program09/30/2013
Form VA-0879Speaker Request Form10/03/2013
Form VA-0880aMemorandum of Service Level Expectations for Part-Time Physicians on Adjust Work10/08/2013
Form VA-0880bWorksheet for Determining Percentages on Memorandum Service Level Expectations10/02/2013
Form VA-0902Actual Expense Per Diem Calculator10/09/2013
Form VA-0904Your Rights to Appeal the General Counsel's Decision Concerning Fee Agreement09/10/2013
Form VA-0926aAthlete Registration Checklist10/01/2013
Form VA-0926bAthlete Application and Event Selection10/10/2013
Form VA-0926cMedia and News Release Questionnaire10/01/2013
Form VA-0926dWaiver and Release of Liability10/08/2013
Form VA-0926eAthletes Medical Information09/12/2013
Form VA-0926fAlternate Activities09/12/2013
Form VA-0926gNon-Athlete Registration Checklist09/12/2013
Form VA-0926hNon-Athlete Application09/12/2013
Form VA-0926jVolunteer Application09/17/2013
Form VA-0926kNon-Athlete Meals09/12/2013
Form VA-0927aNational Veterans Tee Tournament Registration Checklist09/16/2013
Form VA-0927bNatl. Veterans Tee Tournament Participant Registration Application09/12/2013
Form VA-0927cNatl. Veterans Tee Tournament Participant Registration - Physical Exam09/12/2013
Form VA-0927dNatl. Veterans Tee Tournament Media & News Release Questionnaire09/12/2013
Form VA-0927eNatl. Veterans Tee Tournament Participant, Companion & Volunteer Fees09/12/2013
Form VA-0927fNatl. Veterans Tee Tournament Volunteer Registration Application09/12/2013
Form VA-0928aSummer Sports Clinic - Registration Checklist10/02/2013
Form VA-0928bSummer Sports Clinic - Registration Application09/12/2013
Form VA-0928cSummer Sports Clinic - General Medical/Physical Exam Form09/17/2013
Form VA-0928dSummer Sports Clinic - Media & News Release Questionnaire09/17/2013
Form VA-0928eSummer Sports Clinic - Application (Multiple Positions)10/10/2013
Form VA-0928fSummer Sports Clinic - Media Staff Application10/10/2013
Form VA-0928gSummer Sports Clinic - Medical Personnel Application10/10/2013
Form VA-0928hSummer Sports Clinic - Volunteer Application09/16/2013
Form VA-0928iSummer Sports Clinic - Surfing Personnel Application09/16/2013
Form VA-0928jSummer Sports Clinic - Venue Personnel Application09/17/2013
Form VA-0933Statement of Understanding for the Government Travel Charge Card Program10/08/2013
Form VA-10002Consent for Use of Written or Verbal Statement, Picture and/or Voice09/17/2013
Form VA-1100Agreement to Pay Indebtedness10/01/2013
Form VA-1107Request for Repairs, and/or Accessories09/17/2013
Form VA-21Application for Accreditation as Service Organization Representative10/09/2013
Form VA-2130Inspection Sheet - Prosthetic Dealer10/01/2013
Form VA-21aApplication for Accreditation as a Claims Agent or Attorney09/10/2013
Form VA-2793Shop Data Sheet (Artificial Limbs)09/26/2013
Form VA-3215Application of Service Representative for Placement on Mailing List10/02/2013
Form VA-3288Request for and Consent to Release Information from Claimant's Records10/08/2013
Form VA-40-0241State Cemetery Data10/09/2013
Form VA-40-0895-10Certification of Compliance w/Fed Require. State or Tribal Gov't Const. Grants10/09/2013
Form VA-40-0895-13Certification Regarding Documents and Info. Req. for State Cemetery Constr.09/30/2013
Form VA-40-0895-14Checklist of Major Requirements for State or Tribal Gov't Cemetery Const. Grants09/30/2013
Form VA-40-0895-15Cert of Cemetary Maintained in Accordance with Nat'l Cemetary Admin. Stds.09/30/2013
Form VA-40-0895-16Certification Regarding Plan Preparation (39.32 and 39.82)10/02/2013
Form VA-40-0895-17Certification Regarding Documentation of Grant Accomplishment (39.120)10/08/2013
Form VA-40-0895-2Certification of Compliance with Provisions of the Davis-Bacon Act10/03/2013
Form VA-40-0895-3State or Tribal Government Cemetery Grants Service Space Program Analysis - Buil09/30/2013
Form VA-40-0895-6Certification of State or Tribal Government Matching Architectual & Engineering10/03/2013
Form VA-40-0895-7Certification Regarding Debarment, Suspension, and other Responsibility Matters10/08/2013
Form VA-40-1330Claim For Standard Government Headstone or Marker10/03/2013
Form VA-40-1330MClaim for Government Medallion for Placement in a Private Cemetery09/30/2013
Form VA-4078Application for Promotion or Reassignment10/01/2013
Form VA-4107Your Rights to Appeal our Decision10/09/2013
Form VA-4107cYour Rights to Appeal our Decision - Contested Claims09/10/2013
Form VA-4107VHAYour Rights To Appeal Our Decision10/01/2013
Form VA-4597Your Rights to Appeal our Decision09/10/2013
Form VA-4597aYour Rights to Appeal our Decision Concerning the Reasonableness of Your Fee Agreement10/02/2013
Form VA-4597bYour Rights to Appeal Decision on Your Motion for Review Clear & Unmistakable10/03/2013
Form VA-4637Employee Educational Data10/02/2013
Form VA-4667bSupervisory Appraisal of Employee for Promotion10/08/2013
Form VA-4667cSupervisory Appraisal of Employee for Promotion - Narrative Appraisal10/09/2013
Form VA-4670Position Classificatin Worksheet for Research Positions10/01/2013
Form VA-4676aEmployee Supplemental Qualifications Statement10/10/2013
Form VA-4939Complaint of Employment Discrimination10/01/2013
Form VA-5655Financial Status Report10/08/2013
Form VA-5655blankFinancial Status Report (blank copy)10/10/2013
Form VA-646Statement of Accredited Representative in Appealed Case10/02/2013
Form VA-8Certification of Appeal10/02/2013
Form VA-8824iCAATS Contractor Access Request Form09/17/2013
Form VA-9Appeal to Board of Veterans' Appeals10/01/2013