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VA Form 21-0966

Tell VA you intend to file a claim so you can hold an effective date.

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About VA Form 21-0966

VA Form 21-0966, Intent to File a Claim for Compensation and/or Pension, or Survivors Pension and/or DIC, lets you notify the Department of Veterans Affairs that you plan to file a claim. Submitting it can establish a date that VA may use when it later decides the effective date of benefits, giving you time to gather what you need before filing the full claim. On the form you identify the type of benefit you intend to claim.

This page is a general guide and a fillable helper, not legal advice. Always download and file the current official form from the Department of Veterans Affairs at https://www.va.gov/find-forms/ and confirm the fields, time limits, and instructions match before you sign.

Who needs to complete it

  • Veterans who plan to file a compensation or pension claim but need time to prepare.
  • Survivors who intend to file for survivors pension or dependency and indemnity compensation.
  • People who want to notify VA of their intent before submitting a full claim.
  • Claimants who want to preserve a potential effective date while gathering documents.

How to fill out VA Form 21-0966

  1. 1Enter your name and the file number or Social Security number VA uses.
  2. 2Indicate whether you are the veteran or a survivor.
  3. 3Select the type or types of benefit you intend to file for.
  4. 4Provide your contact information so VA can reach you.
  5. 5Note that an intent to file generally has a time window in which to submit the full claim.
  6. 6Sign and date the form.
  7. 7Submit it to VA using the method described in the current instructions, then file the complete claim within the time allowed.
This page is a free fillable helper and general guide, not the official form and not legal or tax advice. Always download and file the current official version from the official source.

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Frequently asked questions

What does an intent to file do?

It notifies VA that you plan to file a claim, which can establish a date VA may use when deciding the effective date of benefits. This gives you time to prepare the full claim. This is a general guide, not legal advice.

How long do I have to file the full claim?

An intent to file generally has a time window for submitting the complete claim. Check the current VA instructions for the applicable time limit and do not wait past it.

Which benefits does it cover?

The form covers compensation, pension, survivors pension, and dependency and indemnity compensation. You indicate which you intend to claim. Review the instructions for details.

Is this the official VA form?

This is a fillable helper to make completion easier. Always download and file the current official form from the Department of Veterans Affairs at https://www.va.gov/find-forms/ and confirm the fields match.