Please read information and instructions before completing attached application.
Monetary allowance: the law includes levels of monetary allowance, each based on the level of disability of the eligible child.
Health care: the law allows health care covering the defects or any disability associated with the birth defects. This care may be provided directly or by contract.
Spina bifida diagnosis: the diagnosis may be established by private physicians, or government or private institution examination reports.
Birth certificate: have you provided a copy of the child's birth certificate to VA? If "No," or unsure, attach a copy of the birth certificate.
Where to send: after completing the form, mail to the Department of Veterans Affairs, Evidence Intake Center.
| Question | Answer |
|---|---|
| Form Name | VA Form 21-0304 |
| Form Length | 4 pages |
| Fillable? | Yes |
| Fillable fields | 88 |
| Avg. time to fill out | 15 min |
| Edition | MAY 2026 |
| Where to send | Department of Veterans Affairs, Evidence Intake Center, PO Box 4444, Janesville, WI, 53547-4444 |
| Matches the agency's file | Yes, checked October 2, 2026 |
| Other names | VA Form 21-0304, 21-0304, VA 21-0304, VA 21 0304, Application for Benefits for a Qualifying Veteran's Child Born with Disabilities |
| Official source | VA Form 21-0304 (Rev MAY 2026), Department of Veterans Affairs |
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