Va 21 8951 Form – Fill Out and Use This PDF

OMB Approved No. 2900-0463

Respondent Burden: 10 minutes

Expiration Date: 01/31/2023

VA DATE STAMP

(DO NOT WRITE IN THIS SPACE)

NOTICE OF WAIVER OF VA COMPENSATION OR PENSION TO RECEIVE

MILITARY PAY AND ALLOWANCES

IMPORTANT: We need this information to determine whether you choose to waive your VA compensation or pension or your military pay and allowances for the days for which you received training pay (10 U.S.C. 12316 and 38 U.S.C.5304(c)). If you have any questions about the information contained on this form or if you need assistance in completing the form, call VA's toll-free number 1-800-827-1000.

SECTION I - VETERAN'S IDENTIFICATION INFORMATION

NOTE: You may complete the form online or by hand. If completed by hand, print the information requested in ink, neatly and legibly, insert one letter per box, and completely fill in each applicable circle to help expedite processing of the form.

1. NAME OF VETERAN (First, Middle Initial, Last)

Enter International Phone Number (If applicable)

SECTION II - TRAINING PAY INFORMATION

Based on your Social Security Number (SSN), the Defense Manpower Data Center (DMDC) has identified you as having been a reservist or guardsman during the fiscal year indicated below. Please verify that the Social Security number shown above is your correct Social Security number. If it is not, please enter the correct number. Also, please enter your telephone number above.

By law, active or inactive duty training pay can't be paid at the same time you're receiving VA disability compensation or pension benefits. You may decide to keep the training pay you received from your military branch. However, to keep your training pay, you must waive your VA benefits for the same number of days as the number of days you received training pay. Usually, it's to your advantage to waive benefits and keep your training pay.

Please enter the number of days for which you received training pay below.

NOTE: A fiscal year runs from October 1 through September 30. For example, fiscal year 2017 runs from October 1, 2016 through September 30, 2017.

Please note that the National Guard and Reserves report one full day's duty pay for each 4-hour session of training you attend. That means they may credit you with 4 days' worth of training for a 2-day drill weekend. The National Guard and Reserves pay most of their members for about 63 training days during a fiscal year. That included 48 armory drills or training sessions, and 15 days of active training.

Please fill out this form, sign it, have your unit commander or commander's designee sign it, and return it to one of the 3 addresses listed on page 3.

VETERAN'S SOCIAL SECURITY NO.

SECTION III - ELECTION NOTICE

8.Complete the appropriate box below, sign this form, secure the signature of your unit commander or designee, and return the completed form to VA within 60 days. Check one of the following boxes. If you check neither, we will assume that you agree with the number of training pay days shown on the front of this form.

I agree that the number of training days shown on the front of this form is correct.

The number of training days shown on the front of this form is not correct. The following is the actual number of days for which I received training pay. (Enter correct information in the boxes below).

9.Check only one of the following boxes:

I elect to waive VA benefits for the days indicated in order to retain my training pay.

I elect to waive military pay and allowances for the days indicated in order to retain my VA compensation or pension. NOTE: Checking this option will give most veterans LESS money.

I received no military pay and allowances during the fiscal year indicated on page 1 of this form.

SECTION IV - CERTIFICATION AND SIGNATURE

If we do not receive a waiver from you, we will assume that you wish to waive VA compensation or pension for the number of days printed on the front of the form. However, we will not adjust your award until we have advised you of the specific changes we propose to make.

NOTE: In the past you may have filed a one-time waiver of disability benefits which was to remain in effect until your reserve/guard status changed or you withdrew the waiver. That waiver is no longer valid. Annual waivers are again required.

I CERTIFY THAT to the best of my knowledge, the information shown above concerning the member's training days is correct.

Enter International Phone Number (If applicable)

PENALTY: The law provides severe penalties which include fine or imprisonment, or both, for the willful submission of any statement or evidence of a material fact, knowing it to be false, or for fraudulent acceptance of any payment to which you are not entitled.

PRIVACY ACT NOTICE: VA will not disclose information collected on this form to any source other than what has been authorized under the Privacy Act of 1974 or Title 38, Code of Federal Regulations 1.576 for routine uses (i.e., civil or criminal law enforcement, congressional communications, epidemiological or research studies, the collection of money owed to the United States, litigation in which the United States is a party or has an interest, the administration of VA programs and delivery of VA benefits, verification of identity and status, and personnel administration) as identified in the VA system of records, 58VA21/22/28, Compensation, Pension, Education, and Vocational Rehabilitation and Employment Records - VA, published in the Federal Register. Your obligation to respond is required to obtain or retain benefits. The requested information is considered relevant and necessary to determine maximum benefits under the law. The responses you submit are considered confidential (38 U.S.C. 5701). Information submitted is subject to verification through computer matching programs with other agencies.

RESPONDENT BURDEN: We need this information to determine whether you choose to waive your VA compensation or pension or your military pay and allowances for the days for which you received training pay (10 U.S.C. 12316 and 38 U.S.C. 5304(c). Title 38, United States Code, allows us to ask for this information. We estimate that you will need an average of 10 minutes to review the instructions, find the information, and complete the form. VA cannot conduct or sponsor a collection of information unless a valid OMB control number is displayed. You are not required to respond to a collection of information if this number is not displayed. Valid OMB control numbers can be located on the OMB Internet Page at www.reginfo.gov/public/do/ PRAMain. If desired, you can call 1-800-827-1000 to get information on where to send comments or suggestions about this form.

WHERE TO SEND WRITTEN CORRESPONDENCE

MAILING ADDRESSES:

Compensation Claims

Department of Veterans Affairs

Compensation Intake Center

P.O. Box 4444

Janesville, WI 53547-4444

Pension & Survivors Benefit Claims

Department of Veterans Affairs

Pension Intake Center

P.O. Box 5365

Janesville, WI 53547-5365

Fiduciary

Department of Veterans Affairs

Fiduciary Intake

P.O. Box 95211

Lakeland, FL 33804-5211

These addresses serve all United States and foreign locations.