Va Form 119 PDF Details

VA employees use VA Form 119, Report of Contact, to record important conversations or contacts related to a veteran’s claim, benefits, or services. The form captures the VA office and identification numbers, the veteran’s full name, address, and phone number, and the name and contact details of the person spoken with. It also includes the type of contact (in-person or telephone), and a narrative statement describing the information requested and provided.

Once completed, it becomes a permanent record in the veteran’s folder and must not be filled out in pencil.

The form’s purpose is to document potentially disputed or sensitive communications so the VA can later show exactly what information was given or received.

Note: For many benefits-related claims, the VA now uses VA Form 21-0820 (Report of General Information) to record claim-specific contacts and information.

QuestionAnswer
Form Name Va Form 119
Form Length 2 pages
Fillable? Yes
Fillable fields 20
Avg. time to fill out 10 min
Other names va report of contact 119, report of contact va form, va report of contact, va form report of contact

Form Preview Example

REPORT OF CONTACT

NOTE: As appropriate, once this form is completed it becomes a permanent record in the veteran's folder. Please do not use a pencil to complete this form.

VA OFFICE

IDENTIFICATION NOS. (C,XC, SS, XSS, V, K, etc.)

LAST NAME-FIRST NAME-MIDDLE NAME OF VETERAN (Type or print)

DATE OF CONTACT

 

 

 

ADDRESS OF VETERAN

TELEPHONE NO. OF VETERAN (Include Area Code)

 

 

PERSON CONTACTED

TYPE OF CONTACT (check one)

 

PERSONAL

TELEPHONE

 

 

ADDRESS OF PERSON CONTACTED

TELEPHONE NO. OF PERSON CONTACTED

 

(Include Area Code)

 

 

 

PERSON WHO CONTACTED YOU

TYPE OF CONTACT (check one)

 

PERSONAL

TELEPHONE

 

 

ADDRESS OF PERSON WHO CONTACTED YOU

TELEPHONE NO. OF PERSON WHO

 

CONTACTED YOU (Include area code)

 

 

 

BRIEF STATEMENT OF INFORMATION REQUESTED AND GIVEN (Continue on page 2 if needed)

 

 

DIVISION OR SECTION

VA FORM

119

SEP 1997 (R)

EXECUTED BY (Signature and title)

BRIEF STATEMENT OF INFORMATION REQUESTED AND GIVEN

VA FORM 119, SEP 1997 (R), PAGE 2

How to Edit Va Form 119 Online for Free

It is easy to fill out the report of contact empty blanks. Our PDF tool makes it practically effortless to prepare any specific PDF. Listed below are the only four steps you need to follow:

Step 1: Get the button "Get Form Here" and hit it.

Step 2: Once you get into our report of contact editing page, there'll be all of the functions you can undertake with regards to your document at the upper menu.

Fill in all of the following areas to fill out the document:

va report of contact blanks to complete

Write down the requested details in the field DIVISION OR SECTION, EXECUTED BY Signature and title, and VA FORM SEP R.

Finishing va report of contact step 2

The software will demand for additional info as a way to automatically prepare the section BRIEF STATEMENT OF INFORMATION.

stage 3 to entering details in va report of contact

Step 3: Select the "Done" button. Now, you may export your PDF document - download it to your electronic device or send it by means of email.

Step 4: To protect yourself from any specific headaches down the road, you should have around several duplicates of the file.

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