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Va Form 21 0788 PDF Details

If you're a veteran or current member of the military, you may be familiar with va form 21 0788. This form is used to apply for disability compensation, and it can be a lifesaver if you're struggling with an injury or illness that's preventing you from working. In this post, we'll discuss what va form 21 0788 is and how to complete it. We'll also provide some tips for making the application process as smooth as possible.

Below is some information that might be handy if you are seeking to learn how long it will require you to fill out va form 21 0788 and the number of PDF pages it has.

Question	Answer
Form Name	Va Form 21 0788
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names	va form 21 0788, va 0788, va apportionment form, requesting an apportionment from the department of veterans affairs

12

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OMB Approved No. 2900-0666 Respondent Burden: 30 minutes Expiration Date: 7/31/2024

INFORMATION REGARDING APPORTIONMENT OF BENEFICIARY'S AWARD

INSTRUCTIONS: Before completing this form, read the Privacy Act and Respondent Burden on page 2. All or part of a veteran's disability award may be apportioned (paid) to the veteran's spouse, child, or dependent parent. A surviving spouse's award may also be apportioned for the veteran's child or children. If you are certifying that you are married for the purpose of VA benefits, your marriage must be recognized by the place where you and/or your spouse resided at the time of marriage, or where you and/or your spouse resided when you filed your claim (or a later date when you became eligible for benefits)

(38 U.S.C. § 103(c)). For additional space, or to describe any financial hardship (not otherwise reflected on this form) you are experiencing or will experience based on the outcome of this claim, use Part III - Remarks. For more information, contact us at https://iris.custhelp.va.gov, or call us toll-free at 1-800-827-1000. If you use a Telecommunications Device for the Deaf (TDD), the Federal relay number is 711. VA forms are available at www.va.gov/vaforms. After completing the form, mail to: Department of Veterans Affairs, Evidence Intake Center, P.O. Box 4444, Janesville, WI, 53547-4444.

VA DATE STAMP

(DO NOT WRITE IN THIS SPACE)

	1. VETERAN'S NAME (First, Middle Initial, Last)					2. VA FILE NUMBER (If known)
						C/CSS-
	3A. PERSON COMPLETING THIS FORM (First, Middle Initial, Last) (If other than veteran)					3B. MAILING ADDRESS (Number and street or rural route, city or
						P.O., State and ZIP Code)

				3C. TELEPHONE NUMBER (Include Area Code)		3D. E-MAIL ADDRESS (If applicable)
	Daytime				Evening

	4A. WHO ARE YOU REQUESTING AN APPORTIONMENT FOR? (List first, middle initial, and last names)						4B. WHAT IS HIS/HER RELATIONSHIP TO THE
								VETERAN?

	5A. HOW MUCH IS THE VETERAN OR VETERAN'S SURVIVING SPOUSE CONTRIBUTING TO THE PERSON(S)						5B. HOW OFTEN ARE THE CONTRIBUTIONS MADE?
		FOR WHOM AN APPORTIONMENT IS BEING CLAIMED?
$
6. IF THE SPOUSE IS CLAIMING AN APPORTIONMENT, IS HE/SHE LIVING WITH ANOTHER PERSON AND							7. HAS THE VETERAN'S CHILD(REN) BEEN
	HOLDING HIMSELF/HERSELF OUT OPENLY TO THE PUBLIC AS THE SPOUSE OF THE OTHER PERSON?						LEGALLY ADOPTED BY ANOTHER PERSON?
		YES		NO (If "Yes," provide an explanation in Part III - Remaks):				YES		NO

PART I - INCOME AND NET WORTH

Report all income and net worth. Report the gross amounts before you take out deductions for taxes, insurance, etc. If you do not receive income or net worth from a particular source, write "0" or "none" in the space provided. Do not leave the space blank. Note: If you are the veteran or surviving spouse, report only your income and net worth. If you are the claimant or are filing on behalf of the claimant(s), report all income and net worth for all persons for whom an apportionment is being claimed. If you are claiming an apportionment as the custodian of the veteran's child or children, report your income and net worth and the income and net worth of the child(ren).

			MONTHLY INCOME
	SOURCE	VETERAN OR	CUSTODIAN	PERSON APPORTIONMENT	PERSON APPORTIONMENT
	SOURCE	SURVIVING SPOUSE	CUSTODIAN	IS CLAIMED FOR	IS CLAIMED FOR
		SURVIVING SPOUSE		IS CLAIMED FOR	IS CLAIMED FOR
	1A. GROSS WAGES FROM ALL
	EMPLOYMENT	$	$	$	$
	1B. SOCIAL SECURITY

1C. RETIREMENT OR ANNUITIES

1D. SUPPLEMENTAL SECURITY INCOME (SSI) / PUBLIC ASSISTANCE

1E. OTHER INCOME (Show source)

1F. OTHER INCOME (Show source)

NET WORTH

SOURCE	VETERAN OR		CUSTODIAN	PERSON APPORTIONMENT	PERSON APPORTIONMENT
SOURCE	SURVIVING SPOUSE		CUSTODIAN	IS CLAIMED FOR	IS CLAIMED FOR
	SURVIVING SPOUSE			IS CLAIMED FOR	IS CLAIMED FOR
2A. CASH/NON-INTEREST-BEARING
BANK ACCOUNTS	$	$		$	$
2B. INTEREST-BEARING BANK
ACCOUNTS

2C. IRAS, KEOGH PLANS, ETC.

2D. STOCKS, BONDS, MUTUAL
FUNDS, ETC.

2E. REAL PROPERTY

(Not your home)

2F. ALL OTHER PROPERTY AND ASSETS

JUL 2021	21-0788	SUPERSEDES VA FORM 21-0788, MAR 2018.	Page 1
VA FORM

PART II - MONTHLY LIVING EXPENSES

Show your monthly living expenses, including any monthly installment payments. If you do not have expenses from a particular source, write "0" or "none" in the space provided. Do not leave the space blank.

Note: If you are the veteran or surviving spouse, report only your expenses. If you are the claimant or are filing on behalf of the claimant(s), report expenses for all persons for whom an apportionment is being claimed. If you are claiming an apportionment as the custodian of the veteran's child or children, report your expenses and the expenses of the child(ren).

SOURCE	VETERAN OR		CUSTODIAN	PERSON APPORTIONMENT	PERSON APPORTIONMENT
SOURCE	SURVIVING SPOUSE		CUSTODIAN	IS CLAIMED FOR	IS CLAIMED FOR
	SURVIVING SPOUSE			IS CLAIMED FOR	IS CLAIMED FOR

1A. RENT OR HOUSE PAYMENT	$	$		$	$

1B. FOOD

1C. UTILITIES Water, gas, electricity)

1D. TELEPHONE

1E. CLOTHING

1F. MEDICAL EXPENSES

1G. SCHOOL EXPENSES

1H. OTHER EXPENSES
(Show source)

1I. OTHER EXPENSES

(Show source)

PART III - REMARKS

8. REMARKS

PART IV - CERTIFICATION AND SIGNATURE

I CERTIFY THAT the foregoing statements are true and correct to the best of my knowledge and belief.

9. SIGNATURE OF VETERAN OR CLAIMANT (Required)

10.DATE SIGNED (MM/DD/YYYY)

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 is false, or fraudulent acceptance of any payment to which you are not entitled.

PRIVACY ACT INFORMATION - The 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, 58VA 21/22/28, 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 an apportionment of VA disability or death benefits may be made (38 U.S.C. 5307). Title 38, United States Code, allows us to ask for this information. We estimate that you will need an average of 30 minutes to review the instructions, find the information, and complete this 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.

VA FORM 21-0788, JUL 2021

Page 2

How to Edit Va Form 21 0788 Online for Free

We were developing this PDF editor having the idea of making it as quick to work with as it can be. That's the reason the procedure of completing the va apportionment form will likely to be smooth use these particular actions:

Step 1: The very first step will be to click the orange "Get Form Now" button.

Step 2: Right now, it is possible to edit the va apportionment form. Our multifunctional toolbar allows you to add, get rid of, adjust, highlight, and also carry out many other commands to the content and fields within the file.

The particular areas are going to make up your PDF file:

part 1 to writing va 0788

Write the data in B SOCIAL SECURITY, C RETIREMENT OR ANNUITIES, D SUPPLEMENTAL SECURITY INCOME SSI, F OTHER INCOME Show source, SOURCE, VETERAN OR SURVIVING SPOUSE, NET WORTH, CUSTODIAN, PERSON APPORTIONMENT IS CLAIMED FOR, PERSON APPORTIONMENT IS CLAIMED FOR, A CASHNONINTERESTBEARING BANK, B INTERESTBEARING BANK ACCOUNTS, C IRAS KEOGH PLANS ETC, D STOCKS BONDS MUTUAL FUNDS ETC, and E REAL PROPERTY Not your home.

va 0788 B SOCIAL SECURITY, C RETIREMENT OR ANNUITIES, D SUPPLEMENTAL SECURITY INCOME SSI, F OTHER INCOME Show source, SOURCE, VETERAN OR SURVIVING SPOUSE, NET WORTH, CUSTODIAN, PERSON APPORTIONMENT IS CLAIMED FOR, PERSON APPORTIONMENT IS CLAIMED FOR, A CASHNONINTERESTBEARING BANK, B INTERESTBEARING BANK ACCOUNTS, C IRAS KEOGH PLANS ETC, D STOCKS BONDS MUTUAL FUNDS ETC, and E REAL PROPERTY Not your home blanks to fill

Jot down all data you may need in the section E REAL PROPERTY Not your home, F ALL OTHER PROPERTY AND ASSETS, VA FORM JUL, SUPERSEDES VA FORM MAR, and Page.

va 0788 E REAL PROPERTY Not your home, F ALL OTHER PROPERTY AND ASSETS, VA FORM JUL, SUPERSEDES VA FORM MAR, and Page fields to fill

As part of section SOURCE, VETERAN OR SURVIVING SPOUSE, CUSTODIAN, PERSON APPORTIONMENT IS CLAIMED FOR, PERSON APPORTIONMENT IS CLAIMED FOR, A RENT OR HOUSE PAYMENT, B FOOD, C UTILITIES Water gas electricity, D TELEPHONE, E CLOTHING, F MEDICAL EXPENSES, G SCHOOL EXPENSES, H OTHER EXPENSES, Show source, and I OTHER EXPENSES Show source, identify the rights and obligations.

Completing va 0788 part 4

Finish by checking these areas and preparing them accordingly: REMARKS, PART IV CERTIFICATION AND, SIGNATURE OF VETERAN OR CLAIMANT, DATE SIGNED MMDDYYYY, PENALTY The law provides severe, and The VA will not disclose.

va 0788 REMARKS, PART IV CERTIFICATION AND, SIGNATURE OF VETERAN OR CLAIMANT, DATE SIGNED MMDDYYYY, PENALTY The law provides severe, and The VA will not disclose fields to complete

Step 3: Hit "Done". Now you can transfer the PDF form.

Step 4: To prevent yourself from any type of problems later on, be sure to have around two or three copies of the file.

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