Va Form 21P 0519C PDF Details

Having trouble completing your VA Form 21P 0519C? This can be a tricky form to fill out correctly, and even those with experience often find themselves spending hours working on the details. But don't lose hope—this guide will provide you with clear instructions that make it easy to understand how this form works and complete it confidently. Whether you're new to filing VA forms or an experienced professional, our step-by-step instructions will help ensure that everything is done right the first time around.

QuestionAnswer
Form NameVa Form 21P 0519C
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesVBA 21P 0519C 1 ARE va form 21 0519c1 eligibility verification

Form Preview Example

OMB Approved No. 2900-0101

Respondent Burden : 30 minutes

FIRST, MIDDLE, LAST NAME OF VETERAN

 

IMPROVED PENSION ELIGIBILITY

 

 

VERIFICATION REPORT

 

VETERAN'S SOCIAL SECURITY NUMBER

(CHILD OR CHILDREN)

9C

 

VA FILE NUMBER

 

 

 

 

COMPLETE MAILING ADDRESS OF CHILD OR CUSTODIAN

VA REGIONAL OFFICE RETURN ADDRESS

 

IMPORTANT -Please read the enclosed EVR Instructions (VA Form 21-0510) prior to completing this form.

1. CHILD(REN)'S MARITAL AND SCHOOL STATUS

List the children's names, dates of birth, and Social Security numbers, and indicate marital and school status for all children being paid on this award. If the child does not have a Social Security number, write "No SSN" in the space provided for the child's Social Security number. If other children are on separate VA awards, they will receive their own EVRs. If additional space is needed, attach a separate sheet of paper.

NOTE: Complete Item 1E only if the child is 18 years of age or older. Complete Item 1F only if the child is between the ages of 18 and 23 and has not been rated disabled by VA. The child is considered to have attended school continuously if the child attended every regular school term except summer school or holiday periods. If Block (2), STOPPED SCHOOL, is checked in Item 1E or "NO" is checked in Item 1F, provide the date the child last attended school in Item 1F.

A. FULL NAME OF EACH

B. DATE OF

C. SOCIAL SECURITY

 

 

 

 

 

 

 

F. ATTENDED SCHOOL

 

 

 

CHILD

BIRTH

 

D. MARITAL STATUS

E. SCHOOL STATUS

 

CONTINUOUSLY

 

 

 

NUMBER

 

 

(First, middle initial, last)

(Mo.,day,yr.)

 

 

 

 

 

 

 

 

SINCE AGE 18

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(1)

 

 

MARRIED

(1)

 

ATTENDS SCHOOL

 

 

 

DATE LEFT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SCHOOL

 

 

 

 

 

 

 

 

(2)

 

 

DIVORCED/WIDOWED

(2)

 

STOPPED SCHOOL

(1)

 

YES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(3)

 

 

NEVEVER MARRIED

(3)

 

DISABLED CHILD

(2)

 

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(1)

 

 

MARRIED

(1)

 

ATTENDS SCHOOL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(2)

 

 

DIVORCED/WIDOWED

(2)

 

STOPPED SCHOOL

(1)

 

YES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(3)

 

 

NEVEVER MARRIED

(3)

 

DISABLED CHILD

(2)

 

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(1)

 

 

MARRIED

(1)

 

ATTENDS SCHOOL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(2)

 

 

DIVORCED/WIDOWED

(2)

 

STOPPED SCHOOL

(1)

 

YES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(3)

 

 

NEVEVER MARRIED

(3)

 

DISABLED CHILD

(2)

 

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(1)

 

 

MARRIED

(1)

 

ATTENDS SCHOOL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(2)

 

 

DIVORCED/WIDOWED

(2)

 

STOPPED SCHOOL

(1)

 

YES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(3)

 

 

NEVEVER MARRIED

(3)

 

DISABLED CHILD

(2)

 

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(1)

 

 

MARRIED

(1)

 

ATTENDS SCHOOL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(2)

 

 

DIVORCED/WIDOWED

(2)

 

STOPPED SCHOOL

(1)

 

YES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(3)

 

 

NEVEVER MARRIED

(3)

 

DISABLED CHILD

(2)

 

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(1)

 

 

MARRIED

(1)

 

ATTENDS SCHOOL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(2)

 

 

DIVORCED/WIDOWED

(2)

 

STOPPED SCHOOL

(1)

 

YES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(3)

 

 

NEVEVER MARRIED

(3)

 

DISABLED CHILD

(2)

 

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2. DID ANY CHILD ON THIS AWARD RECEIVE WAGES AT ANY TIME DURING THE LAST 12 MONTHS?

 

 

 

 

 

 

 

 

 

YES

 

 

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VA FORM

 

 

 

 

SUPERSEDES VA FORM 21-0519C-1, JUN 2004, WHICH

 

(CONTINUED ON REVERSE)

APR 2012 21P-0519C-1

 

WILL NOT BE USED.

 

 

 

 

 

 

 

 

 

 

REPORT OF INCOME AND NET WORTH

IMPORTANT NOTE ABOUT ITEMS 3A THROUGH 3G:

Child Claimants or Payees: If you are a child claiming or receiving pension in your own right, report your income and net worth in the CHILD columns. Leave the

CUSTODIAN columns blank. Custodians of Children: If you are claiming or receiving pension as the custodian of a child or children, report the child's income and net worth in the CHILD columns, and enter your income and net worth in the CUSTODIAN columns. If you are also the child's parent, you are married, and you live with your spouse, add your and your spouse's incomes and net worth together and enter the totals in the CUSTODIAN columns in Items 3A, 3B, and 3G.

Institutional Custodians: If you are an institutional custodian of a child, report the child's income and net worth in the CHILD columns. Leave the CUSTODIAN columns blank.

If no income was received from a particular source, write "0" or "none." Do not leave any items blank unless the instructions specifically indicate that the item does not have to be answered. VA will interpret a blank space as "0" or "None."

3A. MONTHLY INCOME (Read Paragraphs 2 and 3 of the EVR Instructions)

GROSS MONTHLY AMOUNTS

SOURCE

CUSTODIAN:

CHILD:

CHILD:

 

 

 

 

 

 

 

SOCIAL SECURITY

$

$

$

U.S. CIVIL SERVICE

U.S. RAILROAD RETIREMENT

BLACK LUNG BENEFITS

OTHER RETIREMENT

OTHER (Show Source)

OTHER (Show Source)

3B. ANNUAL INCOME (Read Paragraphs 2 and 4 of the EVR Instructions)

NOTE: Report annual income for the dates indicated. If no dates are shown above the columns that follow, then report last calendar year (January through December) income in the left-hand column and current calendar year income in the right-hand column.

 

CUSTODIAN:

 

CHILD:

 

CHILD:

 

SOURCE

FROM:

FROM:

FROM:

FROM:

FROM:

FROM:

 

 

 

 

 

 

 

THRU:

THRU:

THRU:

THRU:

THRU:

THRU:

GROSS WAGES FROM ALL

$

$

$

$

$

$

EMPLOYMENT

 

 

 

 

 

 

 

 

 

 

 

 

 

TOTAL INTEREST AND DIVIDENDS

 

 

 

 

 

 

 

 

 

 

 

 

 

ALL OTHER (Show Source)

 

 

 

 

 

 

 

 

 

 

 

 

 

3C. DID ANY INCOME CHANGE (Increase/Decrease) DURING THE PAST 12 MONTHS? (Answer "NO" if there were no income changes or if the only change was a Social Security/VA cost-of-living adjustment. Answer "YES" if there were any other income changes or if you received any NEW source of income or any ONE-TIME income.)

(1)

 

YES (2)

 

NO

(If "YES," complete Items 3D through 3F. If "NO," go to Item 3G.)

 

 

 

 

 

 

3D. WHAT INCOME CHANGED? (Show what

3E. WHEN DID THE INCOME CHANGE?

 

3F. HOW DID INCOME CHANGE? (Tell

 

 

income changed; for example, wages,

(Show the dates you received any new

 

what happened; for example, quit work,

 

 

 

city pension, etc.)

income or the date income changed)

 

got raise, received inheritance)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3G. NET WORTH (Read Paragraph 5 of the EVR Instructions)

 

 

 

 

 

 

SOURCE

CUSTODIAN:

CHILD:

 

CHILD:

CASH/NON-INTEREST-BEARING BANK ACCOUNTS

$

$

 

 

$

INTEREST-BEARING BANK ACCOUNTS

 

 

 

 

 

IRA'S, KEOGH PLANS, ETC.

 

 

 

 

 

STOCKS, BONDS, MUTUAL FUNDS, ETC.

 

 

 

 

 

REAL PROPERTY (Not your home)

 

 

 

 

 

ALL OTHER PROPERTY

 

 

 

 

 

 

 

 

 

 

 

4. CHILD'S MEDICAL EXPENSES (Read Paragraph 6 of the EVR Instructions)

Normally, medical expenses are reported at the end of the year. If you are using this form as your annual Eligibility Verification Report and Paragraph 6 of the EVR Instructions indicates that you should report medical expenses, use VA Form 21-8416, Medical Expense Report, to report your medical expenses. If you are using this form as a supplement to a pending claim, you do not need to report medical expenses. If entitlement is established, you will have an opportunity to report your medical expenses at the end of the year.

5. CHILD'S EDUCATIONAL EXPENSES (Read Paragraph 7 of the EVR Instructions)

If a school child answered "YES" to Items 1F and 2, report any educational expenses the child paid out of his/her own funds during the past 12 months.

A. SCHOOL CHILD'S NAME

 

B. AMOUNT PAID

 

$

 

 

 

 

 

$

 

 

 

 

6A. SIGNATURE OF PAYEE (Read Paragraph 9 of the EVR Instructions before signing)

 

6B. DATE SIGNED

 

 

 

6C. TELEPHONE NUMBERS (Include Area Code)

DAYTIME

EVENING

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.

VA FORM 21P-0519C, APR 2012

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As a way to fill out this document, make certain you provide the right details in each and every field:

1. The Va Form 21P 0519C will require particular information to be inserted. Make sure the following fields are complete:

Tips on how to fill out Va Form 21P 0519C step 1

2. After filling in this step, go to the next stage and fill in the essential details in all these blank fields - DATE LEFT, SCHOOL, MARRIED, DIVORCEDWIDOWED, NEVEVER MARRIED, MARRIED, DIVORCEDWIDOWED, NEVEVER MARRIED, MARRIED, DIVORCEDWIDOWED, NEVEVER MARRIED, MARRIED, DIVORCEDWIDOWED, NEVEVER MARRIED, and MARRIED.

Simple tips to prepare Va Form 21P 0519C part 2

Be really mindful while filling out DIVORCEDWIDOWED and SCHOOL, since this is the part in which a lot of people make errors.

3. Through this stage, examine GROSS MONTHLY AMOUNTS, SOURCE, CUSTODIAN, SOCIAL SECURITY, US CIVIL SERVICE, US RAILROAD RETIREMENT, BLACK LUNG BENEFITS, OTHER RETIREMENT, OTHER Show Source, OTHER Show Source, CHILD, CHILD, NOTE Report annual income for the, B ANNUAL INCOME Read Paragraphs, and SOURCE. Every one of these will need to be filled in with greatest precision.

Stage no. 3 for filling in Va Form 21P 0519C

4. Completing CASHNONINTERESTBEARING BANK, SOURCE, CUSTODIAN, CHILD, CHILD, G NET WORTH Read Paragraph of the, INTERESTBEARING BANK ACCOUNTS, IRAS KEOGH PLANS ETC, STOCKS BONDS MUTUAL FUNDS ETC, REAL PROPERTY Not your home, ALL OTHER PROPERTY, CHILDS MEDICAL EXPENSES Read, Normally medical expenses are, If a school child answered YES to, and CHILDS EDUCATIONAL EXPENSES Read is key in this next section - ensure that you spend some time and fill out each blank!

Filling in part 4 in Va Form 21P 0519C

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