Va Form 21P 4706B PDF Details

In the careful orchestration of veterans' affairs, ensuring the dignity and financial stability of those who have served is paramount. Central to this endeavor is the VA Form 21P-4706b, a document that stands as a testament to the commitment and trust placed in fiduciaries by the Department of Veterans Affairs. This form serves as a comprehensive accounting record, meticulously documenting every transaction made on behalf of the veteran or beneficiary, from the total estate at the beginning of the period to the assets at its conclusion. The form demands a detailed account of money received and spent, including but not limited to, bank account balances, investment in certificates of deposit, and expenditures on necessities such as room, board, and personal care needs. Furthermore, it delves into the fiduciary's personal background, including any criminal or credit issues that could affect their role. With a respondent burden of 27 minutes and an expiration in late 2024, the form underscores the balance between thorough oversight and respect for the fiduciary's time and responsibilities. Critical for the administration of a beneficiary's estate, it embodies the intersection of diligence, transparency, and the unwavering endeavor to honor the financial wellbeing of those who have served.

QuestionAnswer
Form NameVa Form 21P 4706B
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other names Expiration Date: 12/31/2021

Form Preview Example

 

 

 

 

 

 

 

 

OMB Control No. 2900-0017

 

 

 

 

 

 

 

 

Respondent Burden: 27 Minutes

 

 

 

 

 

 

 

 

Expiration Date: 12/31/2024

 

 

 

 

VA FIDUCIARY'S ACCOUNT

 

NAME AND ADDRESS OF FIDUCIARY

 

 

 

VA FIDUCIARY HUB

 

 

 

 

 

FROM

 

 

TO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NAME OF VETERAN (First-Middle-Last)

NAME OF BENEFICIARY (If not veteran)

 

 

VA FILE NUMBER

 

 

 

 

 

 

 

 

C-

 

SECTION I - STATEMENT OF ACCOUNT

 

 

 

 

 

INSTRUCTIONS: Items 1 through 7 are to be completed by the fiduciary and returned to the VA Fiduciary Hub. Show monthly

 

 

ACCOUNTING PERIOD

 

amount where indicated, in addition to amount for accounting period. Attach detailed monthly financial (bank) statements for the

 

 

 

 

 

FROM

 

TO

entire accounting period to support the transactions noted on this accounting.

 

 

 

 

 

 

 

 

 

 

 

 

IMPORTANT - SEE PRIVACY ACT INFORMATION ON REVERSE.

 

 

 

 

 

 

 

 

IMPORTANT - The fiduciary must account for all funds received on behalf of the beneficiary as VA fiduciary, representative payee for SSA benefits, or in any other fiduciary capacity. The fiduciary must keep receipts and other documentation of expenses because VA may need to examine them during the audit of this accounting.

 

1. MONEY RECEIVED

 

 

 

4. ASSETS AT END OF PERIOD*

 

ITEM

 

 

DESCRIPTION

 

 

AMOUNT

ITEM

 

DESCRIPTION

AMOUNT

A

TOTAL ESTATE AT BEGINNING OF PERIOD

 

A

TOTAL AMOUNT OF CHECKING

 

$

ACCOUNT(S)

$

 

 

 

 

 

 

 

 

 

AMOUNT

NO. OF MONTHS

 

MONTHLY AMT.

 

B

TOTAL AMOUNT OF SAVINGS

 

B

 

 

 

 

 

 

ACCOUNT(S)

 

 

 

 

 

 

 

 

 

RECEIVED

NO. OF MONTHS

 

MONTHLY AMT.

 

 

TOTAL AMOUNT OF

 

 

FROM VA

 

 

C

 

 

 

 

 

 

 

 

CERTIFICATE(S) OF DEPOSIT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

AMOUNT

NO. OF MONTHS

 

MONTHLY AMT.

 

 

TOTAL PURCHASE PRICE OF

 

C

RECEIVED

 

 

 

 

 

 

 

SAVINGS BONDS LISTED ON

 

FROM

 

 

 

 

 

 

 

REVERSE (Complete reverse for

 

 

SOCIAL

NO. OF MONTHS

 

MONTHLY AMT.

 

 

total in this field)

 

 

SECURITY

 

 

 

 

 

 

 

(1) WERE ADDITIONAL BONDS

 

 

 

 

 

 

 

 

 

 

PURCHASED DURING THIS

 

 

 

 

 

 

 

 

 

 

 

D

INTEREST EARNED ON DEPOSITS

 

D

ACCOUNTING PERIOD?

 

 

YES

NO

 

 

 

 

 

 

 

 

 

 

 

E

AMOUNT RECEIVED FROM OTHER SOURCES

 

 

 

 

 

 

 

(2) WERE SAVINGS BONDS CASHED

 

(List in Items 1E thru 1H)

 

 

 

 

 

 

 

 

 

 

DURING THIS ACCOUNTING

 

F

 

 

 

 

 

 

 

 

PERIOD?

 

 

 

 

 

 

 

 

 

 

YES

NO

 

G

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

H

 

 

 

 

 

 

 

 

OTHER (List outstanding checks or other

 

I

*TOTAL RECEIVED (ADD LINES 1A THRU 1H)

$

E

issues that impact the total assets.)

 

 

2. MONEY SPENT

 

 

 

 

 

 

A

ROOM AND

 

NO. OF MONTHS

MONTHLY AMT.

 

 

 

 

 

 

BOARD/RENT

 

 

 

 

 

$

 

5. TOTAL ASSETS

 

 

 

 

 

 

 

 

 

B

CLOTHING

 

 

 

 

 

 

 

(MUST EQUAL ITEM 3)

$

C

ENTERTAINMENT

 

 

 

6. REMARKS (If needed you may attach additional sheets and key

D

PERSONAL

 

NO. OF MONTHS

MONTHLY AMT.

 

responses to item numbers.)

 

USE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E

DEPENDENT

 

NO. OF MONTHS

MONTHLY AMT.

 

 

 

 

 

(S) SUPPORT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FFIDUCIARY FEE IF APPROVED BY VA

G OTHER (Specify)

H

I

J

K

L

M

TOTAL SPENT (ADD LINES 2A THRU 2L)

$

 

3. TOTAL FUNDS UNDER MANAGEMENT AT

 

 

END OF PERIOD (SUBTRACT 2M FROM 1I)

$

* NOTE: Pursuant to my signed Fiduciary Agreement (VA Form 21P-4703), this is a complete accounting of all funds I received for the beneficiary.

I CERTIFY THAT this is a true account of the beneficiary's estate for the period stated, to the best of my knowledge and belief.

7. DATE

 

8. SUBMITTED BY (Signature and title of fiduciary) (Sign in ink)

 

 

 

 

 

 

VA FORM

21P-4706b

SUPERSEDES VA FORM 21-4706b, DEC 2019,

(Continued on Reverse)

DEC 2021

WHICH WILL NOT BE USED.

9. BACKGROUND INFORMATION

Answer the questions below if you are an individual appointed to serve as fiduciary for the beneficiary named on the reverse side of this form. The questions pertain to your personal criminal and credit history. Failure to provide a response may impact your ability to serve as a VA fiduciary.

You are not required to respond to these questions if you are serving as VA fiduciary in one of the following capacities for the beneficiary named on the reverse:

administrator of a facility

company or corporation

court-appointed fiduciary who is also appointed by VA

I certify that during this accounting period, I have not been convicted of any offense under Federal or State law, which resulted in imprisonment for more than one year. I understand the Department of Veterans Affairs may obtain my criminal background history to verify my response. Initial the box below to certify and acknowledge this information.

I certify that during this accounting period, I did not default on a debt, was not the subject of collection action by a creditor and did not file bankruptcy. To the best of my knowledge, no adverse credit information was reported to a credit bureau because I was unable to meet my personal financial obligations. I understand the Department of Veterans Affairs may obtain my credit history report to verify my response. Initial the box below to certify and acknowledge this information.

10. EXPLANATION OF BACKGROUND INFORMATION (If necessary)

LINE

SERIAL NUMBER

DATE OF

PURCHASE

LINE

SERIAL NUMBER

DATE OF

PURCHASE

NO.

PURCHASE

PRICE

NO.

PURCHASE

PRICE

 

 

 

 

 

 

 

 

 

 

1.

 

 

 

6.

 

 

 

 

 

 

 

 

 

 

 

2.

 

 

 

7.

 

 

 

 

 

 

 

 

 

 

 

3.

 

 

 

8.

 

 

 

 

 

 

 

 

 

 

 

4.

 

 

 

9.

 

 

 

 

 

 

 

 

 

 

 

5.

 

 

 

10.

 

 

 

SECTION II - CERTIFICATION OF U.S. SAVINGS BONDS

I CERTIFY THAT the savings bonds listed above are the property of the estate of the beneficiary and are in my custody and control.

SIGNATURE OF FIDUCIARY (Sign in ink)

DATE

PRIVACY ACT INFORMATION: The VA will not disclose information on the form to any source other than what has been authorized under the Privacy Act of 1974 or Title 5, Code of Federal Regulations 1.526 for routine uses (i.e. request from Congressman on behalf of a beneficiary) as identified in the VA system of records, 37VA27, VA Supervised Fiduciary/Beneficiary and General Investigative Records, published in the Federal Register. You are required to respond (38 U.S.C. 5701) to obtain or retain benefits. The information will be used to ensure the proper administration of the beneficiary's income and estate. Failure to furnish the requested information may result in the suspension of payments and/or the appointment of a successor fiduciary.

RESPONDENT BURDEN: We need this information to ensure proper administration of the beneficiary's estate. Title 38, United States Code allows us to ask for this information. We estimate that you will need an average of 27 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 https://reginfo.gov/public/do/PRAMain.

VA FORM 21P-4706b, DEC 2021

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Step 1: Select the button "Get form here" to access it.

Step 2: So you're on the file editing page. You may enhance and add text to the document, highlight words and phrases, cross or check particular words, insert images, insert a signature on it, get rid of unneeded areas, or eliminate them completely.

These sections are what you are going to complete to receive the prepared PDF file.

example of gaps in Va Form 21P 4706B

Type in the data in the F G H I, B C, F G H I J K L M, AMOUNT RECEIVED FROM OTHER SOURCES, TOTAL RECEIVED ADD LINES A THRU H, MONTHLY AMT, ROOM AND BOARDRENT, CLOTHING ENTERTAINMENT, PERSONAL USE, DEPENDENT S SUPPORT, NO OF MONTHS MONTHLY AMT, NO OF MONTHS, MONTHLY AMT, FIDUCIARY FEE IF APPROVED BY VA, and TOTAL SPENT ADD LINES A THRU L area.

Filling out Va Form 21P 4706B step 2

Note down any data you are required inside the area TOTAL FUNDS UNDER MANAGEMENT AT, END OF PERIOD SUBTRACT M FROM I, NOTE Pursuant to my signed, I CERTIFY THAT this is a true, DATE, SUBMITTED BY Signature and title, VA FORM DEC Pb, SUPERSEDES VA FORM b DEC WHICH, and Continued on Reverse.

step 3 to completing Va Form 21P 4706B

The I certify that during this, I certify that during this, EXPLANATION OF BACKGROUND, LINE NO, SERIAL NUMBER, DATE OF PURCHASE, PURCHASE PRICE, LINE NO, SERIAL NUMBER, DATE OF PURCHASE, and PURCHASE PRICE field will be your place to include the rights and obligations of all parties.

Va Form 21P 4706B I certify that during this, I certify that during this, EXPLANATION OF BACKGROUND, LINE NO, SERIAL NUMBER, DATE OF PURCHASE, PURCHASE PRICE, LINE NO, SERIAL NUMBER, DATE OF PURCHASE, and PURCHASE PRICE blanks to complete

Finish the file by looking at these particular fields: SECTION II CERTIFICATION OF US, SIGNATURE OF FIDUCIARY Sign in ink, DATE, PRIVACY ACT INFORMATION The VA, RESPONDENT BURDEN We need this, and VA FORM Pb DEC.

Va Form 21P 4706B SECTION II  CERTIFICATION OF US, SIGNATURE OF FIDUCIARY Sign in ink, DATE, PRIVACY ACT INFORMATION The VA, RESPONDENT BURDEN We need this, and VA FORM Pb DEC blanks to insert

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