Va Form 9957 ≡ Fill Out Printable PDF Forms Online

Va Form 9957 PDF Details

If you are a veteran, then you may be eligible for certain benefits and services through the Department of Veterans Affairs. One such form that you may need to file in order to receive these benefits is VA Form 9957. This form is used to apply for Aid and Attendance benefits, which can provide financial assistance to veterans who require aid with daily living activities. The form can be complex, so it's important to understand what it is and how to complete it correctly. In this blog post, we will go over the basics of VA Form 9957 and provide some tips on how to fill it out correctly.

Here, you will discover quite a few information about va form 9957 PDF. Before you decide to complete the form, it's worth reading more details on it.

Question	Answer
Form Name	Va Form 9957
Form Length	2 pages
Fillable?	Yes
Fillable fields	1
Avg. time to fill out	42 sec
Other names	va9957 pdf, va form 9957 2016, va form 9957 pdf, va form 9957 fillable

12

Form Preview Example

ACCESS FORM

PRIVACY ACT STATEMENT: The information is solicited under authority of Title 38, United States Code and Executive Order 9397 and is necessary to accomplish the action requested by the requester, including establishing, modifying or deleting a Customer Account. Furnishing the information on this form is voluntary; however, if the information is not furnished, we will be unable to take further action on your request.

NOTE: Information from this form is used to establish VA Accounts or to grant access to VA resources.

ARE YOU CURRENT ON YOUR SIGNED RULES OF BEHAVIOR; CYBER SECURITY AND PRIVACY TRAINING?

YES

NO

TYPE OF ACCESS
ZOS (Mainframe)	WINDOWS	EMAIL
UNIX	DATABASE	LAN ACCOUNT
USD	OTHER (Specify)	MDS/SVH
USD

TYPE OF ACTION REQUESTED

CREATE NEW CUSTOMER MODIFY EXISTING CUSTOMER

DELETE EXISTING CUSTOMER

2. CUSTOMER INFORMATION

A. NAME (Last, First, Middle Initial)					B. CUSTOMER ID			C. TELEPHONE NUMBER (Include Area Code)

D.STATION (FACILITY) NUMBER			E. MAIL ROUTING SYMBOL		F. JOB TITLE
			OR STOP CODE

G. CONTRACTOR, OR IF TEMPORARY ACCESS, SHOW					H. GOVERNMENT ORGANIZATION, CONTRACTOR NAME EMPLOYER OR OTHER
EXPIRATION DATE (Month, day, year)

I. CONTRACTOR OR OTHER GOVERNMENT ORGANIZATION,							J. ACTIVE DIRECTORY (AD) USERNAME		K. ACTIVE DIRECTORY (AD) DOMAIN
OFFICE ADDRESS (Street, City, State, Zip Code)

							L. E-MAIL ADDRESS

NOTE: See reverse for instructions.
				3. ACCESS REQUESTED
CHECK	NAME OF FUNCTIONAL TASK CODES; PROFILES, WEB
APPROPRIATE	NAME OF FUNCTIONAL TASK CODES; PROFILES, WEB					DEFINE LEVEL OF ACCESS REQUESTED OR CONCURRING SYSTEM MANAGER OF
BOX	SERVERS; UNIX ACCOUNTS; DATABASE OR OTHER						RECORD (SMR) DESIGNEE SIGNATURE AND TITLE (If required)
ADD DELETE		ACCESS
ADD DELETE
	Grant the following Web site Access					MDS/SVH Facility View
						Level of Access: Read Only

	Grant the following Web site Access					MDS/SVH Facility Transmit
						Level of Access: Update

4. SIGNATURES

A. REQUESTING OFFICIAL & TITLE				B.DATE
A. REQUESTING OFFICIAL & TITLE				B.DATE


C. APPROVING OFFICIAL & TITLE				D. DATE
C. APPROVING OFFICIAL & TITLE				D. DATE


E. SECOND APPROVING OFFICIAL & TITLE (If required)				F. DATE
E. SECOND APPROVING OFFICIAL & TITLE (If required)				F. DATE


G. NAME AND TITLE OF FACILITY POINT OF CONTACT OR INFORMATION SECURITY OFFICER				G. DATE


VA FORM	All prior editions of VA Form 9957 are not acceptable for submission.
DEC 2012 9957

INSTRUCTIONS FOR COMPLETING THE ACCESS REQUEST FORM

1. Action Requested

ARE YOU CURRENT ON YOUR SIGNED RULES OF BEHAVIOR; CYBER SECURITY AND PRIVACY TRAINING? - If current, check "YES". If "NO" is checked then access form can not be processed.

TYPE OF ACCESS - check appropriate box.

TYPE OF ACTION REQUESTED - check appropriate box.

2. Customer Information

The following are detailed instructions on completing this form. This form must be completed electronically. Block 4, Signature Block, must have the name and title completed electronically.

a.Name - If VA employee, name must match name in PAID System.

b.Customer Identification (if for Austin mainframe access enter seven (7) character Time Sharing Customer Identification).

c.Telephone Number - Required for all employees and contractors

d.Facility (Station) Number/Suffix - Required for all employees and contractors

e.Mail Routing Symbol or Mail Stop Code

-Required for all employees and contractors requesting ZOS (Mainframe accounts)

f.Job Title - Use the title from Position Description

g.Expiration Date - For contractors and students

h.Employer - Required for contractors and anyone other than a VA employee

i.Office Address - Required

j.Active Directory (AD) Username - Required for all employees and contractors

k.Active Directory (AD) Domain - Required for all employees and contractors

l.E-mail Address - Required for all employees and contractors

3.Access Requested

Please contact your facility point of contact or Information Security Officer for a list of functional task codes and requirements.

4. Signatures

The person approving the access, Approving Official, cannot be the person requesting the access, Requesting Official. Digital signatures are REQUIRED.

a. Requesting Official & Title:

-For Austin Information Technology Center and National Data Systems (NDS) require a typed name, title, date, and digital signature

-For all others use your local policy b. Approving Official & Title:

-For Austin Information Technology Center and National Data Systems (NDS) require a typed name, title, date, and digital signature

-For all others use your local policy.

BACK OF VA FORM 9957, DEC 2012, PAGE 2 OF 2

All prior editions of VA Form 9957 are not acceptable for submission.

How to Edit Va Form 9957 Online for Free

This PDF editor allows you to fill out forms. You don't need to do much to update va form 9557 files. Just keep up with the following actions.

Step 1: Choose the button "Get Form Here" on the webpage and select it.

Step 2: At the moment, you are able to change your va9957 pdf. Our multifunctional toolbar will let you add, erase, alter, highlight, and also conduct other commands to the content material and areas within the file.

For every single area, add the information requested by the application.

va form 9957 access form fields to fill out

Enter the requested data in the space CHECK, BOX ADD, DELETE ACCESS, A, REQUESTING, OFFICIAL, TITLE C, APPROVING, OFFICIAL, TITLE SIGNATURES, and B, DATE

va form 9957 access form CHECKBOX, ADDDELETE, ACCESS, AREQUESTINGOFFICIALTITLE, CAPPROVINGOFFICIALTITLE, SIGNATURES, and BDATE blanks to complete

You can be asked for particular significant particulars if you would like complete the C, APPROVING, OFFICIAL, TITLE D, DATE F, DATE G, DATE and VA, FORM, DEC segment.

va form 9957 access form CAPPROVINGOFFICIALTITLE, DDATE, FDATE, GDATE, and VAFORMDEC blanks to insert

Step 3: After you have selected the Done button, your form should be available for export to each electronic device or email you indicate.

Step 4: You could make copies of the document tostay clear of any type of forthcoming challenges. You need not worry, we don't disclose or monitor your details.

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