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The VA 119 form, also known as the Report of Contact, plays a critical role in ensuring that important communications regarding veterans are documented properly. This form serves as a permanent record in a veteran’s folder once filled out, making it essential for both the individual veterans and the professionals who assist them. It requires detailed information, such as the veteran's full name, contact information, and the nature of the contact—be it personal or via telephone. Furthermore, it captures essential details about the person contacted and who initiated the communication. The form prioritizes clarity and precision, so only ink should be used to complete it, avoiding any potential issues from pencil markings. Additionally, there are sections dedicated to a brief statement of the information requested and given, allowing for a concise summary of the interaction. For those involved in the veterans' services, understanding the significance of the VA 119 form is crucial, as it facilitates the effective exchange of important information and ensures continuity of care for veterans.

Va 119 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

Form Characteristics

Fact Name Details
Form Purpose The VA 119 form serves to document contact concerning a veteran's case.
Permanent Record Once completed, this form is stored permanently in the veteran's file.
Identification Numbers It requires VA office identification numbers such as C, XC, SS, etc.
Veteran’s Information Includes fields for the veteran's last name, first name, middle name, address, and telephone number.
Contact Method Type of contact must be indicated as either personal or telephone.
Request Details Requires a brief statement of information requested and provided. An additional page can be used if necessary.
Signature Requirement The form must be executed by a person who signs and provides their title.
Governing Law Governing laws related to this form are specified under Title 38 of the U.S. Code.

Guidelines on Utilizing Va 119

Once you have the VA 119 form in front of you, it’s time to start filling it out. This form will become a permanent record in the veteran's folder, so accuracy is essential. It's crucial to use a pen rather than a pencil when completing it. Follow the steps below to ensure all necessary information is provided correctly.

  1. Identify the VA Office: In the space provided, write the VA office identification numbers (C, XC, SS, XSS, V, K, etc.).
  2. Veteran Information: Enter the veteran's last name, first name, and middle name. Make sure this is clear and legible.
  3. Date of Contact: Fill in the date you are completing the form.
  4. Veteran's Address: Write the complete address of the veteran, including street, city, state, and ZIP code.
  5. Veteran's Telephone Number: Provide the veteran's telephone number, including the area code.
  6. Person Contacted: State the name of the person contacted.
  7. Type of Contact: Choose the appropriate check box to indicate if it was a personal visit or a telephone call.
  8. Address of Person Contacted: Write the complete address of the person you contacted.
  9. Telephone Number of Person Contacted: Enter the telephone number of the person contacted, including the area code.
  10. Person Who Contacted You: Fill in the name of the person who reached out to you.
  11. Type of Contact: Again, choose between personal or telephone for the contact type.
  12. Address of Person Who Contacted You: Provide the full address of the person who contacted you.
  13. Telephone Number of Person Who Contacted You: Write down the telephone number of this person, including area code.
  14. Brief Statement of Information: Summarize the information that was requested and given. If you need more space, continue on page 2.
  15. Division or Section: Specify the division or section related to this contact.
  16. Executed By: Sign your name and include your title where indicated.

Double-check all entries before submitting the form. Keep a copy for your records if necessary. Once completed, the form is ready to become part of the veteran's permanent record.

What You Should Know About This Form

What is the VA Form 119?

The VA Form 119, also known as the Report of Contact, serves as a record-keeping tool used by the Department of Veterans Affairs. It documents any interactions between veterans, their representatives, and VA personnel. After completion, this form becomes a permanent part of a veteran's record, highlighting important communications and requests for information.

How do I fill out the VA Form 119?

Completing the VA Form 119 is straightforward. First, ensure you use pen rather than pencil, as the form must be clear and durable. Provide your personal information such as full name, contact details, and the specifics of your interaction. Be thorough, especially in the "Brief Statement of Information Requested and Given" section, as this will capture the essence of the communication. If more space is needed, you can continue on a second page.

Who should use the VA Form 119?

The form is primarily intended for veterans and their representatives who interact with VA personnel. If you are a veteran seeking assistance or information, or if you are a family member or advocate representing the veteran, this form is appropriate for documenting your communication with the VA.

When should I use the VA Form 119?

Use the VA Form 119 to document any contact with the VA regarding inquiries, assistance requests, or updates to veteran records. It is especially useful during times of significant communication regarding benefits, claims, or medical services. This form can help keep track of what information was shared or requested during those interactions.

Where do I submit the completed VA Form 119?

After filling out the VA Form 119, you generally do not submit it to a central location. Instead, ensure that the completed form is kept in the veteran's file or folder. The form should be appropriately filed within the relevant section at the VA office to maintain accurate records of all communications.

What happens to the VA Form 119 after submission?

Once submitted and filed, the VA Form 119 remains a part of the veteran’s permanent record. It is important to maintain accuracy in the information provided, as it may be reviewed in future communications or when processing claims. The form facilitates ongoing support and ensures that there is a clear record of past interactions.

Can I request a copy of the VA Form 119 that was submitted?

Yes, veterans or their representatives can request copies of any forms submitted, including the VA Form 119. This is often done by contacting the VA office where the form was filed. Keeping a personal copy of any form submitted is also a recommended practice to easily reference the information shared during your contact with the VA.

Common mistakes

When filling out the VA Form 119, many individuals inadvertently make mistakes that can lead to delays or complications in processing. Here are eight common errors that people should be mindful of.

First, many fail to use the correct writing instrument. The instructions clearly state, “Please do not use a pencil.” Yet, some individuals habitually reach for a pencil, believing it allows for easier edits. Unfortunately, pencil marks can smudge or fade, creating issues with legibility and permanence. It is essential to use a black or blue pen for clarity.

Another frequent mistake is not including the full name of the veteran. It may seem simple to leave out the middle name, but this can lead to confusion in locating records. Ensure that the last name, first name, and middle name are all typed or printed clearly. This information should match official documents.

People often overlook the importance of complete contact information. When providing phone numbers, including the area code is crucial. Omitting this detail can result in missed communications or delays in response. Likewise, ensuring the address is accurate helps prevent misdirected correspondence.

Additionally, individuals sometimes neglect to double-check the type of contact made. Whether it’s a personal visit or a phone call should be marked clearly. This distinction may seem trivial, but it aids in the proper classification and follow-up on the request made.

Further confusion can arise if the section for the person who contacted you remains incomplete. This section requires specific details about the individual who reached out, and failing to fill it out can hinder processing. Include their full name and contact information for clarity.

In the summary sections regarding information requested and given, brevity is not always beneficial. Some individuals provide vague information or leave these sections blank. This form is designed to document the details of the interaction. Providing a thorough and clear statement can save time and effort in any required follow-ups.

Moreover, individuals often forget to sign the form. An unsigned form lacks validity and can lead to the information not being recognized. Ensure that whoever filled out the form, whether it's the veteran or a representative, has signed it appropriately.

Lastly, many people do not realize that this form becomes a permanent record in the veteran's folder. Thus, the importance of completing it accurately cannot be overstated. Errors in this document can affect future benefits or communication. Taking the time to review and verify all entries will lead to a smoother process and help avoid unnecessary complications.

Documents used along the form

The VA Form 119, officially known as the Report of Contact, is an essential document for veterans and those involved in their care or benefits. In many cases, this form is not used in isolation. A variety of other forms and documents often accompany the VA Form 119 to ensure comprehensive record-keeping and communication regarding veteran services. Below is a list of commonly associated forms along with brief descriptions of each.

  • VA Form 21-526EZ: This form is used by veterans to apply for disability compensation and related benefits. It streamlines the application process, making it easier for veterans to provide the necessary information.
  • VA Form 21-534EZ: This form serves as an application for Dependency and Indemnity Compensation (DIC) and other related benefits for surviving spouses and children. It ensures that families receive the support they deserve after a veteran's passing.
  • VA Form 21-0845: This form allows veterans to authorize a designated individual to discuss their claims and benefits with the VA. It is critical for facilitating communication between the veteran, their representatives, and the VA.
  • VA Form 20-0995: Used for submitting a Supplemental Claim, this form allows veterans to provide new and relevant evidence to support their requests for changes to previously denied claims.
  • VA Form 555: This document is necessary for the Notice of Intent to File a Claim. Veterans use it to inform the VA of their intent to file a claim for benefits, thereby preserving the effective date of their application.
  • VA Form 21-530: This form is utilized to apply for burial benefits, including plots and burial allowances. It plays a crucial role in ensuring that veterans receive appropriate recognition after their deaths.
  • VA Form 10-10EZ: This is the Application for Health Benefits, which veterans must fill out to access health care services through the VA. Completing this form is essential for establishing eligibility for various health care programs.

Each of these forms plays a distinctive role in the overall process of securing benefits and services for veterans. By understanding the functions and importance of these accompanying documents, individuals can better navigate the complexities of the VA system and ensure that all necessary information is accurately recorded and communicated.

Similar forms

The VA Form 119 is a crucial document used for reporting contact between veterans and VA representatives. It serves as a permanent record and maintains vital communication details. Several other documents share a similar purpose or structure. Below is a list outlining those documents and how they relate to the VA Form 119.

  • VA Form 21-534EZ: This form is used to apply for Dependency and Indemnity Compensation (DIC) benefits. Like the VA Form 119, it documents key information and must be completed accurately for correct processing.
  • VA Form 21-526EZ: This is the application for disability compensation. Similar to the VA Form 119, it requires clear personal information, contact details, and the nature of the claim being filed.
  • VA Form 21-686C: Used to include dependents in the veteran’s benefits, this form collects extensive personal information and contact details, analogous to the structured format of the VA Form 119.
  • VA Form 21-4142: This form is utilized for releasing medical records. It mirrors the VA Form 119 in its requirement for detailed contact information and specific data related to the request.
  • VA Form 22-1990: The application for education benefits utilizes a format that necessitates applicant information and details about the program sought, akin to how the VA Form 119 captures essential communication notes.
  • VA Form 27-0820: This form is for reporting allegations of fraud. It is similar in ensuring accountability by documenting conversations and concerns in a structured manner similar to the VA Form 119.
  • VA Form A-0120: Utilized for beneficiary designations, it requires personal details and communication records. The structure is reminiscent of the straightforward, organized approach found in VA Form 119.
  • VA Form 21-4142a: This form is a request to obtain relevant records from third parties. Like the VA Form 119, it prioritizes clarity and accuracy in gathering contact information and requests.
  • VA Form 20-0996: This is a notice of disagreement, and it also demands specific personal and claim details. The form aims to create a transparent flow of communication, much like the VA Form 119.
  • VA Form 21-2680: This is used for examination for housebound status or permanent need for regular aid and attendance. It shares a detailed structure that demands thorough input similar to the VA Form 119.

Each of these forms serves a unique purpose but maintains similarities in structure and the importance of accurate contact documentation.

Dos and Don'ts

Deciding how to complete the VA Form 119 requires attention to detail. Follow these tips to ensure the process goes smoothly and prevents any unnecessary complications.

Do's:

  • Use a pen with black or blue ink to fill out the form.
  • Provide accurate and complete information for all requested fields.
  • Clearly print the veteran’s last name, first name, and middle name.
  • Double-check the contact information for the veteran and other parties involved.

Don'ts:

  • Do not use a pencil; it can smudge and make the information illegible.
  • Avoid leaving any fields blank; if not applicable, indicate that appropriately.
  • Do not provide vague statements; be specific in the information requested and given.
  • Never forget to sign the form; an unsigned form is not valid.

Following these guidelines will help ensure that the VA Form 119 is completed correctly and efficiently. Pay attention to the details, for they often make all the difference in navigating the necessary processes with the VA.

Misconceptions

Understanding the VA Form 119 can often be confusing. Here are some common misconceptions that people have about this form:

  • It is only for veterans. Many believe that only veterans can fill out this form. In reality, anyone who needs to report contact regarding a veteran can complete it, including family members or representatives.
  • Pencil can be used to complete the form. Some might think that using a pencil is acceptable. However, it is important to use a pen. Once completed, the form becomes a permanent record and needs to be legible.
  • Only contact information is needed. Another misconception is that the form only collects basic contact details. In truth, it also requires a brief statement of the information requested and given during the contact.
  • The form is optional. Many people think that filling out the VA Form 119 is optional. However, it plays a crucial role in recording important interactions and can impact a veteran's file.
  • The information disappears after submission. Some assume that once the form is submitted, it is no longer relevant. In reality, it becomes a permanent record in the veteran's folder and is retained indefinitely.
  • The form is only for specific types of contact. There is a belief that the VA Form 119 is limited to certain types of interactions. In actuality, it can be used for any personal or telephone contact regarding a veteran.

Being aware of these misconceptions helps ensure that the VA Form 119 is filled out correctly and used effectively.

Key takeaways

Here are some key takeaways about the VA 119 form, designed to assist you in navigating the process:

  • Permanent Record: Once completed, the VA 119 form becomes a permanent record in the veteran’s folder. This means accuracy is essential, as it can have lasting implications on the veteran's file.
  • Use of Pen: Avoid using a pencil when filling out the form. A pen ensures that the information remains legible and cannot be easily altered.
  • Contact Information: Fill in all relevant contact details. It’s crucial to provide correct addresses and phone numbers for both the veteran and any individuals contacted to avoid confusion and ensure clear communication.
  • Type of Contact: Indicate the type of contact made. This can help categorize the nature of the communication, whether it was personal or via telephone, aiding in the processing of the request.
  • Additional Information: If you need more space, don’t hesitate to continue on a separate page. Ensure all statements regarding the information requested and provided are thorough and explicit.

Understanding these aspects can make the completion and utilization of the VA 119 form much more manageable. Take your time to fill it out correctly, as it plays a crucial role in the veteran’s records and future interactions with the VA.