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The VA Form 21-0788 plays a crucial role in the administration of veteran benefits, specifically regarding the apportionment of disability awards. This form allows for all or part of a veteran's disability compensation to be allocated to eligible family members such as a spouse, child, or dependent parent. It is essential to understand that a surviving spouse can also claim apportionment for the veteran's children. The form requires personal details from both the veteran and the claimant, including names, relationships, and contact information. It meticulously asks for financial disclosures pertaining to income and net worth, ensuring that the VA can assess the need for apportionment accurately. Individuals submitting this form must be aware of the legal recognition of their marriage when applying for benefits. The design of this form includes sections for monthly living expenses, contributing factors to financial hardship, and a remarks area for additional comments. Clear instructions accompany the form, guiding users through its completion while emphasizing the importance of honesty in reporting financial situations. The VA offers resources for assistance and clarifies how sensitive information will be handled under the Privacy Act. Ultimately, the VA Form 21-0788 serves as a foundational document for those seeking to ensure their loved ones receive appropriate support from disability benefits.

Va 21 0788 Example

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

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

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

 

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
Get Va 21 0788 PDF Form

Form Characteristics

Fact Name Description
OMB Approval This form is OMB Approved with the number 2900-0666, ensuring compliance with federal regulations.
Respondent Burden It's estimated that completing this form takes around 30 minutes on average.
Expiration Date The current version of the form is set to expire on July 31, 2024.
Purpose The form is intended for the apportionment of a veteran's disability award to a spouse, child, or dependent parent.
Governing Law Apportionment rules fall under 38 U.S.C. § 5307, governing benefits for veterans and their families.
Privacy Act The collection of information on this form is subject to the Privacy Act of 1974, ensuring confidentiality of personal data.
Submission Instructions Once completed, mail the form to the Department of Veterans Affairs, Evidence Intake Center in Janesville, WI.

Guidelines on Utilizing Va 21 0788

After gathering the necessary information, filling out the VA Form 21-0788 is your next step. This form is used to request an apportionment of a veteran's disability benefits, and it requires careful attention to detail. Follow these steps to ensure the form is completed accurately.

  1. Fill in the Veteran's Name: Write the veteran's first name, middle initial, and last name in the provided space at the top of the form.
  2. Enter the VA File Number: If known, input the veteran's VA file number. If this is not known, you can leave it blank.
  3. Complete the Information about the Person Completing the Form: If you are not the veteran, enter your first name, middle initial, and last name, followed by your mailing address, telephone number, and email address.
  4. Specify the Person for Apportionment: In this section, write the names of the individual(s) you are requesting an apportionment for, including their first name, middle initial, and last name.
  5. Describe Their Relationship: Clearly state the relationship of each person you listed in the previous step to the veteran.
  6. Detail Contributions: Indicate how much the veteran or surviving spouse contributes to the person(s) for whom the apportionment is claimed, along with the frequency of these contributions.
  7. Living Situation of the Spouse: If the spouse is claiming the apportionment, specify whether he or she is living with another person and provide an explanation in Part III if necessary.
  8. Report Income and Net Worth: Carefully record all sources of monthly income and net worth for both the veteran and anyone the apportionment is being claimed for. Include gross amounts before deductions.
  9. Document Monthly Living Expenses: List all the monthly living expenses encountered, ensuring that none of the spaces are left blank. Write "0" or "none" instead.
  10. Add Remarks: Utilize Part III to provide any additional information or detail financial hardships that may not be captured on the form.
  11. Certify and Sign: The person completing the form must sign and date it in the designated areas to certify that the statements are true and correct to the best of their knowledge.

Ensure the form is completely filled out and legible before proceeding to mail it to the designated address: Department of Veterans Affairs, Evidence Intake Center, P.O. Box 4444, Janesville, WI, 53547-4444. Taking the time to verify every detail will help facilitate the processing of your request.

What You Should Know About This Form

What is the purpose of the VA Form 21-0788?

The VA Form 21-0788 is designed to facilitate the apportionment of a veteran's disability benefits to eligible dependents—such as spouses, children, or dependent parents. This means that a portion of the veteran's financial awards can be allocated to support their family members who may need assistance. The form collects necessary information about the veteran and their dependents to ensure that benefits are distributed fairly and in accordance with the law.

Who can request an apportionment using this form?

This form can be completed by veterans, surviving spouses, or any individual acting on behalf of a claimant. Whether it's a spouse, child, or dependent parent, anyone who can demonstrate a financial need and relationship to the veteran may file the form to request a share of the veteran's disability benefits.

How long does it take to complete the VA Form 21-0788?

On average, it will take about 30 minutes to review the instructions, gather necessary information, and complete the form. This timeline may vary based on individual circumstances, including the complexity of the financial situation being reported.

What information needs to be reported on the form?

Completing the VA Form 21-0788 requires detailed reporting of both income and monthly living expenses for the individual for whom apportionment is being requested. This includes all sources of income, such as wages, Social Security, and other assistance, as well as expenses like rent, utilities, and medical costs. The form aims to provide a comprehensive picture of the financial situation of the claimant and any dependents.

What if additional space is needed to explain my situation?

There is a designated section known as Part III - Remarks, included on the form. This area is intended specifically for individuals who need more space to describe financial hardships or provide additional context about their situation. It allows for a further explanation of any circumstances that may not be fully captured within the structured parts of the form.

Where should the completed VA Form 21-0788 be sent?

Once the form is filled out, it must be mailed to the Department of Veterans Affairs, specifically to the Evidence Intake Center located in Janesville, WI. The full mailing address is: P.O. Box 4444, Janesville, WI, 53547-4444. Ensuring that the form is sent to the correct address is crucial for timely processing.

What happens if I do not provide all the requested information?

Failing to provide complete and accurate information can result in delays or even denial of the apportionment request. The VA requires all relevant information to assess the situation fairly. If any sections are left blank or filled in incorrectly, the application may not be processed as intended, necessitating additional communication or resubmission by the claimant.

Common mistakes

Submitting the VA Form 21-0788 can be a straightforward process, yet many people encounter common mistakes that can delay their claims. One of the most frequent errors involves incomplete or inaccurate personal information. Ensure that names, addresses, and relationships to the veteran are correctly listed. Missing or incorrect details could result in processing delays.

Another common mistake pertains to the financial information section of the form. Some individuals fail to report all sources of income, opting instead to leave certain sections blank. It is crucial to include every income source, even if it amounts to zero. Not responding with "0" or "none" is something that can cause issues with the claim.

Additionally, the use of incorrect figures can be problematic. People sometimes write amounts that do not reflect their actual income or expenses. Providing false information, whether intentional or not, can lead to severe repercussions. Accuracy in reporting financial details is key to avoiding problems.

Moreover, many individuals neglect to check that they have signed and dated the form. A missing signature can halt the processing of your claim. It's advisable to create a checklist of required signatures and dates before submission.

Another area where applicants often stumble is in the remarks section. If you have financial hardships that are not fully captured elsewhere in the form, you must elaborate in Part III - Remarks. Some fail to utilize this section, inadvertently omitting critical information that could influence the outcome of their claims.

Additionally, misunderstanding the living expenses section can lead to errors. People may not list expenses correctly or may exclude certain ongoing costs. It’s essential to evaluate your true monthly expenses comprehensively to avoid underreporting and ensure an accurate representation of your financial situation.

Another frequent oversight involves not reading the instructions carefully. Before completing the form, potential applicants often rush through the instructions, missing essential guidelines that could simplify the process. Taking the time to familiarize yourself with the instructions can prevent many common issues.

Furthermore, one mistake involves the submission of the form to the wrong address. Ensure that you are sending the completed form to the appropriate VA office. Incorrect submissions can lead to significant delays in receiving benefits.

Lastly, not keeping a copy of your completed form can be a crucial oversight. Always retain a copy for your records. Having a backup allows you to reference your submission if necessary and can help clarify any misunderstandings or follow-up questions later.

Documents used along the form

The VA Form 21-0788 is used to request the apportionment of a veteran's disability award to a spouse, child, or dependent parent. This form is one among several that veterans and their families may need to complete to ensure that benefits are appropriately distributed. Below is a list of other forms and documents that are often used in conjunction with the VA Form 21-0788.

  • VA Form 21-526EZ: This form is utilized to apply for disability compensation and outlines the conditions that may qualify a veteran for benefits.
  • VA Form 21-4138: Commonly known as the Statement in Support of Claim, this document allows veterans to provide additional information or evidence related to their claim.
  • VA Form 22-5490: This form is relevant for applying for Dependents' Educational Assistance. It supports claims related to education benefits for dependents of veterans.
  • VA Form 21-0845: This form is used to authorize the release of information to a designated person. This may be important when discussing benefits with family members or advocates.
  • VA Form 21-530: This document requests burial benefits for a veteran. It is essential for families seeking financial support during a loved one's death.
  • VA Form 21-527EZ: This form is for applying for pension benefits. It's aimed at veterans who may not qualify for disability benefits but still need financial assistance.

Understanding and completing these forms can seem overwhelming, but they play a crucial role in securing benefits for those entitled to them. Each document serves a specific purpose, and obtaining proper support can facilitate a smoother process. If assistance is needed, contacting a representative familiar with VA forms might be beneficial.

Similar forms

The VA Form 21-0788 is designed for apportionment of a veteran's disability awards among family members. Here are nine other forms that share similar purposes or functions, each serving a specific administrative need:

  • VA Form 21-526EZ - This is the Application for Disability Compensation and Related Compensation Benefits. Both forms require detailed information and verification of financial status to determine the distribution of benefits.
  • VA Form 21-22 - This document serves as a Request for Appointment of Veterans Service Organization as Claimant’s Representative. Like the 21-0788, it involves ensuring proper representation in matters of VA benefits.
  • VA Form 21-534EZ - This Application for Death Benefits requires information similar to that in the 21-0788 regarding financial support and familial relationships, focusing on claims following the death of a veteran.
  • VA Form 21-0958 - This form is used to file a Notice of Disagreement regarding VA benefits decisions. It echoes the 21-0788 in that it addresses issues related to the distribution of entitlements based on approval or denial of benefits.
  • VA Form 21-4165 - This is the Claim for Amounts Due a Deceased Beneficiary. Similar to the 21-0788, it pertains to the disbursement of funds, in this case, to a deceased veteran's beneficiaries.
  • VA Form 21-610 - This Application for Benefits is closely related as it collects information pertinent to eligibility and financial status, akin to the details required on the 21-0788.
  • VA Form 21-0781 - This information is used when filing a claim for PTSD. The focus on personal and financial information connects it to the purpose of the 21-0788 in assessing eligibility for benefits.
  • VA Form 21-4502 - This form, which is a Request for Determination of Loan Guaranty Eligibility, similarly delves into financial assessments required for various VA benefits, like the 21-0788.
  • VA Form 21-8940 - This is the Application for Increased Compensation Based on Unemployability. Both forms analyze the veteran’s financial situation, determining benefit adjustments based on individual circumstances.

Dos and Don'ts

When filling out the VA Form 21-0788, it is important to follow some guidelines to ensure accuracy and efficiency. Here are five things to do and five things to avoid:

  • Do read the instructions thoroughly before starting the form.
  • Do provide complete and accurate information regarding income, expenses, and relationships.
  • Do use Part III for any remarks or additional explanations required.
  • Do report all sources of income and net worth; do not leave any spaces blank.
  • Do mail the completed form to the correct address specified in the instructions.
  • Don't omit any required signatures; the form must be signed to be valid.
  • Don't provide false information – doing so can lead to penalties.
  • Don't leave any sections incomplete; write "0" or "none" where applicable.
  • Don't forget to check the expiration date and ensure you are using the current form.
  • Don't ignore the privacy notice; know your information is protected.

Misconceptions

Understanding the VA Form 21-0788 is crucial for those seeking to navigate the benefits process appropriately. Several misconceptions exist surrounding this form and its purpose. The following list addresses seven common misunderstandings, providing clarity to ease the process for beneficiaries and their families.

  • Myth 1: The form can only be submitted by the veteran.

    • While typically the veteran completes the form, anyone may submit it on behalf of the veteran, including a spouse or legal guardian.

  • Myth 2: Only financially dependent individuals can receive apportionments.

    • Apportionments may be made to a spouse, child, or dependent parent, regardless of financial dependency, depending on specific circumstances of need.

  • Myth 3: The form guarantees an apportionment award.

    • Submitting this form does not ensure approval of an apportionment. The VA will assess the claim based on the information provided and other qualifications.

  • Myth 4: Details of personal finances are not necessary.

    • It is essential to report all income and net worth accurately. The VA uses this information to determine eligibility and need for apportionment.

  • Myth 5: There is no consequence for submitting false information.

    • The law imposes severe penalties for providing false statements. This includes fines and potential imprisonment, aiming to maintain integrity in the benefits system.

  • Myth 6: Once submitted, the VA will not provide guidance or support.

    • The VA offers resources and assistance regarding the completion of the form. Individuals can contact the VA through the provided website or toll-free number for help.

  • Myth 7: The form is outdated and not relevant.

    • The VA regularly updates forms to reflect current policies. The VA Form 21-0788 is valid and necessary for managing apportionments as defined by law.

Being informed about these misconceptions can empower veterans and their families. A clear understanding of the VA Form 21-0788 enhances the chances of receiving the necessary support and benefits.

Key takeaways

Key Takeaways for Filling Out VA Form 21-0788:

  • Understand the purpose: This form is used to request the apportionment of a veteran's disability benefits to their spouse, children, or dependent parents.
  • Time requirement: Completing this form may take approximately 30 minutes, so plan accordingly.
  • Certification of marriage: Marriages must be recognized by the state where you or your spouse lived at the time of marriage or when the claim is filed.
  • Provide complete information: Report all sources of income and net worth. If you don't receive income from a source, indicate "0" or "none" rather than leaving it blank.
  • Collect supporting details: Have documentation ready that outlines living expenses, as well as financial hardships not addressed in the form.
  • Use Part III for remarks: This section is meant for additional explanations, such as financial hardships or further details regarding your request.
  • Mail instructions: After finishing the form, send it to the specified address for the Department of Veterans Affairs in Janesville, WI.
  • Confidentiality assurance: Information you provide is confidential and will only be shared as allowed by the Privacy Act.

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