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The VA Form 21-0792 is a crucial document for individuals seeking to become fiduciaries for veterans or beneficiaries of VA benefits. This form serves as the Fiduciary Statement in Support of Appointment, assessing the qualifications of prospective fiduciaries. It requires personal information, such as names, contact details, and Social Security numbers of both the fiduciary and the beneficiary. Moreover, it collects details about the fiduciary's relationship with the beneficiary and their financial background, including income sources and character references. The VA is committed to protecting your privacy, and information submitted will be kept confidential as per the Privacy Act. Completing this form accurately is essential for obtaining the necessary approvals; therefore, attention to detail is required. Remember, this process typically takes about 15 minutes. By submitting the form, you take the first step toward ensuring that VA beneficiaries receive the support and care they deserve.

Va 21 0792 Example

OMB Control No. 2900-0670

Respondent Burden: 15 minutes

Expiration Date: XXXX

FIDUCIARY STATEMENT IN SUPPORT OF APPOINTMENT

PRIVACY ACT NOTICE: 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, 58VA21/22/28, Compensation, Pension, Education, and Vocational Rehabilitation and Employment Records - VA, and published in the Federal Register. Your obligation to respond is required to obtain or retain benefits. Giving us your SSN account information or Tax ID number is voluntary. The VA will not deny an individual benefits for refusing to provide his or her SSN unless the disclosure of the SSN is required by a Federal Statute of law in effect prior to January 1, 1975, and still in effect. The requested information is considered relevant and necessary in order to appoint the appropriate fiduciary for a VA beneficiary. 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 assess your qualification as a potential fiduciary (38 U.S.C. Chapters 55 and 61). Title 38, United States Code, allows us to ask for this information, and complete this form. We estimate that you will need an average of 15 minutes to review the instructions, find the information, and complete the 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.

INSTRUCTIONS: All items are to be completed by the prospective fiduciary. Print all answers clearly. Your answer to every question is important to help us assess your qualification as a potential fiduciary. If you do not know the answer, write "unknown." If you don't have complete identifying information for the beneficiary, VA will supply that information. For additional space, attach a separate sheet, indicating the item number to which the answers apply. Prospective fiduciaries must complete this form before certification.

FIDUCIARY IDENTIFICATION

1. NAME

 

 

2. ADDRESS

 

 

 

 

 

 

 

3. TELEPHONE NUMBER

4. E-MAIL ADDRESS (If applicable)

A. DAYTIME (Include Area Code)

 

B. EVENING (Include Area Code)

 

 

 

 

 

 

5. SOCIAL SECURITY OR TAX ID NUMBER

6. DATE OF BIRTH

BENEFICIARY IDENTIFICATION

7. NAME

 

 

8. ADDRESS

 

 

 

 

 

 

 

9. TELEPHONE NUMBER

10. E-MAIL ADDRESS (If applicable)

A. DAYTIME (Include Area Code)

 

B. EVENING (Include Area Code)

 

 

 

 

 

 

11. VA CLAIM NUMBER

12. SOCIAL SECURITY NUMBER

13. DATE OF BIRTH

14. TYPE OF VA BENEFIT(S)

COMPENSATION

 

PENSION

 

DEPENDENCY AND INDEMNITY COMPENSATION

 

OTHER (Specify)

 

 

 

FIDUCIARY QUALIFICATIONS

15A. WHAT IS YOUR RELATIONSHIP TO THE BENEFICIARY?

15B. HOW LONG HAVE YOU BEEN ACQUAINTED WITH BENEFICIARY?

16. YOUR HIGHEST EDUCATION LEVEL OR PROFESSIONAL DESIGNATION (college graduate, attorney, etc.)

17A. LIST YOUR SOURCES OF INCOME (wages, retirement pension, disability, etc.)

17B. WHAT IS YOUR APPROXIMATE ANNUAL INCOME?

$

18.LIST THE NAMES, ADDRESSES, AND DAYTIME TELEPHONE NUMBERS OF TWO CHARACTER WITNESSES, UNRELATED TO YOU, WHO CAN VOUCH FOR YOUR GOOD CHARACTER AND REPUTATION IN THE COMMUNITY. VA MAY CONTACT THESE CHARACTER WITNESSES.

 

A. NAME

 

B. NAME

 

 

 

 

C. ADDRESS

D. ADDRESS

 

 

 

 

E. DAYTIME PHONE NUMBER (Include Area Code)

F. DAYTIME PHONE NUMBER (Include Area Code)

 

 

 

 

XXXX

21P-0792

WILL NOT BE USED.

VA FORM

 

EXISTING STOCK OF VA FORM 21-0792, OCT 2012,

19. REMARKS

FIDUCIARY BACKGROUND INFORMATION

I understand that the Department of Veterans Affairs may obtain a credit report on me that has been issued within one year of the date of this application.

Please initial the block

I have NEVER been convicted of an offense under Federal or State law, which resulted in imprisonment for more than one year. I understand that the Department of Veterans Affairs may obtain criminal background history on me prior to my appointment as fiduciary.

Please initial the block

I have been convicted of an offense under Federal or State law, which resulted in imprisonment for more than one year. Additionally, I understand that the Department of Veterans Affairs my obtain criminal background history on me prior to my appointment as fiduciary.

Please initial the block

I understand that completion of this form will not necessarily result in my appointment as a VA fiduciary.

I CERTIFY THAT the statements on this form are true and correct to the best of my knowledge and belief.

Signature (Do NOT print your name)

 

Date Signed

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 to be false.

VA FORM 21P-0792, XXXX

Page 2
Get Va 21 0792 PDF Form

Form Characteristics

Fact Name Detail
OMB Control Number The form is identified by OMB Control No. 2900-0670.
Estimated Completion Time Respondents are expected to spend approximately 15 minutes completing the form.
Privacy Act Notice Information collected is protected and will not be disclosed outside authorized uses as specified in the Privacy Act of 1974.
Confidentiality Responses submitted are considered confidential under 38 U.S.C. 5701.
Legal Authority The collection of information is mandated by Title 38, U.S. Code, particularly Chapters 55 and 61.
SSN Disclosure Providing a Social Security Number (SSN) is voluntary, but the VA cannot deny benefits based on refusal to provide it unless required by law.
Character Witnesses Two unrelated character witnesses must be listed to vouch for the prospective fiduciary's reputation.
Potential Background Checks The VA may conduct credit and criminal background checks on the prospective fiduciary.
Applicability of the Form This form is necessary for appointing a fiduciary who will manage VA benefits for a beneficiary.
Signature Requirement The prospective fiduciary must certify the truthfulness of the information by providing an original signature.

Guidelines on Utilizing Va 21 0792

After completing the VA Form 21-0792, it is crucial to submit it to the appropriate VA office. This process may involve a review of the information provided and a verification of your qualifications for fiduciary duties. Correct completion of all sections is essential to ensure a smooth appointment process.

  1. Enter your full name in Section 1.
  2. Provide your current address in Section 2.
  3. List your telephone number in Section 3.
  4. If applicable, include your email address in Section 4.
  5. In Section 4A, enter your daytime telephone number (include area code).
  6. In Section 4B, provide your evening telephone number (include area code).
  7. Fill in your Social Security or Tax ID number in Section 5.
  8. Indicate your date of birth in Section 6.
  9. In Section 7, enter the beneficiary's name.
  10. Fill in the beneficiary's address in Section 8.
  11. List the beneficiary's telephone number in Section 9.
  12. If applicable, include the beneficiary's email address in Section 10.
  13. In Section 10A, provide the beneficiary's daytime telephone number (include area code).
  14. In Section 10B, give the beneficiary's evening telephone number (include area code).
  15. Enter the beneficiary's VA claim number in Section 11.
  16. Fill in the beneficiary's Social Security number in Section 12.
  17. Indicate the beneficiary's date of birth in Section 13.
  18. Select the type of VA benefit(s) in Section 14 (Compensation, Pension, Dependency and Indemnity Compensation, or Other).
  19. In Section 15A, state your relationship to the beneficiary.
  20. In Section 15B, indicate how long you have known the beneficiary.
  21. In Section 16, note your highest level of education or professional designation.
  22. List your sources of income in Section 17A.
  23. Provide your approximate annual income in Section 17B.
  24. In Section 18A, list the name of the first character witness.
  25. In Section 18B, provide the name of the second character witness.
  26. In Section 18C, enter the first character witness's address.
  27. In Section 18D, enter the second character witness's address.
  28. In Section 18E, provide the first character witness's daytime phone number.
  29. In Section 18F, provide the second character witness's daytime phone number.
  30. In Section 19, read and understand the fiduciary background information section, and initial where required.
  31. Sign and date the form at the bottom.

What You Should Know About This Form

What is the purpose of the VA Form 21-0792?

The VA Form 21-0792 serves as a Fiduciary Statement in Support of Appointment. It is primarily designed to collect essential information from individuals who wish to be appointed as fiduciaries for veterans or beneficiaries who are unable to manage their VA benefits. By filling out this form, prospective fiduciaries provide the VA with critical details that help determine their qualifications for administering the financial affairs of the beneficiaries. In essence, it acts as a preliminary step in the fiduciary appointment process, ensuring that those entrusted with these responsibilities are suitable candidates.

How long does it take to complete the VA Form 21-0792?

Completing the VA Form 21-0792 is estimated to take about 15 minutes on average. This time includes reviewing the instructions, gathering necessary information, and filling out the form. Although this may seem brief, it is vital to understand that each answer contributes significantly to the evaluation of a prospective fiduciary. Therefore, while you can expect to spend a relatively short amount of time on the form, the information you provide must be both accurate and thoughtful.

What information is required on the form?

The form requires a variety of information to ensure a comprehensive assessment of a prospective fiduciary’s background and qualifications. Key details include the fiduciary's name, address, social security or tax ID number, and relationship to the beneficiary. Additionally, the form asks for information about the beneficiary, such as their VA claim number and types of benefits received. It also seeks relevant background details, including education levels, sources of income, and character references. All of these elements combined allow the VA to make a well-informed decision regarding fiduciary appointments.

What happens after submitting the VA Form 21-0792?

Once the VA Form 21-0792 is completed and submitted, the VA will begin to review the provided information. This review process may include verifying the background details and assessing your suitability for the fiduciary role. The VA may also conduct a credit report check and criminal background investigations. It's important to remember that completing the form does not guarantee an appointment as a fiduciary. The decision ultimately lies with the VA, which will evaluate all aspects of your application to ensure that the best interests of the beneficiary are upheld.

Common mistakes

Filling out the VA Form 21-0792 can be a critical step for those seeking fiduciary status on behalf of a beneficiary. Yet, many people overlook essential details that can lead to mistakes. One common error is failing to fill out all required fields thoroughly. Each question on the form plays an important role in assessing qualifications. Leaving any field blank, even if it feels insignificant, can delay the application process or lead to a denial. If a question doesn’t apply to the individual, writing "not applicable" or providing a brief explanation is necessary instead of omitting the response altogether.

Another frequent mistake involves providing unclear or unreadable information. It’s crucial to print answers clearly, as legibility is essential for processing the application. Illegible handwriting can result in misunderstandings and further complications down the line. If necessary, consider typing the answers or using capital letters to enhance clarity. Remember, every character in your response matters.

Moreover, individuals often underestimate the importance of accurate identification information for both themselves and the beneficiary. Errors in social security numbers or VA claim numbers can lead to significant delays. Double-checking these numbers against official documents ensures that everything is correct before submission. Eliminating any discrepancies at the outset will save time and frustration later.

A lack of character witnesses can also jeopardize an application. Section 18 of the form requires the names and contact information of two unrelated character witnesses. Neglecting this section or providing insufficient details means the process could stall. Take the time to identify appropriate witnesses and ensure they are willing to provide support for your application. Their input can be pivotal in establishing your credibility as a fiduciary.

Finally, individuals sometimes overlook the importance of following up after submitting their application. Once the form is sent in, it is advisable to monitor its status. Checking in with the VA about your application can clarify any outstanding issues. If a request for additional information arises, responding promptly is crucial to avoiding complications or delays in the appointment process.

Documents used along the form

The VA Form 21-0792 is an important document for those seeking to become a fiduciary for a veteran's benefits. Often, additional forms and documents are required to support this process. Below are some commonly associated forms you'll encounter, each playing a specific role in ensuring that the appointment is thorough and transparent.

  • VA Form 21-534EZ: This form is used to apply for Dependency and Indemnity Compensation (DIC) benefits. It collects information about the veteran's service, the claimant, and the relationship to the deceased veteran.
  • VA Form 21-526EZ: Intended for veterans applying for disability compensation, this form gathers essential details about the veteran’s service history and the nature of their disability.
  • VA Form 21-0845: This is an Authorization to Release Information to a Third Party. It allows the VA to share information with someone the veteran or fiduciary designates, aiding in communication and assistance.
  • VA Form 21-0781: When a veteran files a claim for PTSD, this form is essential. It helps document the stressor events that caused the diagnosis.
  • VA Form 21-530: This form is used to apply for burial benefits. It ensures that all necessary information regarding the veteran’s service and burial arrangements are documented.
  • VA Form 22-5490: This form is for applying for educational assistance for dependents of veterans. It collects information related to the veteran's service and the dependent’s education goals.

These forms are pivotal in the fiduciary appointment process. Filling them out correctly ensures that veterans and their families receive the benefits they deserve, while also helping to establish a reliable and trustworthy fiduciary relationship.

Similar forms

  • VA Form 21-534: This form, titled "Application for Dependency and Indemnity Compensation (DIC), Death Pension, and Accrued Benefits," is used by surviving family members to apply for benefits after a veteran's passing. Like the VA 21-0792, it gathers personal information and identifies relationships to beneficiaries, making it essential for assessing eligibility.
  • VA Form 21-686c: Known as the "Declaration of Status of Dependents," this form allows veterans to declare their dependents for benefits. Similar to VA 21-0792, it requires detailed information about family members and is crucial for determining benefit amounts based on dependents.
  • VA Form 21-22: This form, titled "Appointment of Veterans Service Organization as Claimant's Representative," enables veterans to appoint an organization to assist them with claims. Both documents focus on identifying individuals and their roles, helping ensure the right people are designated for benefit management.
  • VA Form 21-526: The "Application for Compensation and/or Pension" form is used by veterans to apply for benefits. VA Form 21-526 collects personal details, military history, and supporting evidence similar to how the VA 21-0792 assesses a fiduciary's background for appropriate appointments.
  • VA Form 21-5510: This is the "Application for Survivor Benefits," which is submitted by surviving spouses of veterans. Both this form and VA 21-0792 require comprehensive information about the applicant and their relationship to the veteran, aiding in the evaluation of eligibility for benefits.

Dos and Don'ts

When filling out the VA 21-0792 form, consider the following dos and don'ts:

  • Ensure all items are completed by the prospective fiduciary to avoid delays.
  • Print all answers clearly to enhance readability and processing.
  • Provide complete identifying information for both the fiduciary and beneficiary.
  • Indicate "unknown" if you do not know the answer to a question.
  • Attach additional sheets for longer responses, clearly stating the item number corresponding to your answers.
  • Double-check the accuracy of the social security number and tax ID number, as made available.
  • Initial the blocks regarding your criminal history accurately to maintain credibility.
  • Sign and date the form, ensuring you do not print your name in the signature area.
  • Do not leave any required fields blank; this can delay the processing of your application.
  • Avoid using abbreviations or nicknames; provide full names and information.
  • Do not lie or provide false information; this could lead to severe penalties.
  • Refrain from submitting the form without reviewing all answers for completeness and accuracy.
  • Do not assume the VA will fill in any missing information; it is your responsibility to provide complete data.
  • Avoid submitting the form if you are uncertain about your eligibility as a fiduciary.
  • Do not print your name where your signature is required; this is a critical error.
  • Do not forget to include your contact information, as the VA may need to reach you for clarification.

Misconceptions

  • Misconception 1: The VA 21-0792 form is optional.

    • This form is mandatory for anyone seeking to be appointed as a fiduciary for a VA beneficiary. Submitting this form is a crucial step in the appointment process.

  • Misconception 2: You can skip questions if you don't have the answers.

    • While it's understandable that some information may not be readily available, it's important to fill out every question. If you're unsure, write "unknown." This helps the VA assess your qualifications effectively.

  • Misconception 3: Providing a Social Security Number is always mandatory.

    • While a Social Security Number (SSN) may be requested, it is not mandatory for everyone. You can provide it voluntarily. The VA will not deny benefits solely based on your choice to withhold this information, unless required by a specific law.

  • Misconception 4: The VA will not check the information I provide.

    • The VA has protocols in place to verify the information supplied through this form. They may perform background checks or confirm details with other agencies.

  • Misconception 5: My past criminal history will not affect my application.

    • A criminal background may influence the VA's decision, especially if it includes imprisonment for over a year. The VA will assess your character in relation to your potential fiduciary duties.

  • Misconception 6: Completing the VA 21-0792 guarantees appointment as a fiduciary.

    • Filling out the form is just one part of the process. Completion does not ensure that you will be appointed as a fiduciary. The VA will evaluate all submitted information before making a decision.

  • Misconception 7: I need to have a lawyer present to complete the form.

    • While having legal assistance can be beneficial, it is not a requirement. Many individuals successfully complete this form on their own without legal representation.

  • Misconception 8: My financial situation is not relevant to the appointment.

    • Your financial background is important. The VA looks at sources of income and overall financial stability to determine if you are a suitable fiduciary for the beneficiary.

  • Misconception 9: The VA will share my personal information freely.

    • The VA is limited by the Privacy Act of 1974 in how it can disclose your information. They maintain strict confidentiality and only share details for authorized purposes.

Key takeaways

Filling out the VA Form 21-0792, also known as the Fiduciary Statement in Support of Appointment, is an important step in the process of being appointed as a fiduciary for a VA beneficiary. Here are some key takeaways to keep in mind:

  • Time Commitment: Completing the form will generally take around 15 minutes. Make sure you have all the necessary information ready to streamline the process.
  • Required Information: You must provide detailed information about both yourself as the prospective fiduciary and the beneficiary. This includes names, addresses, and Social Security numbers.
  • Confidentiality: The information you submit is confidential and protected under federal law. It will only be used for specific purposes related to the appointment process.
  • Character References: You need to list two character witnesses who are not related to you. They should be individuals who can vouch for your good character and reputation.
  • Verification: The VA may verify the information provided through various sources, including computer matching programs with other agencies.
  • False Statements: Be aware that the law imposes penalties, including fines or imprisonment, for knowingly submitting false information.
  • Voluntary Disclosure: While providing your Social Security Number or Tax ID is voluntary, refusal to provide it may delay the process unless required by federal law.
  • Submission Process: After filling out the form, ensure that you follow the correct submission guidelines, which typically involve mailing it to the appropriate VA office.
  • Navigating Unknowns: If you're unsure about any questions on the form, you can write "unknown." This will still allow the VA to assist you effectively.

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