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The VA 21-8049 form, known as the Request for Details of Expenses, plays a crucial role in the benefits application process for veterans and their claimants. This form is designed to collect important financial information, ensuring that the Department of Veterans Affairs can accurately determine eligibility for various benefits, including pensions and dependency compensations. It takes approximately 15 minutes to complete, and individuals can either submit it online or by hand, as long as the information is clear and legible. The form requires personal details from both the veteran and the claimant, including names, dates of birth, relationship, and Social Security numbers. It also contains sections that detail expenses related to housing, utilities, food, and education, ensuring a comprehensive view of financial obligations. Additional spaces allow claimants to report on dependents, medical expenses, and even financial contributions to support others, whether living with the claimant or not. It is essential to fill out all sections accurately, especially when reporting monthly expenses and anticipated costs related to medical care. The privacy of the information provided is protected under the Privacy Act, and the VA emphasizes that responses will remain confidential. Therefore, collecting the required details not only aids in the benefits determination process but also upholds the integrity of veterans' personal information.

Va 21 8049 Example

OMB Approved No. 2900-0138

Respondent Burden: 15 minutes

Expiration Date: 01/31/2023

VA DATE STAMP

(DO NOT WRITE IN THIS SPACE)

REQUEST FOR DETAILS OF EXPENSES

IMPORTANT: Please read the Privacy Act and Respondent Burden on page 3 before completing the form.

For mailing information see Page 3 of the application.

INSTRUCTIONS - We need additional information to determine whether you are entitled to

benefits. Please complete all items. If an answer is "none" or "0" write that. For additional space, use Item 20, "Remarks," or attach a separate sheet indicating the item number to which the answers apply. If you have any questions or need assistance, please call 1-800-827-1000 (Hearing Impaired TDD line 711).

NOTE: You may either complete the form online or by hand. If completed by hand, print the information requested in ink, neatly, and legibly to expedite processing of the form.

SECTION I: VETERAN'S PERSONAL INFORMATION (MUST COMPLETE)

1.VETERAN'S NAME (Last, first, middle)

2. VETERAN'S SOCIAL SECURITY NUMBER (SSN)

3. VA CLAIM NUMBER

4. VETERAN'S DATE OF BIRTH (MM,DD,YYYY)

Month DayYear

SECTION II: CLAIMANT'S PERSONAL INFORMATION (MUST COMPLETE)

5.CLAIMANT'S NAME (Last, first, middle)

6. CLAIMANT'S SOCIAL SECURITY NUMBER (SSN)

7. CLAIMANT'S DATE OF BIRTH (MM,DD,YYYY)

8. CLAIMANT'S RELATIONSHIP TO VETERAN

Month

Day

Year

 

9.CLAIMANT'S MAILING ADDRESS (Number and street or rural route, P.O. Box, City, State, ZIP Code and Country)

No. &

Street

Apt./Unit Number

State/Province

Country

City

ZIP Code/Postal Code

10. TELEPHONE NUMBER(S) (Include Area Code)

 

11. PREFERRED E-MAIL ADDRESS (Optional)

Daytime

Evening

 

 

 

 

SECTION III - DEPENDENTS NOT LIVING WITH YOU

 

 

(List ONLY persons you support who DO NOT live with you)

 

12A. NAME

12B. AGE

12C. RELATIONSHIP

12D. AMOUNT YOU CONTRIBUTE TO SUPPORT

$

$

$

$

$

SECTION IV - DEPENDENTS LIVING WITH YOU (List ONLY persons you support who DO live with you)

13A. NAME

13B. AGE

13C. RELATIONSHIP

VA FORM

21P-8049

SUPERSEDES VA FORM 21-8049, SEP 2016,

PAGE 1

JAN 2020

WHICH WILL NOT BE USED.

 

SECTION V - MONTHLY EXPENSES (EXCEPT MEDICAL)

FOR YOU AND THOSE LISTED IN ITEM 13A AS LIVING WITH YOU

14A. ITEM

14B. AMOUNT

14A. ITEM (Continued)

14B. AMOUNT(Continued)

HOUSING

$

UTILITIES

$

 

 

 

FOOD

$

EDUCATION OF CHILDREN

$

TAXES

$

OTHER

$

(Specify)

INTEREST

$

 

$

 

 

 

 

CLOTHING

$

 

$

SECTION VI - HOSPITAL AND MEDICAL EXPENSES

15A. DO YOU HAVE OR EXPECT TO HAVE ANY LARGE OR UNUSUAL HOSPITAL OR MEDICAL EXPENSES FOR YOURSELF AND OTHERS YOU SUPPORT AND LIVE WITH?

 

YES

 

NO

 

 

15B. ESTIMATED COST PER YEAR

$

15C. EXPLANATION

SECTION VII - EDUCATIONAL EXPENSES

16. DO YOU EXPECT TO MAKE PROVISIONS FOR YOUR CHILDREN'S EDUCATIONAL NEEDS, INCLUDING ADVANCED TECHNICAL OR COLLEGE EDUCATION?

YES

NO

SECTION VIII - EXPENSES OF LAST ILLNESS AND BURIAL OF VETERAN, SPOUSE, OR CHILD

AND JUST DEBTS OF DECEASED VETERAN OR PARENT'S SPOUSE

17A. NAME OF DECEASED PERSON (First-middle-last)

17B. RELATIONSHIP TO YOU

SPOUSE CHILD

PARENT

17C. DATE OF DEATH

EXPENDITURES FOR PERSON NAMED IN ITEM 17A

NOTE - Furnish information concerning unreimbursed expense as follows:

A VETERAN - For his/her spouse's or child's last illness and burial.

A CHILD - For veteran's last illness, burial and just debts.

A PARENT - For his/her spouse's or veteran's last illness and burial and for his/her spouse's just debts.

A SPOUSE - For the last illness and burial of veteran's child.

A WIDOW(ER) - For veteran's last illness, (paid before or after the veteran's death), burial and just debts and for the last illness and burial of veteran's child.

18A. NAME AND ADDRESS OF

PERSON TO WHOM PAID

18B. NATURE OF

EXPENSES OR DEBT

18C. TOTAL AMOUNT

18D. AMOUNT

18E. DATE

OF EXPENSES OR DEBT

PAID BY YOU

PAID

 

 

$

$

 

 

 

$

$

 

 

 

 

 

 

 

 

 

$

$

 

 

 

$

$

 

 

 

 

 

 

 

 

 

SECTION IX - COMMERCIAL LIFE INSURANCE PAYMENTS

 

 

 

 

 

 

NOTE: Under Public Law 108-454, VA may not count as income the lump sum proceeds of a life insurance policy on a

AMOUNT

 

veteran who dies after December 9, 2004. Proceeds from all other insurance payments may be countable.

 

 

 

 

 

19A.

 

TOTAL RECEIVED OR EXPECTED BY CLAIMANT

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

19B.

 

EXPECTED OR ACTUAL DATE OF RECEIPT (If paid by installments, explain payment schedule in

 

 

 

 

Item 12, Remarks)

 

 

 

 

 

 

 

 

19C.

 

NAME OF THE DECEASED FOR WHOM PAYMENT IS RECEIVED.

 

 

 

 

 

 

 

 

 

 

 

 

 

VA FORM 21P-8049, JAN 2020

 

PAGE 2

 

 

SECTION X - REMARKS, CERTIFICATION AND SIGNATURE

20. REMARKS

PENALTY - The law provides severe penalties which include fine or imprisonment, or both, for the willful submission or any statement or evidence of a material fact, knowing it to be false (18 U.S.C. §§ 1001-1002).

I CERTIFY THAT the foregoing statement(s) are true and correct to the best of my knowledge and belief.

21A. SIGNATURE OF CLAIMANT (Do not print, sign in ink)

21B. DATE SIGNED

MAIL TO

Department of Veterans Affairs

Pension Intake Center

PO Box 5365

Janesville, WI 53547-5365

FEES FOR CLAIMS: Section 5904, Title 38, United States Code (codified in § 14.636, Title 38, Code of Federal Regulations) contains provisions regarding fees that may be charged, allowed, or paid for services provided by a VA-accredited attorney or agent in connection with a proceeding before the Department of Veterans Affairs with respect to a claim for benefits under laws administered by the Department. Generally, a VA-accredited attorney or agent may charge you a fee for assisting in seeking further review of a claim for VA benefits only after VA has issued an initial decision on the claim and the attorney or agent has complied with the applicable power-of-attorney and the fee agreement requirements.

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, 58VA21/22, Compensation, Pension, Education and Rehabilitation Records - VA, published in the Federal Register. You are required to respond to obtain or retain benefits. The requested information is considered relevant and necessary to determine entitlement to benefits. 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. You are required to provide the Social Security number requested under 38 U.S.C. 5101(c)(1). VA may disclose Social Security numbers as authorized under the Privacy Act, and, specifically may disclose them for purposes stated above.

Respondent Burden: We need this information to determine entitlement to pension or parent's dependency and indemnity compensation (38 U.S.C. 1503 and 1315). Title 38, United States Code, allows us to ask for this information. We estimate that you will need an average of 15 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 21P-8049, JAN 2020

PAGE 3
Get Va 21 8049 PDF Form

Form Characteristics

Fact Name Description
Form Purpose The VA Form 21P-8049 is used to request additional details about expenses for veterans and their dependents to determine eligibility for benefits.
OMB Approval This form has been approved by the Office of Management and Budget under OMB No. 2900-0138.
Estimated Completion Time Respondents are estimated to need about 15 minutes to complete the form.
Instructions Available Clear instructions are provided on the form to guide users in filling out required information accurately.
Expiration Date The form was set to expire on January 31, 2023, necessitating timely completion by applicants.
Governing Law The information collected is governed under Title 38 of the United States Code, which outlines veterans' benefits.

Guidelines on Utilizing Va 21 8049

Completing the VA Form 21-8049 is a straightforward process. This form is used to gather detailed information regarding expenses, which is necessary for determining benefits eligibility. Once the form is filled out, it will need to be submitted to the appropriate office for processing.

  1. Begin with Veteran's Personal Information in Section I. Fill in the veteran’s full name, Social Security number, VA claim number, and date of birth.
  2. Proceed to Claimant's Personal Information in Section II. Fill in the claimant’s full name, Social Security number, date of birth, relationship to the veteran, mailing address, and contact information.
  3. In Section III, list any dependents that do not live with you. Write down their names, ages, relationships, and the amount you contribute to support them.
  4. For Section IV, specify the names, ages, and relationships of dependents living with you.
  5. Next, go to Section V. Here, list monthly expenses for yourself and the dependents in Section IV. This includes expenses for housing, utilities, food, education, taxes, other items, interest, and clothing.
  6. In Section VI, answer whether you have or expect to have large medical expenses and provide an estimated yearly cost if applicable.
  7. Section VII asks whether you plan to provide for your children’s educational needs. Indicate yes or no.
  8. In Section VIII, if applicable, list details regarding any deceased person and expenses related to their last illness and burial. Include information such as the name of the deceased, relationship, date of death, and the detailed breakdown of expenses.
  9. Move to Section IX to report on commercial life insurance payments received or expected, including the total amount and expected date of receipt.
  10. Finally, in Section X, provide any additional remarks as needed. Sign and date the form to certify that the information provided is accurate.
  11. Mail the completed form to the specified address: Department of Veterans Affairs Pension Intake Center, PO Box 5365, Janesville, WI 53547-5365.

What You Should Know About This Form

What is the VA Form 21-8049?

The VA Form 21-8049, also known as the Request for Details of Expenses, is designed to gather information regarding your financial situation. The information collected is crucial in determining your eligibility for veterans' benefits. This form includes sections for personal and dependent information, monthly expenses, hospital and medical expenses, and educational expenses.

Who should fill out this form?

This form needs to be filled out by the veteran or the claimant. A claimant can be a family member or someone who is representing the veteran. It is important that both the veteran’s and claimant’s personal information is provided to ensure accurate processing.

How long does it take to complete the VA Form 21-8049?

Filling out the form typically takes about 15 minutes. This includes reviewing the instructions and collecting the necessary information. Taking a little extra time to ensure accurate and complete answers can help speed up the overall process.

What if I do not have all the necessary information?

If you do not have all the necessary information while completing the form, it is acceptable to write "none" or "0" where applicable. You can also use the "Remarks" section to add any additional information or explain any missing details.

Are there any specific instructions for filling out the form?

Yes, it is important to read the instructions carefully before completing the form. If filling it out by hand, ensure to use ink and write clearly. Complete all items, use the "Remarks" section for additional information, and do not leave any sections blank.

What kind of expenses need to be reported on this form?

On this form, you will need to report various living expenses, including housing, utilities, food, education of children, taxes, clothing, and any other expenses that are relevant. It is important to detail both monthly expenses for those living with you and any large medical expenses you expect.

What should I do if I have large medical expenses?

If you have or expect to have large or unusual medical expenses, indicate this in Section VI of the form. You also need to provide an estimated cost per year as well as a brief explanation of these expenses to help VA assess your situation.

Where do I send the completed form?

Once you have completed the form, send it to the Department of Veterans Affairs Pension Intake Center. The mailing address is provided on the last page of the form. Make sure to mail it to the correct address to ensure timely processing.

What should I do if I need help while filling out the form?

If you have questions or need assistance while completing the VA Form 21-8049, you can contact the VA helpline at 1-800-827-1000. They have resources available to help you through the process.

Common mistakes

Filling out the VA Form 21-8049 can be a straightforward process, but mistakes can lead to delays in benefits. One common error is leaving out essential information. The form requires precise details about both the veteran and the claimant. Failing to complete all mandatory fields, especially those outlined in Section I and Section II, can result in a rejection of the application. All items need addressing—even if the answer is "none" or "0," that must be written clearly.

Another frequent mistake involves misreporting Social Security numbers. Since both the veteran and the claimant must provide their Social Security numbers, any inaccuracies can create complications. Ensure you double-check these numbers before submission. Small typographical errors in this area can lead to significant delays in processing the claim.

Many people overlook the requirement for a valid signature in Section X. Without the claimant's signature, the form will not be officially recognized. Additionally, the date of the signature is crucial. In the absence of these details, the claim may be deemed incomplete.

Underestimating the request for monthly expenses can also cause issues. Many applicants skip this section or rush through it, leading to inaccuracies in the reported amounts. Each item listed under Section V requires careful consideration to ensure that all expenses are accounted for properly, including housing, utilities, and food.

Some applicants neglect to provide explanations where needed, particularly in Section VI about anticipated hospital and medical expenses. Simply answering "yes" or "no" is not sufficient. Each section that calls for an explanation should be filled out with appropriate details to provide a clear understanding of any unusual expenses expected.

Lastly, make sure to use the correct submission address. The form explicitly states where to send the completed application, but it's easy to miss this detail. Sending the application to the wrong address can lead to further delays and setbacks in receiving benefits. Pay close attention to these instructions to avoid unnecessary complications.

Documents used along the form

When filling out the VA Form 21-8049, you may encounter several other forms and documents that can help in your claims process. Understanding these documents can streamline your experience and ensure you're providing all necessary information.

  • VA Form 21-526EZ: This is the Application for Disability Compensation and Related Compensation Benefits. It is essential for veterans seeking compensation for a service-related injury or illness. Completing this form can be the first step toward receiving financial support for your service-related disabilities.
  • VA Form 21-4138: Known as the Statement in Support of Claim, this form allows claimants to submit additional information or evidence that could strengthen their claims. It is particularly useful when details or documents required by the VA are not included in other forms.
  • VA Form 21-530: This is the Application for Burial Benefits. If you are seeking burial benefits for a veteran, this form will be necessary. It provides the VA with the information required to determine eligibility for burial-related financial assistance.
  • Form 21-8416: The Request for Details of Expenses allows you to report deductible expenses related to the veteran's medical care, dependent support, or other financial obligations. This can clarify your financial situation in connection with your claim.

Your understanding of these related forms will contribute significantly to your overall claims experience. It’s wise to gather all relevant documents before proceeding, as this preparation can help expedite the evaluation of your benefits application. If you have further questions about these forms or need assistance, consider reaching out for support from knowledgeable resources.

Similar forms

The VA Form 21-8049 is specifically designed to help the Department of Veterans Affairs determine a veteran’s entitlement to benefits. It closely resembles several other documents in its purpose and structure. Below are eight documents that share similarities with the VA Form 21-8049:

  • VA Form 21-2680: This form, entitled “Examination for Housebound Status or Permanent Need for Regular Aid and Attendance,” collects detailed information regarding an individual’s medical needs, much like the VA Form 21-8049 gathers financial information.
  • VA Form 21-526EZ: As a “Application for Disability Compensation and Related Compensation Benefits,” this form is used to determine eligibility for benefits, requiring personal and dependent information similar to the VA Form 21-8049.
  • VA Form 21-534EZ: This form, titled “Application for DIC, Death Pension, and Accrued Benefits,” serves to assess benefits for survivors. It also collects vital personal data and financial details, paralleling the inquiry from the VA Form 21-8049.
  • VA Form 21-4176: Known as the “Report of Accidental Injury in Support of Claim for Compensation or Pension,” this document gathers incident-related information. The focus on personal data for claims makes it akin to the VA Form 21-8049.
  • VA Form 21-4138: This is the “Statement in Support of Claim” form, allowing claimants to provide additional information or evidence. Like the VA Form 21-8049, it often requires details about dependents and living situations.
  • VA Form 21-526ADA: The “Application for Disability Benefits for former prisoners of war” form collects personal information for a specific group of veterans. Its intent to qualify applicants for benefits aligns with the goals of the VA Form 21-8049.
  • VA Form 21-5510: This is the “Request for a Waiver of Application for VA Benefits.” It asks for personal financial information to consider a waiver, echoing the detailed financial inquiries seen in the VA Form 21-8049.
  • VA Form 21-709: Designed for claiming “Dependency and Indemnity Compensation for a Child,” this form also gathers both personal and financial information about the claimant and dependents, similar to the format and purpose of the VA Form 21-8049.

Each of these forms emphasizes the importance of personal, dependent, and financial information for determining eligibility for various VA benefits, thus highlighting the critical role they play in the veterans' benefits process.

Dos and Don'ts

When completing the VA 21 8049 form, it's important to ensure accuracy and clarity. Here’s a helpful list of do's and don'ts to guide you through the process:

  • Do read the instructions carefully before starting the form.
  • Do fill out all required fields, even if some answers are "none" or "0."
  • Do use Item 20, "Remarks," for any extra information you need to provide.
  • Do print your responses clearly in ink if completing by hand.
  • Do make sure to sign and date the form before mailing it in.
  • Don't leave any mandatory fields blank; each item must be addressed.
  • Don't submit the form without reviewing it for any potential errors or omissions.
  • Don't forget to include any relevant documentation that may support your expenses.
  • Don't ignore the deadlines for submission; timely filing is crucial in processing your claim.

By following these guidelines, you can help ensure that your form is processed efficiently and accurately.

Misconceptions

Understanding the VA Form 21-8049 is crucial for anyone applying for veterans' benefits. Despite its importance, several misconceptions persist. Here are five common misconceptions about this form and the truths behind them:

  • Misconception 1: The form is optional for applying for benefits.

    • This is incorrect. The VA Form 21-8049 is essential for providing necessary financial information about the veteran and the claimant. Completing this form is a requirement for the benefits process.

  • Misconception 2: You cannot complete the form electronically.

    • On the contrary, the VA allows applicants to fill out the form online. This option is available for those who prefer a faster and more convenient method of submission.

  • Misconception 3: The information on the form will not be treated confidentially.

    • This is not true. The VA ensures that all information provided on the form complies with the Privacy Act. Your information is handled with strict confidentiality and is only disclosed as authorized.

  • Misconception 4: You can leave items blank if they do not apply.

    • It is important to note that if an answer is "none" or "0," you should indicate that on the form. Leaving items blank may result in delays or potential issues with your claim.

  • Misconception 5: The form is only necessary for veterans, not their dependents.

    • This is misleading. The VA Form 21-8049 collects information not just from the veteran but also from the claimant and dependents. Accurate information regarding all parties is critical in determining eligibility for benefits.

Key takeaways

Key Takeaways for Filling Out VA Form 21-8049:

  • Ensure you read the Privacy Act and Respondent Burden information before starting.
  • Complete all sections accurately. If no expenses exist, write "none" or "0".
  • Use Item 20, "Remarks", if you need additional space for answers.
  • Consider filling the form online for convenience, but if using paper, print legibly with ink.
  • All relevant personal information for both the veteran and claimant is mandatory, including Social Security numbers.
  • Clearly list and describe all dependents, categorizing those living with you versus those who do not.
  • Double-check for completeness before mailing it to the specified address in Janesville, WI.

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