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This form should be used to report or verify income and/or net worth. Changes to income and net worth over multiple years must be reported on a separate VA Form 21P-0969 for each year. Changes to dependents and medical expenses may impact your benefits. Submit the following forms if you need to update dependent or medical expense information.
- VA Form 21P-0969
Get VA Form 21P-0969, Income and Asset Statement in Support...
- IB 10-439 Income Verification Fact Sheet
Income Verification is a process VA uses to match Veterans’...
- VA Form 21P-0969
17 paź 2024 · Get VA Form 21P-0969, Income and Asset Statement in Support of Claim for Pension or Parents’ Dependency and Indemnity Compensation (DIC). Use this VA form if you’ve already filed a DIC claim and want to provide supporting financial evidence.
The Eligibility Verification Report (EVR) form will refer you to the instruction paragraphs that apply to you. There are specific instructions for each type of EVR. You can determine what type of EVR you have by looking at the number in the upper right hand corner on the front of this form.
Income Verification is a process VA uses to match Veterans’ gross household income information obtained from the Internal Revenue Service (IRS) and Social Security Administration (SSA). Gross household income includes income of the Veteran, spouse and dependent children.
: VA will compare the information you report on this form to Internal Revenue Service (IRS) and Social Security Administration (SSA) records to verify your income for the past three tax years for which information is available.
Paragraph 6 of the EVR Instructions indicates that you should report medical expenses, use VA Form 21P-8416, Medical Expense Report, to report your medical expenses. If you are using this form as a supplement to a pending claim, you do not need to report medical expenses.
Veteran - Income Verification Response. Income Year: Case Number: Before completing this form, please refer to the enclosed instructions which include examples of deductible out-of-pocket non-reimbursed expenses.
