Clinton County Veterans Affairs | 230 East Water Street

Forms and Publications

The Veterans Affairs office has assembled these forms on our web site for the veterans of Clinton County, Pennsylvania. Please read the instructions carefully before filling out any of the forms. If you have any questions please call our office at: 570.893.4339. The VA will make reasonable efforts to help you get the evidence you need to file your claim. You can help by telling us about all the evidence that supports your claim. Evidence is information that confirms that what you are telling us is correct. For instance, if you are claiming service connection for a certain disability, we will help you by requesting medical records from your doctor or from VA that show you have this disability. We will also help you by requesting records from other Federal or non-Federal agencies or companies. We will request your service medical records in claims for compensation.

Instructions for filing a claim
VA-21-526: Veterans Application for Compensation and/or Pension
VBA-21-4138: Statement in support of Claim
VBA-21-4142: Authorization and consent to release information to the Department of Veterans Affairs
VA-21-534: Application for Dependency and Indemnity Compensation, Death Pension and Accrued Benefits by a Surviving Spouse or Child (Including Death Compensation if Applicable)
VBA-22-1990-ARE-GI-Bill: Application for VA Education Benefits
VHA-10-10ez: Application for Federal Health Benefits
VHA-10-10ezr: Application for Federal Health Benefits Renewal Form
MA-VA17: Application for Emergency Assistance
MA-VA Form 40/41 and MA-VA 40ss/41: Disabled Veterans Real-Estate Tax Exemption Program
VA Form 26-1880: Veterans Home Loan Request

You will need Adobe Acrobat Reader to download these forms.

Instructions for filing a claim (Download this form first)

VA-21-526

Veterans Application for Compensation and/or Pension VA-21-526

You should apply for compensation benefits if any of the following are true:

You were injured while you were in the service.
You were seriously ill while you were in the service, and you believe you have continuing problems.
You developed a mental or physical condition that may be related to your military service.
You are permanently and totally disabled and you believe it is because of your military service.

You should apply for pension benefits if all of the following are true:

You are permanently and totally disabled (but not as a result of your military service).
You served on active duty during a wartime period.
Your income is limited.

VBA-21-4138

Statement in support of claim.

VBA-21-4142

Authorization and consent to release information to the Department of Veterans Affairs (VA)

We need this information to obtain your treatment records. Title 38, United States Code, allows us to ask for this information. We estimate that you will need an average of 5 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.whitehouse.gov/library/omb/OMBINVC.html#VA. If desired, you can call1-800-827-1000 to get information on where to send comments or suggestions about this form.

VA-21-534

Application for Dependency and Indemnity Compensation, Death Pension and Accrued Benefits by a Surviving Spouse or Child (Including Death Compensation if Applicable) VA Form 21-534

What is the purpose of VA Form 21-534? Use VA Form 21-534 to apply for:

VA benefits you may be entitled to receive as a surviving spouse or child of a deceased veteran, and
any money VA owes the veteran but did not pay prior to his/her death (accrued benefits).

If you apply for any one of these benefits, the law requires that we also consider you for the others.

Forms and Publications

Contents:

You should apply for compensation benefits if any of the following are true:

You should apply for pension benefits if all of the following are true: