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About VA Form 21-0966

Form name: Intent to File a Claim for Compensation and/or Pension, or Survivors Pension and/or DIC
Related to: Disability, Family member benefits, Pension
Form last updated: April 2023

When to use this form

Use VA Form 21-0966 if you’re still gathering information to support your claim, and want to start the filing process. Submitting an intent to file can secure the earliest possible effective date for any retroactive payments you may be eligible to receive.

Downloadable PDF

Download VA Form 21-0966 (PDF)

Online tool

You can submit your intent to file online instead of filling out and sending us the paper form.

Go to the online tool
  • Learn about the steps for filing a claim for disability compensation or increased disability compensation. Note: If you file your disability claim online, you don’t need to submit a paper Intent to File form.

  • Find out how to apply for tax-free VA pension benefits as a Veteran. Note: If you apply online for pension benefits, you still need to submit VA Form 21-0996 as your intent to file.