Intent to file form for certain VA benefit claims
- Form name:Intent to File a Claim for Compensation and/or Pension, or Survivors Pension and/or DIC (VA Form 21-0966)
- Form revision date: February 2023
- Related to: Disability, Family member and caregiver benefits, Pension
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. This form is for disability, Veterans pension, survivors pension, or Dependency and Indemnity Compensation (DIC) claims. Submitting an intent to file can secure the earliest possible effective date for any retroactive payments you may be eligible to receive.
Information for accredited representatives: If you’re an accredited representative who helps Veterans and their dependents with benefit claims, the information you need is on a different page.
Use the VA Accredited Representative Portal
Downloadable PDF
Online tool
You can submit your intent to file online instead of filling out and sending us the paper form.