VA Form 21P-0969
- Form name:Income and Asset Statement for Pension or Parents’ Dependency and Indemnity Compensation (DIC) Claims
- Form revision date: November 2023
- Related to: Disability, Family member and caregiver benefits, Pension, Service member benefits
When to use this form
Use VA Form 21P-0969 when you’re instructed to while completing VA Forms 21P-527EZ or 21P-534EZ.
You can also submit it when you need to verify or update your income or net worth. If you need to report changes over multiple years, submit a separate VA Form 21P-0969 each year.
Downloadable PDF
Online tool
You can submit this form online instead of filling out and sending us the paper form.
Related forms and instructions
VA Form 21P-534EZ
Form name: Application for DIC, Survivors Pension, and/or Accrued Benefits
VA Form 21P-527EZ
Form name: Application for Veterans Pension
Use VA Form 21P-527EZ if you’re a wartime Veteran and want to file a pension claim.