919-825-1300

Serving Those Who Served The Nation

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SURVIVING SPOUSE (WIDOW)

Forms to be completed:

Click on the form name to download the actual form

VA Form 21-534EZ – Pension Application​

VA Form 21P-0969 – Income and Asset Statement

VA Form 21-2680 – Medical Certification signed by a Medical Doctor.​

VA Form 21-0845 – This form authorizes someone(s) other than the claimant, to speak with the VA on their behalf (i.e. son, daughter, friend).​

SF 180 – Official Military Document Request Form from the National Archives

Senior Woman Forms

Documents to be submitted along with the above Forms:

  • Certified Discharge Papers – you can send what you have on hand or wait to receive them from the National Archives (Use Form 180 to request them)
  • Income Statements – Social Security and/or any pensions that you are receiving
  • Statement(s) to show who you are paying to aid with the Activities of Daily Living (ADL’s) that you are unable to perform on your own – this can be an Assisted Living Community, Home Health Agency, or Private Caregiver. This must include the services they are providing (such as assistance with bathing, dressing, toileting, feeding, transferring from place to place or in/out bed), the monthly cost they are being paid to provide the care and when the services started.
  • Death Certificate – MUST show a cause of death for the VA to accept it

Tips:

  • When you are completing the paperwork, please make sure that every single box has something marked in it. Blank areas can cause the VA to kick the application back for additional information. Use a zero (0), X, or N/A.
  • The Veteran will need to sign each form or they can place an X. If an X is used, the VA requires that two witnesses sign next to each of the X’s on each signature.

Resources

VSO

Consider getting assistance from a local VSO which can be found by on the VA website:

CLICK HERE

VA Website

Use the VA website for further helpful information:
CLICK HERE

VA Pension Hotline

To contact the VA Pension Toll Free Hotline call 877-294-6380
877-294-6380

eBenefits

eBenefits is also offered on the VA Website which provides direct access for applying for benefits online. Information, answers to questions, and online contact with the VA:
CLICK HERE

Books of Value

Veterans Benefits For Dummies – Which you can find at your local bookstore or:
CLICK HERE

Books of Value

How to Apply for Department of Veterans Affairs Benefits for Senior Veterans and Their Survivors
CLICK HERE

Application Submission

Intake Center Fax: 844-655-1604

Where to Mail Your Forms:

Department of Veterans Affairs Claims Intake Center
Attn: Milwaukee Pension Center 
PO Box 5192 
Janesville, WI 53547-5192

Claimants Residing in: Alabama, Arkansas, Illinois, Indiana, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Ohio, Tennessee, Wisconsin

Department of Veterans Affairs Claims Intake Center
Attn: St. Paul Pension Center 
PO Box 5192 
Janesville, WI 53547-5192

Claimants Residing in: Alaska, Arizona, California, Colorado, Hawaii, Nevada, New Mexico, North Dakota, Oklahoma, Oregon, Idaho, Iowa, Kansas, Minnesota, Montana, Nebraska, South Dakota, Texas, Utah, Washington, Wyoming

Department of Veterans Affairs Claims Intake Center
Attn: Philadelphia Pension Center 
PO Box 5192 
Janesville, WI 53547-5192

Claimants Residing in: Connecticut, Delaware, Florida, Georgia, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, North Carolina, Philadelphia, Puerto Rico, Rhode Island, South Carolina, Vermont, Virginia, West Virginia
Need Help? Call Our Support Team at   (919) 825-1300
CONTACT NOW
Senior Veterans Council has been such a great asset during the most difficult time when my father and my mother needed care. When I was feeling totally overwhelmed with paperwork and not knowing which direction to take, David Cole and the staff at Senior Veterans Council were very helpful in guiding me and helping complete the forms correctly. They were also able to guide me and provide advice with the medical process and other questions I had for my elderly parents. Errors in the application for the VA benefit have the potential to delay the claim for many months and at a time when getting the compensation could be detrimental and crucial to my parents care. I submitted the claim and my parents were awarded the VA benefit for care. I appreciate their help so much, I don't feel I could have gotten through the paperwork on my own.
Lisa ElizondoJanuary 15, 2019
David and his team were very responsive in providing details and then pursuing V.A. benefits for our widowed mother. We started the process at a time when the V.A. was reassessing requirements and the pipeline was at a standstill. It's evident to us that we would have become frustrated and unable to accomplish the task on our own. But, Senior Veterans Council stayed the course and finally we were awarded the benefit as submitted including being retro-active to the original request acceptance date. Thanks to David for their help now and in the future.
Steve ShifflettMay 20, 2020
My family is extremely grateful for all the time and help David Cole and Jenny Powell did for my mother, Dorothy. My brother-in-law, Dana, was also given advice on the phone, including help with all of the forms that are required to receive the VA benefit. You both helped him through the steps, and told us that it was going to take time and to be patient. My mother lived for two-and-a-half years, so the benefit really helped with all her medical needs, as well as Hospice helping my sister, Peggie, with the care of her. Because of both of you, Mom was able to be home and not put in a hospital for the rest of her life. Again, thank you so much.
Nancy TilburyNovember 21, 2019
I am extremely grateful to the Senior Veterans Council for their awesome help on behalf of my husband, Harvey La Salle. David Cole was very responsive to our concerns and needs. And my sincerest thanks to Jenny Powell for her continuous dedication and patience in helping Harvey. I have already shared this resources with my friends and several people I know. I am forever grateful to the Senior Veterans Council for helping a lot of Veterans in need.
Thelma Moore & Harvey LasalleAugust 20, 2019
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Serving Those Who
Served The Nation

Contact Us

150 Wrenn Drive, #5749
Cary, NC 27511

(919) 825-1300

[email protected]

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