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