Claims Cheat Sheet - Intent to File (ITF) - 21-22 & SDDVA Policy Statement & HIPAA Disclosure

Oct 13, 2026

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Claims Cheat Sheet consolidates key requirements and filing checkpoints for multiple VA-related claim types. It outlines where specific forms apply, including Intent to File (ITF), compensation and pension pathways, special programs for MST, PTSD, and specially adapted housing, and dependency and income documentation. It also specifies evidence collection such as DD 214 certified records, service treatment records, medical records thresholds, and Title XIX documentation. Additional sections cover death pension and DIC submissions with marriage, divorce, and birth certificates, plus confirmation notes for NOD boxes and page attachments.

LanguageEnglish

CategoryGeneral

FormatPDF

Pages2

Reading Time1 min

AccessFree to download

Claims filing checklist

Core policy and authorization

Compensation and pension claims

Dependency, MST/PTSD, and special adaptations

Special monthly pension and housing assistance

Death pension and DIC documentation

NOD and supporting attachments

Claims Cheat Sheet Intent to File –ITF-(informal claim) 21-22 & SDDVA policy statement & HIPPA Disclosure 21-0966 for compensation (Claims Office can sign if we have POA) -Formalize within one year FDC Compensation 21-22 & SDDVA policy statement & HIPPA Disclosure DD 214-Certified 21P-526EZ – All blanks filled out (Claims Office can sign if we have POA) Reserve/National Guard must provide Service Treatment Records (STRs) Private treatment records Dependency 21-686C if applicable PTSD Claims – VA form 21-0781 or 21-0781a for MST Claims IU – 8940 & 4192 (1 rating at least 60% or Combined 70% 1 being 40% or more) Specially Adapted Housing or Special Home Adaptation – 26-4555 Auto Allowance – 21-4502 FDC Pension 21-22 & SDDVA policy statement & HIPPA Disclosure DD 214-Certified 21P-527EZ – All blanks/ boxes must be filled out & 0 or none is placed in any unfilled boxes for Income 21P-0969 – Income and Asset Statement (if applicable) 21P-8416 if more room needed for medical expenses Medical Records if under 65 Special Monthly Pension 21-0779 (Nursing home) 21-2680 (Aid and Attendance or Housebound) Any Title XIX documentation Vet must have served at least one day during war time, be over age 65 or have a disability preventing work, & meet income guidelines. FDC Death Pension 21-22 & SDDVA policy statement & HIPPA Disclosure DD 214-Certified 21P-534EZ – All blanks/ boxes must be filled out & 0 or none is placed in any unfilled boxes for Income 21P-0969 – Income and Asset Statement (if applicable) Medical Records if under 65 21-8416 if more room needed for medical expenses Death Certificate Marriage/ Divorce/ birth certificates Medical Records if under 65 Special Monthly Pension 21-0779 (Nursing home) 21-2680 (Aid and Attendance, Housebound, Assisted Living) Any Title XIX documentation FDC DIC 21-22 & SDDVA policy statement & HIPPA Disclosure DD 214 – Certified 21P-534EZ – All blanks/ boxes must be filled out & Must have spouse/dependent’s birthdays and SSN Death Certificate Marriage/ Divorce/ birth certificates NOD 21-22 & Policy Statement & HIPPA Disclosure 21-0958 – be sure to note how many pages are attached - Box 9 = NO - Box 10 = DRO Champ VA (Processed at CAMPVA in Denver) 21-22 & Policy Statement & HIPPA Disclosure DD214-Certified P&T letter or Rating Decision Granting Ch 35 10-7959c 10-10d Copy of other health insurance card Burial Benefits (Processed at PMC in St. Paul, MN) 21-22 & Policy Statement & HIPPA Disclosure 21-530 DD 214-Certified Death Certificate Funeral Expense Statements Headstone Request (Processed at Memorial Affairs in Quantico, VA) 21-22 & Policy Statement & HIPPA Disclosure 40-1330 DD 214 – Certified Death Certificate

FAQs

What initial step should be filed for a claim, and what does ITF mean?

File an Intent to File (ITF) as the initial step. The sheet labels it as “Intent to File – ITF – (informal claim)”. “Formalize within one year” is noted for at least one compensation pathway.

Which documents are repeatedly required across compensation, pension, death, and DIC claims?

The cheat sheet repeatedly calls for the “21-22 & SDDVA policy statement & HIPPA Disclosure” and “DD 214 – Certified” (or “DD 214-Certified”). It also highlights required supporting records such as service treatment records (STRs), medical records depending on age, and various certificates depending on the claim type.

How should income-related forms and box fields be handled on EZ forms and the NOD section?

For forms marked “EZ,” the sheet states “All blanks/ boxes must be filled out” and that “0 or none is placed in any unfilled boxes for Income.” For the NOD section, it explicitly instructs: “Box 9 = NO” and “Box 10 = DRO,” and reminds filing to note attached page counts (e.g., “21-0958 – be sure to note how many pages are attached”).

Oct 13, 2026

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