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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.",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":51,"@type":70,"position":76},"https://docshare.wps.com/template/general/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/claims-cheat-sheet-intent-to-file-itf-21-22-sddva-policy-statement-hipaa-disclosure/571737/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/claims-cheat-sheet-intent-to-file-itf-21-22-sddva-policy-statement-hipaa-disclosure/571737.png","ImageObject",442,249,{"name":88,"@type":89},"Putri","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-25","2026-10-13",true,{"@type":98,"interactionType":99,"userInteractionCount":47},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"What initial step should be filed for a claim, and what does ITF mean?","Question",{"text":108,"@type":109},"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.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"Which documents are repeatedly required across compensation, pension, death, and DIC claims?",{"text":113,"@type":109},"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.",{"name":115,"@type":106,"acceptedAnswer":116},"How should income-related forms and box fields be handled on EZ forms and the NOD section?",{"text":117,"@type":109},"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”).","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},571737,1792481793,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":50,"category_name":51,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":47,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":73,"language":135,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":61,"update_tm":139,"read_time":9},962085571259,"https://ap-avatar.wpscdn.com/davatar_29158cc5080c5b710cf443261637dec0","Claims Cheat Sheet  \nIntent to File –ITF-(informal claim)  \n21-22 & SDDVA policy statement & HIPPA Disclosure  \n21-0966 for compensation (Claims Office can sign if we have POA) -Formalize within one year  \nFDC Compensation  \n21-22 & SDDVA policy statement & HIPPA Disclosure DD 214-Certified  \n21P-526EZ – All blanks filled out (Claims Office can sign if we have POA)  \nReserve/National Guard must provide Service Treatment Records (STRs) Private treatment records  \nDependency 21-686C if applicable  \nPTSD Claims – VA form 21-0781 or 21-0781a for MST Claims  \nIU – 8940 & 4192 (1 rating at least 60% or Combined 70% 1 being 40% or more)  \nSpecially Adapted Housing or Special Home Adaptation – 26-4555  \nAuto Allowance – 21-4502  \nFDC Pension  \n21-22 & SDDVA policy statement & HIPPA Disclosure DD 214-Certified  \n21P-527EZ – All blanks/ boxes must be filled out & 0 or none is placed in any unfilled boxes for Income  \n21P-0969 – Income and Asset Statement (if applicable) 21P-8416 if more room needed for medical expenses Medical Records if under 65  \nSpecial Monthly Pension  \n21-0779 (Nursing home)  \n21-2680 (Aid and Attendance or Housebound) Any Title XIX documentation  \nVet must have served at least one day during war time, be over age 65 or have a disability preventing work, & meet income guidelines.  \nFDC Death Pension  \n21-22 & SDDVA policy statement & HIPPA Disclosure DD 214-Certified  \n21P-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)  \nMedical Records if under 65  \n21-8416 if more room needed for medical expenses Death Certificate  \nMarriage/ Divorce/ birth certificates Medical Records if under 65  \nSpecial Monthly Pension  \n21-0779 (Nursing home)  \n21-2680 (Aid and Attendance, Housebound, Assisted Living)  \nAny Title XIX documentation  \nFDC DIC  \n21-22 & SDDVA policy statement & HIPPA Disclosure  \nDD 214 – Certified  \n21P-534EZ – All blanks/ boxes must be filled out & Must have spouse/dependent’s birthdays and SSN Death Certificate  \nMarriage/ Divorce/ birth certificates  \nNOD  \n21-22 & Policy Statement & HIPPA Disclosure  \n21-0958 – be sure to note how many pages are attached  \n- Box 9 = NO  \n- Box 10 = DRO  \nChamp VA (Processed at CAMPVA in Denver) 21-22 & Policy Statement & HIPPA Disclosure DD214-Certified  \nP&T letter or Rating Decision Granting Ch 35 10-7959c  \n10-10d  \nCopy of other health insurance card  \nBurial Benefits (Processed at PMC in St. Paul, MN) 21-22 & Policy Statement & HIPPA Disclosure 21-530  \nDD 214-Certified Death Certificate  \nFuneral Expense Statements  \nHeadstone Request (Processed at Memorial Affairs in Quantico, VA) 21-22 & Policy Statement & HIPPA Disclosure  \n40-1330  \nDD 214 – Certified Death Certificate","cbCaiehprUJ5hxJs","https://ap.wps.com/l/cbCaiehprUJ5hxJs","pdf",51774,"English","# Claims filing checklist\n## Core policy and authorization\n## Compensation and pension claims\n## Dependency, MST/PTSD, and special adaptations\n## Special monthly pension and housing assistance\n## Death pension and DIC documentation\n## NOD and supporting attachments","[{\"question\":\"What initial step should be filed for a claim, and what does ITF mean?\",\"answer\":\"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.\"},{\"question\":\"Which documents are repeatedly required across compensation, pension, death, and DIC claims?\",\"answer\":\"The cheat sheet repeatedly calls for the “21-22 \\u0026 SDDVA policy statement \\u0026 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.\"},{\"question\":\"How should income-related forms and box fields be handled on EZ forms and the NOD section?\",\"answer\":\"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”).\"}]","Claims Cheat Sheet - Intent to File (ITF) - 21-22 & SDDVA Policy Statement & HIPAA Disclosure | PDF",1791923462]