[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-detail-187205-en":3,"doc-seo-187205-105":29,"detail-sidebar-cat-1-en-105":90},{"code":4,"msg":5,"data":6},0,"success",{"doc_id":7,"user_id":8,"nickname":9,"user_avatar":10,"doc_module":11,"category_id":12,"category_name":13,"doc_title":14,"doc_description":15,"doc_content":16,"file_id":17,"file_url":18,"file_type":19,"file_size":20,"view_count":11,"is_deleted":4,"is_public":11,"is_downloadable":11,"audit_status":11,"page_count":21,"language":22,"language_code":23,"site_id":24,"html_lang":23,"table_of_contents":25,"faqs":26,"seo_title":27,"seo_description":15,"update_tm":28,"read_time":11},187205,2336475104736,"วิน","https://ap-avatar.wpscdn.com/avatar/22000c4c5e0e5b17e70?x-image-process=image/resize,m_fixed,w_180,h_180&k=1786591360781797222",1,17,"Forms","STATEMENT IN SUPPORT OF CLAIM - VA Form Instructions","STATEMENT IN SUPPORT OF CLAIM provides a structured way for a veteran or beneficiary to submit a written statement supporting a benefits claim to the Department of Veterans Affairs. The form includes instructions for completing the submission, and it collects identification details, contact information, and address information. It also provides sections for remarks related to the claim and a declaration of intent with signature and date. Privacy Act information and penalties for false statements are included, along with guidance for mailing the completed form to the Evidence Intake Center.","Expiration Date:07/31/2027  \n\n| Department of Veterans Affairs   |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | VA DATE STAMP  \u003Cbr>(DO NOT WRITE IN THIS SPACE)   |  |  |  |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |\n| STATEMENT IN SUPPORT OF CLAIM   |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| INSTRUCTIONS:Before completing this form,read the Privacy Act and Respondent Burden on page 2.Use this form to  \u003Cbr>submit a statement to support a claim.For more information you can contact us through Ask VA:https://ask.va.govl,or call us  \u003Cbr>toll-free at 800-827-1000(TTY:711).VA forms are available at www.va.gov/vaforms.After completing the form,mail to:  \u003Cbr>Department of Veterans Affairs,Evidence Intake Center,P.O.Box 4444,Janesville,WI53547-4444.   |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| SECTION I:VETERAN/BENEFICIARY'S IDENTIFICATION INFORMATION   |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| NOTE:You may complete the form online or by hand.If completed by hand,print the information requsted in ink,neatly and legibly,and insert one letter per box to  \u003Cbr>help expedite processing of the form.   |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| 1.VETERAN/BENEFICIARY'S NAME (FirstMiddle Initial,Last)   |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| 2.VETERAN'S SOCIAL SECURITY NUMBER(999-99-9999)  \u003Cbr>3.VA FILE NUMBER (If applicable)   |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 4.VETERAN'S DA   |  |  |  |  | TE OF BIRTH (   |  |  | MM/DD/YYYY)   |  |  |  |\n| 一   |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 一   |  |  |  |  |\n| 5.VETERAN'S SERVICE NUMBER(Ifapplicable)   |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| 6.TELEPHONE NUMBER(Include Area Code)(999)999-9999)   |  |  |  |  |  |  |  |  |  |  | 7.E-MAIL ADDRESS (Optional)   |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| Enter International Phone Number   |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| (If applicable)   |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| 8.MAILIN  \u003Cbr>No.&  \u003Cbr>Street   | G ADDRESS (Number and street or rural route,P.O.Box,City,State,ZIP Code and Country)   |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| City  \u003Cbr>Apt/Unit Number  \u003Cbr>ZIP Code/Postal Code  \u003Cbr>Country  \u003Cbr>State/Province   |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| SECTION II:REMARKS  \u003Cbr>(The following statement is made in connection with a claim for benefits in the case of the above-named veteran/beneficiary)   |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n\n\n|  |  |  |  |\n| --- | --- | --- | --- |\n\n\n|  |  |  |\n| --- | --- | --- |\n\n\n|  |  |\n| --- | --- |\n\n一  \n\n| SECTION II:REMARKS (Continued)  \u003Cbr>(The following statement is made in connection with a claim for benefits in the case of the above-named veteran/beneficiary)   |  |\n| --- | --- |\n|  |  |\n| SECTION Ⅲ:DECLARATION OF INTENT   |  |\n| I CERTIFY THAT the statements on this form are true and correct to the best of my knowledge and belief.   |  |\n| 9.SIGNATURE OF VETERAN/BENEFICIARY(Required)   | 10.DATE SIGNED(MM/DD/","cbCaifAZEdziV2PF","https://ap.wps.com/l/cbCaifAZEdziV2PF","pdf",881905,2,"English","en",105,"# Instructions\n## Submission and mailing details\n# Section I: Veteran/Beneficiary identification information\n## Name, SSN, file number, birth date, service number, contact details, mailing address\n# Section II: Remarks\n## Claim-related statement\n# Section III: Declaration of intent\n## Signature and date, penalties, Privacy Act information","[{\"question\":\"What is the purpose of the STATEMENT IN SUPPORT OF CLAIM form?\",\"answer\":\"It is used to submit a statement in support of a VA benefits claim on behalf of the named veteran or beneficiary.\"},{\"question\":\"What information must be 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