City of Jacksonville


VA forms in the LAVATS program

10-10D Application for Medical Benefits for Dependents Apr-79
10-10EZ Application for Health Benefits Apr-98
10-10T Application for Medical Benefits May-95
21-0515 EVR Veteran NO Dependents (5) Jun-04
21-0516 EVR Veteran NO Children (6) Jun-04
21-0517 EVR Veteran WITH Children (7) Jun-04
21-0518 EVR Surviving Spouse with NO Children (8) Jun-04
21-0519 EVR Surviving Spouse and/or Children (9) Jun-04
21-22 Veteran Service Organization Jun-03
21-4138 Statement in Support of Claim Jun-00
21-4142 Authorization for Release of Information May-04
21-526 Application for Compensation or Pension Apr-93
21-526 Part A Veterans General Information Jan-04
21-526 Part B Veterans Compensation Jan-04
21-526 Part C Veterans Dependency Jan-04
21-526 Part D Veterans Pension Jan-04
21-527 Income Net Worth & Employment Statement Jul-92
21-530 Application for Burial Benefits Feb-90
21-534 Application for Dependency and Indemnity Comp. Jun-98
21-686C Declaration of Status of Dependents Dec-99
21-8416 Medical Expense Report Jan-94
21-8940 Application for Increased Compensation Mar-00
22-1990 Application for Education Benefits Mar-97
26-1880 Certification for VA Home Loan Mar-99
28-1900 Application for Vocational Rehabilitation Aug-87
40-1330 Headstone Request Just Logs usage
5655 Financial Status Report May 2001 (RS)
572 Change of Address/Cancel Direct Deposit Apr-84
Income Info Income Verification Local
Record Check Sheriff's Office Record Check Local
SCRC-2860 Special Combat Related Compensation Apr 2004
SF-180 Request Pertaining to Military Records Rev.7-86
VA-9 Appeal to Board of Veterans' Appeals JAN 1998(RS)
Vet Calls Call Log and Topic of Call Local