VA Form 21-0966: Intent to File a Claim for Compensation and/or Pension, or Survivors Pension and/or DIC

Fill out VA Form 21-0966 online by answering plain-English questions. Claim Raven puts your answers on the official May 2026 edition of the form, and you download the filled PDF ready to sign. It is free with a Claim Raven account.

What VA Form 21-0966 is for

Use this form to tell VA you intend to apply for compensation, pension, or survivors pension and/or DIC while you finish preparing the full application. If VA receives the completed application for the benefit you select within one year, it can be treated as filed on the date VA received this form.

Starting an online disability compensation claim, disability Supplemental Claim or pension application while signed in to an identity-verified VA.gov account can record your intent to file automatically. That does not apply to DIC applications. Read VA's intent-to-file guidance.

What you fill in by hand

The filler never asks for your Social Security number, VA file number, date of birth or signature. You write those in by hand. Leave these boxes for yourself:

  • Item 2: veteran's Social Security number
  • Item 4: veteran's VA file number
  • Item 5: veteran's date of birth
  • Item 6: veteran's service number
  • Items 7 to 9 when the claimant is not the veteran
  • Items 8 and 17: international phone number
  • Items 11, 13 and 15: claimant's Social Security number, VA file number and date of birth
  • Items 20 and 21: signature and date signed
  • Item 22: name of attorney, agent or VSO

Where to send it

  • Online: VA's intent-to-file application on VA.gov.
  • By phone: call VA at 800-827-1000 (TTY 711) and tell VA you intend to file.
  • In person: at a VA regional office.
  • By mail: Department of Veterans Affairs, Evidence Intake Center, P.O. Box 4444, Janesville, WI 53547-4444.
  • Keep the signed form, your submission confirmation and VA's acknowledgment. Your one-year window runs from the date VA receives the form, not the date you signed it.
  • After VA confirms receipt, you can record that date in Claim Raven's intent-to-file tracker. Entering it there does not notify VA.

Claim Raven does not submit forms to VA. You review the filled PDF, sign and date it, and send it to VA yourself. Claim Raven is independent and is not affiliated with VA.

Official form and guide

This filler uses the May 2026 edition of the form.