VA Form 21-0966

Intent to File a Claim for Compensation and/or Pension, or Survivors Pension and/or DIC

Files an "intent to file" date with VA — locks in your effective date so back-pay starts from when you filed this even if the formal claim takes weeks to assemble. Always file this first.

Who files

Anyone planning to file a VA claim within the next 12 months.

Next step

File 21-0966 within 1 day of deciding to claim. Then assemble medical records before filing 21-526EZ.

Related VA Disability Claim forms

• VA Form 21-526EZ — Application for Disability Compensation and Related Compensation BenefitsPrimary form for filing a VA disability claim — the standard "Fully Developed Claim" application. Use for orig…
• VA Form 21-0781 — Statement in Support of Claim for Service Connection for PTSDCompanion form for a PTSD claim. Documents the in-service stressor (combat, MST, accident). Required for non-p…
• VA Form 21-0781a — Statement in Support of Claim for Service Connection for PTSD Secondary to Personal AssaultSpecial MST-related variant of 21-0781. VA can use "markers" (medical-record changes, pregnancy tests, transfe…

About this form catalog

This is part of a 22-form catalog covering disability claims, appeals, representation, education benefits, healthcare, housing, pension, and records access — maintained by Wounded Warriors / Warriors Fund. Every entry includes the official VA download URL, plain-English description, who-files-it, and next-step routing to free claims help (CVSOs and VSOs). Free to use under CC-BY 4.0. Browse all forms → · Find a free CVSO →