Disability compensationVA Form 21-0966
Intent to File a Claim for Compensation and/or Pension, or Survivors Pension and/or DIC
Establish an effective date for a future VA benefits claim to preserve your potential start date.
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Our on-site copy came from VA.gov on July 1, 2026. We check for updates monthly.
The VA updated this form on June 1, 2026. We’re double-checking that our on-site copy matches, so filling it out here is paused for the moment. The blank PDF and the VA.gov links above are always current.
Have these ready
This form asks for:
- Your name and date of birth
- Your Social Security number, and your VA file number if you have one
- Contact details: your mailing address and phone number
BeneVets provides benefits navigation and education. For formal claims representation, connect with an accredited VSO representative.