These fields are usually pre-printed on the form VA sends you. Verify they are correct and note any errors. If anything is wrong, contact VA to correct before returning the form.

(pre-printed by VA; verify accuracy)

• ×Not verifying pre-printed information - if VA has a wrong address or SSN on file, this is your chance to correct it.

If your spouse is still living and you are still married, confirm that. If you have divorced or your spouse has died, report it here with the effective date. VA needs the exact date of divorce (finalization, not filing) or date of death.

e.g., Still married to Jane Smith as of this date. OR: Divorced from Jane Smith, divorce finalized 11/15/2025.

• ×Not reporting a divorce that happened since the last verification - VA will eventually discover it and seek recovery of overpayments with penalties.
• ×Using the divorce filing date instead of the finalization date - VA adjusts payment from the legal finalization date.

For each child listed on your award: confirm they are still living, still under 18 (or 18-23 and in school, or permanently helpless at any age). Report any child who has turned 18 and is NOT in school, graduated, left school, married, or died.

e.g., Emily Smith (DOB 06/15/2008) - still living, under 18, no change.
Timothy Smith (DOB 03/22/2005, age 21) - enrolled full time at ASU, 21-674 filed 08/2025.

• ×Not reporting a child who turned 18 and left school - dependency terminates automatically at 18 unless in school or helpless.
• ×Not knowing which children are on your award - review your latest rating decision letter before completing this section.

If a parent is on your award as a dependent, confirm they are still living, still have income below VA thresholds, and you are still contributing to their support. Report any change in their income, death, or your cessation of support.

e.g., Mary Smith (mother) - still living, SSA income $1,200/month, still contributing $600/month to support.

• ×Not reporting a significant increase in the parent's income - if their income exceeds VA thresholds, dependency terminates.
• ×Not reporting the parent's death - VA discovers it through SSA death records and will recover overpayments.

Sign and return by the deadline on the form. If you miss the deadline, contact VA immediately and explain the delay. Missing the deadline and not responding results in suspension of the dependent portion of your benefits.

(signature/date)

• ×Missing the response deadline without notifying VA - benefits suspended and reinstatement requires additional paperwork.
• ×Discarding this form thinking it is junk mail - it looks routine but has a deadline with real consequences.