VA Form 21-0966
Intent to File a Claim for Compensation, Pension, Survivors Pension, and/or DIC
You know you intend to file but need time to gather evidence, see a doctor, or finish records requests. Filing this protects months (sometimes years) of back pay.
- Who fills it
- veteran
- Journey phase
- Before You File
- Estimated time
- 5-10 minutes. Single page form.
- When to file
- AS SOON AS you decide to file. Same day if possible. Every day you delay an ITF is a day of potential back pay you forfeit.
Official VA form page: https://www.va.gov/find-forms/about-form-21-0966/
Gather before you start
- ▸Your full legal name as it appears on DD-214
- ▸SSN and (if applicable) VA File Number
- ▸Date of birth
- ▸Current mailing address, phone, email
- ▸Which benefit(s) you intend to claim: Compensation, Pension, Survivors Pension, DIC
Attach with the form
- ▸None required. Plain ITF stands alone.
Section I - Veteran/Claimant Identification
Blocks 1-7Name, SSN, VA File Number, DOB, address, phone, emailPII
Match exactly to your DD-214 / VA records. The ITF is filed under your identity and creates the placeholder claim that the formal application will attach to.
(use legal name from DD-214)
Common mistakes
- ×Mismatched name or SSN with VA records - ITF rejected at intake; you lose the protected effective date.
- ×Forgetting VA File Number when one exists (older veterans) - ITF may file separately from the active jacket.
Section II - Benefit Type
Block 8Which benefit(s) do you intend to claim?
Check ALL that apply: (a) Compensation (service-connected disability), (b) Pension (low-income wartime non-service-connected), (c) Survivors Pension (surviving spouse/child needs-based), (d) DIC (Dependency and Indemnity Compensation for survivors of service-connected death). You can check multiple if you intend to file multiple types - but each ITF box only protects the date for that specific benefit.
Check all applicable boxes
Common mistakes
- ×Checking only "Compensation" when you also intend to claim Pension - you lose pension back pay if you later add it.
- ×Survivors checking only DIC and not Survivors Pension when both might apply - file both to preserve eligibility.
- ×Veterans filing ITF for Compensation when planning to claim Survivors benefits later - those are different ITF buckets.
Authority
- 38 CFR 3.155 - Standardized claim forms and Intent to File mechanics.
- 38 CFR 3.400 - Effective date rules including ITF protection of effective date.
- 38 USC 5110 - General effective-date rules and ITF protection.
Related ClaimRecon tools
- form-guide-21-526ez - Compensation: file 21-526EZ within 1 year of this ITF.
- form-guide-21p-527ez - Pension: file 21P-527EZ within 1 year.
- form-guide-21p-534ez - DIC/Survivors Pension: file 21P-534EZ within 1 year.
Section III - Signature
Block 9-10Signature and datePII
Sign and date today (or whatever date you want as your protected effective date - VA accepts the receipt date as the ITF date for online filings via VA.gov, or the postmark date for mailed forms).
(signature/date when filing)
Common mistakes
- ×Backdating the signature - federal crime. The protected effective date is the date VA RECEIVES the ITF, not the date you write on it.
- ×Filing ITF and then forgetting the 1-year deadline to submit the formal application - back-pay protection EXPIRES at 1 year. Set a calendar reminder.
- ×Filing on paper when faster electronic filing via VA.gov is available - the online pathway timestamps immediately.
Statutory and regulatory authority
- 38 CFR 3.155 - Standardized claim forms and Intent to File mechanics.
- 38 CFR 3.400 - Effective date rules including ITF protection of effective date.
- 38 USC 5101 - Standardized form requirement.
- 38 USC 5102 - VA must provide forms; ITF mechanism.
- 38 USC 5110 - General effective-date rules and ITF protection.