These are pre-printed by VA from your file. Verify each field is correct. If any information has changed (especially address or phone), note the correction. An incorrect address means future VA mail goes to the wrong location.

(pre-printed by VA; verify and correct if needed)

• ×Not correcting a pre-printed error - this is your opportunity; write corrections clearly in the margins.
• ×Missing a deadline because mail went to a wrong address - update your address with VA immediately when you move.

Check all changes that apply: income changed, new dependent added or removed, marital status changed, moved, medical expenses changed, entered nursing home, health changed significantly. For each change, you will need to provide updated documentation on the accompanying EVR form.

e.g., No changes from prior year. OR: Income increased - new SSA COLA; medical expenses increased - new home aide.

• ×Saying "no changes" when Social Security gave a COLA increase - even small income increases must be reported.
• ×Not reporting a new dependent (remarriage, additional child) - affects pension computation.

Sign and return with the completed EVR form by the deadline. Missing the deadline triggers pension suspension. If you cannot respond by the deadline due to illness or incapacity, contact VA immediately.

(signature/date)

• ×Returning only the cover sheet without the completed EVR income form - both must be returned together.
• ×Missing the deadline - contact VA immediately if you cannot respond in time.