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Forms on this site are available in several formats. Fillable pdf can be filled on-line, printed, saved and edited. XFT forms can be filled on-line, printed, and saved to your pc but cannot be edited later (TURN OFF YOUR POP-UP BLOCKER TO USE XFT). Some PDF are printable blank forms.

You can download viewer software at https://www.va.gov/viewer.htm
To find a form, enter the form number (example: 12-1234 or 1234) or a word from the form's title or subject.
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Number Title Issue Date Revision Date # Pages
10-7959D CHAMPVA Potential Liability Claim 09/15/2004 2
10-7959E Claim for Miscellaneous Expenses- fillable 09/15/2004 05/2010 2
10-7959f-1 Foreign Medical Program (FMP) Registration Form - fill 12/06/2006 11/2008 1
10-7959f-2 CLAIM COVER SHEET FOREIGN MEDICAL PROGRAM (FMP) - fill 12/06/2006 11/2008 2
10-8678 Application for Annual Clothing Allowance (FILLABLE) 12/29/2004 5/2015 3
10-9012 Investigational Drug Information Record 01/31/2000 1
20-0968 Claim for Reimbursement of Travel Expenses (Fillable) 04/09/2015 03/2015 3
20-572 Request for Change of Address/Cancellation of Direct Deposit (Fillable) 06/04/2010 03/1996 1
20-8206 VA Statement of Assurance of Compliance with Equal Opportunity Laws 11/07/2016 05/2006 1
20-8800 Request for VA Forms and Publications (Fillable) 06/04/2010 01/2001 1
21- 4140 Employment Questionnaire (Fillable) 05/31/2018 10/2017 2
21-0304 Application for Benefits for Certain Children with Disabilities Born of Vietnam and Certain Korea Service Veterans (Fillable) 06/22/2016 06/2016 3
21-0307 Award Attachment for Certain Children with Disabilities Born of Vietnam Veterans 01/13/2015 03/2004 2
21-0506 Due Process Rights (No Fill-in) 06/12/2015 04/2012 1
21-0760 VA Benefits in Brief (No Fill-in) 11/03/2017 11/2017 2
21-0779 Request for Nursing Home Information in Connection with Claim for Aid and Attendance (Fill) 03/28/2017 02/2017 1
21-0781 Statement in Support of Claim for Service Connection for PTSD (Fillable) 10/04/2017 9/2017 2
21-0781a Statement in Support of Claim for Service Connection for Post-Traumatic Stress Disorder (PTSD) Secondary to Personal Assault (Fillable) 09/14/2017 9/2017 3
21-0788 Information Regarding Apportionment of Beneficiary's Award (Fillable) 04/02/2018 03/2018 2
21-0789 Your Rights to Representation and A Hearing (No Fill-in) 06/07/2017 06/2017 2
21-0790 Your Rights to Representation and a Hearing (Possible Overpayment) (No Fill-in) 06/07/2017 06/2017 2
21-0819 VA/DOD Joint Disability Evaluation Board Claim (Fillable) 07/25/2016 07/2016 2
21-0845 Authorization To Disclose Personal Information To a Third Party (Fillable) 11/10/2016 09/2016 3
21-0958 Notice of Disagreement (Fillable) 06/20/2017 9/2015 4
21-0960A-1 Ischemic Heart Disease (IHD) Disability Benefits Questionnaire (Fillable) 08/09/2017 06/2017 2
21-0960A-2 Artery and Vein Conditions (Vascular Diseases Including Varicose Veins) Disability Benefits Questionnaire (Fillable) 03/29/2018 3/2018 5
21-0960A-3 Hypertension Disability Benefits Questionnaire (Fillable) 03/29/2018 3/2018 2
21-0960A-4 Heart Conditions (Including Ischemic and Non-Ischemic Heart Disease, Arrhythmias, Valvular Disease and Cardiac Surgery) Disability Benefits Questionnaire (Fillable) 03/29/2018 3/2018 7
21-0960B-1 Hairy Cell and Other B-Cell Leukemias Disability Benefits Questionnaire (Fillable) 08/09/2017 06/2017 2
21-0960B-2 Hematologic and Lymphatic Conditions, Including Leukemia Disability Benefits Questionnaire (Fillable) 05/16/2018 05/2018 4
21-0960C-1 Parkinson's Disease Disability Benefits Questionnaire (Fillable) 08/09/2017 06/2017 2
21-0960C-10 Peripheral Nerves Conditions (Not Including Diabetic Sensory - Motor Peripheral Neuropathy) Disability Benefits Questionnaire (Fillable) 05/16/2018 05/2018 8
21-0960C-11 Seizure Disorders (Epilepsy) Disability Benefits Questionnaire (Fillable) 11/21/2016 09/2016 4
21-0960C-2 Amotrophic Lateral Sclerosis (Lou Gehrig's Disease) Disability Benefits Questionnaire (Fillable) 05/16/2018 05/2018 7
21-0960C-3 Cranial Nerves Diseases Disability Benefits Questionnaire (Fillable) 11/21/2016 09/2016 5
21-0960C-4 Diabetic Sensory-Motor Peripheral Neuropathy Disability Benefits Questionnaire (Fillable) 04/03/2018 03/2018 5
21-0960C-5 Central Nervous System and Neuromuscular Diseases (Except Trau. Brain Injury, etc.) Disability Benefits Questionnaire (Fillable) 11/22/2016 11/2016 9
21-0960C-6 Narcolepsy Disability Benefits Questionnaire (Fillable) 11/21/2016 09/2016 2
21-0960C-7 Fibromyalgia Disability Benefits Questionnaire (Fillable) 11/21/2016 09/2016 3
21-0960C-8 Headaches (Including Migraine Headaches) Disability Benefits Questionnaire (Fillable) 11/22/2016 11/2016 3
21-0960C-9 Multiple Sclerosis (MS) Disability Benefits Questionnaire (Fillable) 11/22/2016 11/2016 9
21-0960D-1 Oral and Dental Conditions Including Mouth, Lips and Tongue (Other Than Temporomandibular Joint Conditions) Disability Benefits Questionnaire 11/21/2016 09/2016 5
21-0960E-1 Diabetes Mellitus Disability Benefits Questionnaire (Fillable) 04/03/2018 03/2018 3
21-0960E-2 Endocrine Diseases (Other than Thyroid, Parathyroid or Diabetes Mellitus) Disability Benefits Questionnaire (Fillable) 11/21/2016 09/2016 4
21-0960E-3 Thyroid and Parathyroid Conditions Disability Benefits Questionnaire (Fillable) 11/21/2016 09/2016 6
21-0960F-1 Scars/Disfigurement Disability Benefits Questionnaire (Fillable) 04/09/2018 03/2018 7
21-0960F-2 Skin Diseases Disability Benefits Questionnaire (Fillable) 04/09/2018 03/2018 5
21-0960G-1 Esophageal Conditions (Including gastroesophageal reflux disease (GERD), hiatal hernia and other esophageal disorders) Disability Benefits Questionnaire (Fillable) 11/22/2016 11/2016 4
21-0960G-2 Gallbladder and Pancreas Conditions Disability Benefits Questionnaire (Fillable) 11/22/2016 11/2016 4
21-0960G-3 Intestinal Conditions (Other than Surgical or Infectious) (Including Irritable Bowel Syndrome, Crohn's Disease, Ulcerative Colitis, and Diverticulitis) Disability Benefits Questionnaire (Fillable) 11/22/2016 11/2016 4
 
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