VA · Official form

VA Form 21P-527EZ, Application for Veterans Pension

VA Form 21P-527EZ is the application for Veterans Pension, a tax-free monthly payment for wartime veterans with limited income and net worth who are 65 or older or permanently and totally disabled.

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This is the genuine VA PDF, unmodified. Source: VA official page.

What is VA Form 21P-527EZ?

Veterans Pension is a needs-based benefit, separate from disability compensation. To qualify, a veteran generally needs qualifying wartime service, an income and net worth below the limits VA sets each year, and either age 65 or older, a permanent and total disability, or residence in a nursing home. The 527EZ is the fully developed claim version of the application, designed so VA can decide the claim faster when you submit your evidence up front.

The form collects service history, marital and dependent information, and a detailed picture of household income, assets, and unreimbursed medical expenses, since those figures determine both eligibility and the payment amount. Veterans who need help with daily living can also pursue Aid and Attendance or Housebound amounts, usually supported by VA Form 21-2680.

Who files VA Form 21P-527EZ?

Wartime veterans age 65 or older with income and net worth within VA limits
Veterans of any age who are permanently and totally disabled or receiving nursing home care
Veterans applying for increased pension based on Aid and Attendance or Housebound status
Veterans who filed an intent to file (VA Form 21-0966) and want to lock in an earlier effective date

How to fill out VA Form 21P-527EZ

Gather your discharge papers, marriage and dependent records, and a full accounting of household income, assets, and recurring medical expenses.
Complete the veteran identification, service, and dependency sections, answering every question that applies.
Report income and net worth carefully; attach VA Form 21P-8416 for medical expenses and VA Form 21P-0969 for income and assets if the instructions call for them.
Sign and date the form, and have any required witnesses sign if you sign by mark.
Mail the package to the Pension Intake Center address listed in the form instructions, apply online at va.gov, or file through an accredited representative or VA regional office.

Quick fill VA Form 21P-527EZ on this page

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These are the form's own fields, in the order they appear on the pages. Fill in what you know; anything left blank stays a fillable field in the PDF, so you can finish it in any PDF reader. Nothing you type here is sent to VA.

Page 7 17 fields

Page 8 65 fields

Page 9 55 fields

SECTION 5: EMPLOYMENT HISTORY. 5. A. ARE YOU CURRENTLY EMPLOYED? YES.

5. C. HOW MANY HOURS PER WEEK DO YOU AVERAGE? 3 digits max.

5. F. WHAT WAS YOUR JOB TITLE? 30 characters max.

5. G. WHAT KIND OF WORK DID YOU DO? 27 characters max.

SECTION 6: MARITAL STATUS (MUST COMPLETE). 6. A. WHAT IS YOUR MARITAL STATUS? (Check one). MARRIED.

6. D. SPOUSE'S SOCIAL SECURITY NUMBER. Enter first three numbers.

6. D. SPOUSE'S SOCIAL SECURITY NUMBER. Enter middle two numbers.

6. D. SPOUSE'S SOCIAL SECURITY NUMBER. Enter last four numbers.

6. B. SPOUSE'S CURRENT LEGAL NAME (First, Middle Initial, Last). Enter First Name. 12 characters max.

6. B. SPOUSE'S CURRENT LEGAL NAME. Enter Last Name. 18 characters max.

6. B. SPOUSE'S CURRENT LEGAL NAME. Enter Middle Initial. 1 character max.

6. E. PLACE OF MARRIAGE. CITY AND STATE OR COUNTRY. 22 characters max.

6. F. TYPE OF MARRIAGE (Ceremonial, Common-Law, Proxy, Tribal, etc.). CEREMONIAL.

6. F. Other (Specify). 22 characters max.

6. G. IS YOUR SPOUSE ALSO A VETERAN? YES.

6. H. WHAT IS YOUR SPOUSE'S V. A. FILE NUMBER (If any)? Enter nine digit file number.

6. I. IF YOU ARE SEPARATED, PLEASE TELL US THE REASON YOU ARE SEPARATED (Illness, work, etc.). MEDICAL REASON.

6J. SPOUSE'S MAILING ADDRESS (If separated). Enter Number and Street. 30 characters max.

6. J. SPOUSE'S MAILING ADDRESS (If separated). Enter Apartment / Unit Number. 5 characters max.

6. J. SPOUSE'S MAILING ADDRESS (If separated). Enter City. 18 characters max.

6. J. SPOUSE'S MAILING ADDRESS (If separated). Enter State / Province. 2 characters max.

6. J. SPOUSE'S MAILING ADDRESS (If separated). Enter Country. 2 characters max.

6. J. SPOUSE'S MAILING ADDRESS (If separated). Enter first 5 digits of Zip Code / Postal Code.

6. J. SPOUSE'S MAILING ADDRESS (If separated). Enter last 4 digits of Zip Code / Postal Code.

6. K. HOW MUCH DO YOU CONTRIBUTE MONTHLY TO YOUR SPOUSE'S SUPPORT? (If separated). First 3 digits.

SECTION 7: PRIOR MARITAL HISTORY. Tell us about your and your spouse's previous marriages. If you have never been married or your current

7. A. WHO WERE YOU MARRIED TO? Enter Last Name. 18 characters max.

7. A. WHO WERE YOU MARRIED TO? Enter Middle Initial. 1 character max.

7. B. HOW DID YOUR PREVIOUS MARRIAGE END? (Death, divorce, etc.). DEATH.

5. D. WHEN DID YOU LAST WORK? Enter 4 digit year.

5. D. WHEN DID YOU LAST WORK? Enter 2 digit day.

5. D. WHEN DID YOU LAST WORK? Enter 2 digit Month.

6. C. SPOUSE'S BIRTH DATE. Enter 4 digit year.

6. C. SPOUSE'S BIRTH DATE. Enter 2 digit day.

6. C. SPOUSE'S BIRTH DATE. Enter 2 digit Month.

6. E. DATE OF MARRIAGE. Enter 4 digit year.

6. E. DATE OF MARRIAGE. Enter 2 digit day.

6. E. DATE OF MARRIAGE. Enter 2 digit Month.

7. C. END DATE. Enter 4 digit year.

7. C. END DATE. Enter 2 digit day.

7. C. WHAT ARE THE DATES OF YOUR PREVIOUS MARRIAGE? END DATE. Enter 2 digit Month.

7. C. START DATE. Enter 4 digit year.

7. C. START DATE. Enter 2 digit day.

7.C. WHAT ARE THE DATES OF YOUR PREVIOUS MARRIAGE? START DATE. Enter 2 digit Month.

5. B. WHAT KIND OF WORK ARE YOU CURRENTLY DOING? 35 characters max.

6. I. Other (Specify).

7. D. PLACE OF MARRIAGE (City and State or Country).

7. E. PLACE OF MARRIAGE TERMINATION (City and State or Country).

5. E. HOW MANY HOURS PER WEEK DID YOU AVERAGE? 3 digits max.

7. B. Other (Specify).

6. J. SPOUSE'S MAILING ADDRESS (If separated). Enter State / Province. 2 characters max.

6. J. SPOUSE'S MAILING ADDRESS (If separated). Enter Country. 2 characters max.

7. F. WHO WERE YOU MARRIED TO? Enter Last Name. 18 characters max.

VETERAN'S PRIOR MARRIAGES - CONTINUED (If None, skip to question 7. L). 7. F. WHO WERE YOU MARRIED TO? (First, Middle Initial, Last). Enter

7. F. WHO WERE YOU MARRIED TO? Enter Middle Initial. 1 character max.

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7. K. NO.

7. U. PLACE OF MARRIAGE TERMINATION (City and State or Country).

7. T. PLACE OF MARRIAGE (City and State or Country).

7. R. HOW DID YOUR PREVIOUS MARRIAGE END? (Death, divorce, etc.). DEATH.

7. Q. WHO WAS YOUR SPOUSE MARRIED TO? Enter Middle Initial. 1 character max.

7. Q. WHO WAS YOUR SPOUSE MARRIED TO? Enter Last Name. 18 characters max.

7. Q. WHO WAS YOUR SPOUSE MARRIED TO? (First, Middle Initial, Last). Enter First Name. 12 characters max.

7. V. NO.

SECTION 8: DEPENDENT CHILDREN. Read Note above. 8. A. HOW MANY DEPENDENT CHILDREN LIVE WITH YOU? (Please complete a V. A. Form 21-6 86 c,

8. B. CHILD'S NAME (First, Middle Initial, Last). Enter First Name. 12 characters max.

8. B. CHILD'S NAME. Enter Last Name. 18 characters max.

8. B. CHILD'S NAME. Enter Middle Initial. 1 character max.

8. D. CHILD'S SOCIAL SECURITY NUMBER. Enter first three numbers.

8. D. CHILD'S SOCIAL SECURITY NUMBER. Enter middle two numbers.

8. D. CHILD'S SOCIAL SECURITY NUMBER. Enter last four numbers.

8. F. PREVIOUSLY MARRIED.

8. F. STEPCHILD.

8. F. SERIOUSLY DISABLED.

8. F. WHAT IS THE CHILD'S STATUS? (Select all that apply). BIOLOGICAL.

8. F. ADOPTED.

8. F. 18 TO 23 YEARS OLD (IN SCHOOL).

8. F. DOES NOT LIVE WITH YOU BUT CONTRIBUTES.

8. F. AMOUNT OF CONTRIBUTION. First 2 digits.

8. C. CHILD'S BIRTH DATE. Enter 4 digit year.

8. C. CHILD'S BIRTH DATE. Enter 2 digit day.

8. C. CHILD'S BIRTH DATE. Enter 2 digit Month.

8. E. PLACE OF BIRTH (City and State or Country).

7. G. HOW DID YOUR PREVIOUS MARRIAGE END? (Death, divorce, etc.). DEATH.

7. H. START DATE. Enter 4 digit year.

7. H. START DATE. Enter 2 digit day.

7. H. WHAT ARE THE DATES OF YOUR PREVIOUS MARRIAGE? START DATE. Enter 2 digit Month.

7. I. PLACE OF MARRIAGE (City and State or Country).

7. J. PLACE OF MARRIAGE TERMINATION (City and State or Country).

SPOUSE'S PRIOR MARRIAGES (If "None," skip to Section 8). 7. L. WHO WAS YOUR SPOUSE MARRIED TO? (First, Middle Initial, Last). Enter First

7. L. WHO WAS YOUR SPOUSE MARRIED TO? Enter Last Name. 18 characters max.

7. L. WHO WAS YOUR SPOUSE MARRIED TO? Enter Middle Initial. 1 character max.

7. M. HOW DID YOUR PREVIOUS MARRIAGE END? (Death, divorce, etc.). DEATH.

7. O. PLACE OF MARRIAGE (City and State or Country).

7. P. PLACE OF MARRIAGE TERMINATION (City and State or Country).

8. G. CHILD'S NAME (First, Middle Initial, Last). Enter First Name. 12 characters max.

8. G. CHILD'S NAME. Enter Last Name. 18 characters max.

8. G. CHILD'S NAME. Enter Middle Initial. 1 character max.

8. I. CHILD'S SOCIAL SECURITY NUMBER. Enter first three numbers.

8. I. CHILD'S SOCIAL SECURITY NUMBER. Enter middle two numbers.

8. I. CHILD'S SOCIAL SECURITY NUMBER. Enter last four numbers.

8. H. CHILD'S BIRTH DATE. Enter 4 digit year.

8. H. CHILD'S BIRTH DATE. Enter 2 digit day.

8. H. CHILD'S BIRTH DATE. Enter 2 digit Month.

8. J. PLACE OF BIRTH (City and State or Country).

7. G. Other (Specify).

7. M. Other (Specify)

7. R. Other (Specify)

7. C. END DATE. Enter 4 digit year.

7. C. END DATE. Enter 2 digit day.

7. C. WHAT ARE THE DATES OF YOUR PREVIOUS MARRIAGE? END DATE. Enter 2 digit Month.

7. H. START DATE. Enter 4 digit year.

7. H. START DATE. Enter 2 digit day.

7. H. WHAT ARE THE DATES OF YOUR PREVIOUS MARRIAGE? START DATE. Enter 2 digit Month.

7. C. END DATE. Enter 4 digit year.

7. C. END DATE. Enter 2 digit day.

7. C. WHAT ARE THE DATES OF YOUR PREVIOUS MARRIAGE? END DATE. Enter 2 digit Month.

7. H. START DATE. Enter 4 digit year.

7. H. START DATE. Enter 2 digit day.

7. H. WHAT ARE THE DATES OF YOUR PREVIOUS MARRIAGE? START DATE. Enter 2 digit Month.

7. C. END DATE. Enter 4 digit year.

7. C. END DATE. Enter 2 digit day.

7. C. WHAT ARE THE DATES OF YOUR PREVIOUS MARRIAGE? END DATE. Enter 2 digit Month.

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SECTION 10: INFORMATION ABOUT YOUR UNREIMBURSED MEDICAL EXPENSES. Read information above. 10. A. ARE YOU OR YOUR DEPENDENTS CLAIMING

10B. 2. NAME OF PROVIDER AND TYPE OF CARE (Select one).

10B. 3. IF THIS IS AN IN-HOME CARE PROVIDER, WHAT IS THE RATE PER HOUR? 3 digits.

10B. 3. HOURS WORKED PER WEEK. 3 digits max.

10B. 5. PAYMENT FREQUENCY. MONTHLY.

10B. 4. NO END DATE.

10B. 6. AMOUNT YOU PAY BASED ON FREQUENCY SELECTED. First 3 digits.

9K1. WHO IS THE INCOME RECIPIENT? (Select one). VETERAN.

9K1. Child (Specify).

9J1. Child (Specify).

9J1. WHO IS THE INCOME RECIPIENT? (Select one). VETERAN.

SECTION 9: QUESTIONS REGARDING INCOME AND ASSETS (Continued). 9I1. WHO IS THE INCOME RECIPIENT? (Select one). VETERAN.

9I1. Child (Specify).

IN-HOME CARE OR CARE FACILITY. Read Important information above. 10B. 1. WHOSE EXPENSES WERE PAID? (Select one). VETERAN.

9I2. SPECIFY THE TYPE OF INCOME. SOCIAL SECURITY.

9I3. Specify Income Payer (Name of business, financial institution, etc.).

9J3. Specify Income Payer (Name of business, financial institution, etc.)

9J2. SPECIFY THE TYPE OF INCOME? SOCIAL SECURITY.

9K3. Specify Income Payer (Name of business, financial institution, etc.)

9K2. SPECIFY THE TYPE OF INCOME. SOCIAL SECURITY.

9J(2). Other (Specify Type Of Income).

9K(2). Other (Specify Type Of Income).

9H2. Other (Specify Type Of Income).

10B(1). Child (Specify).

9H4. CURRENT GROSS MONTHLY INCOME. First 3 digits.

6. I. IF YOU ARE SEPARATED, PLEASE TELL US THE REASON YOU ARE SEPARATED (Illness, work, etc.). MEDICAL REASON.

7. H. START DATE. Enter 4 digit year.

7. H. START DATE. Enter 2 digit day.

7. H. WHAT ARE THE DATES OF YOUR PREVIOUS MARRIAGE? START DATE. Enter 2 digit Month.

7. C. END DATE. Enter 4 digit year.

7. C. END DATE. Enter 2 digit day.

7. C. WHAT ARE THE DATES OF YOUR PREVIOUS MARRIAGE? END DATE. Enter 2 digit Month.

10B. 2. NAME OF PROVIDER AND TYPE OF CARE (Select one).

10B. 3. HOURS WORKED PER WEEK. 3 digits max.

10B. 5. PAYMENT FREQUENCY. MONTHLY.

10B. 4. NO END DATE.

IN-HOME CARE OR CARE FACILITY. Read Important information above. 10B. 1. WHOSE EXPENSES WERE PAID? (Select one). VETERAN.

10B(1). Child (Specify).

6. I. IF YOU ARE SEPARATED, PLEASE TELL US THE REASON YOU ARE SEPARATED (Illness, work, etc.). MEDICAL REASON.

7. H. START DATE. Enter 4 digit year.

7. H. START DATE. Enter 2 digit day.

7. H. WHAT ARE THE DATES OF YOUR PREVIOUS MARRIAGE? START DATE. Enter 2 digit Month.

7. C. END DATE. Enter 4 digit year.

7. C. END DATE. Enter 2 digit day.

7. C. WHAT ARE THE DATES OF YOUR PREVIOUS MARRIAGE? END DATE. Enter 2 digit Month.

10B. 3. IF THIS IS AN IN-HOME CARE PROVIDER, WHAT IS THE RATE PER HOUR? 3 digits.

10B. 6. AMOUNT YOU PAY BASED ON FREQUENCY SELECTED. First 3 digits.

Page 13 69 fields

10F1. WHOSE EXPENSES WERE PAID? (Select one). VETERAN.

10H1. WHOSE EXPENSES WERE PAID? (Select one). VETERAN.

10I5. PAYMENT FREQUENCY. MONTHLY.

10I3. PURPOSE (Insurance premium, medical supplies, etc.).

10I4. DATE COSTS PAID. Enter 4 digit year.

10I4. DATE COSTS PAID. Enter 2 digit day.

10I4. DATE COSTS PAID. Enter 2 digit Month.

10I1. WHOSE EXPENSES WERE PAID? (Select one). VETERAN.

10H4. DATE COSTS PAID. Enter 2 digit Month.

10H4. DATE COSTS PAID. Enter 2 digit day.

10H4. DATE COSTS PAID. Enter 4 digit year.

10H3. PURPOSE (Insurance premium, medical supplies, etc.).

10H5. PAYMENT FREQUENCY. MONTHLY.

10G5. PAYMENT FREQUENCY. MONTHLY.

10G3. PURPOSE (Insurance premium, medical supplies, etc.).

10G4. DATE COSTS PAID. Enter 4 digit year.

10G4. DATE COSTS PAID. Enter 2 digit day.

10G4. DATE COSTS PAID. Enter 2 digit Month.

10G1. WHOSE EXPENSES WERE PAID? (Select one). VETERAN.

10F4. DATE COSTS PAID. Enter 2 digit Month.

10F4. DATE COSTS PAID. Enter 2 digit day.

10F4. DATE COSTS PAID. Enter 4 digit year.

10F3. PURPOSE (Insurance premium, medical supplies, etc.).

10F5. PAYMENT FREQUENCY. MONTHLY.

10E5. PAYMENT FREQUENCY. MONTHLY.

10E2. PAID TO (Name of Provider, Insurance Company, etc.).

10E3. PURPOSE (Insurance premium, medical supplies, etc.).

10E4. DATE COSTS PAID. Enter 4 digit year.

10E4. DATE COSTS PAID. Enter 2 digit day.

10E4. DATE COSTS INCURRED. Enter 2 digit Month.

OTHER MEDICAL, LAST AND / OR BURIAL EXPENSES. 10E1. WHOSE EXPENSES WERE PAID? (Select one). VETERAN.

10E(1). Child (Specify).

10F(1). Child (Specify).

10G(1). Child (Specify).

10H(1). Child (Specify).

10I(1). Child (Specify).

10B. 2. NAME OF PROVIDER AND TYPE OF CARE (Select one).

10B. 3. IF THIS IS AN IN-HOME CARE PROVIDER, WHAT IS THE RATE PER HOUR? 3 digits.

10B. 3. HOURS WORKED PER WEEK. 3 digits max.

10B. 5. PAYMENT FREQUENCY. MONTHLY.

10B. 4. NO END DATE.

IN-HOME CARE OR CARE FACILITY. Read Important information above. 10B. 1. WHOSE EXPENSES WERE PAID? (Select one). VETERAN.

10B(1). Child (Specify).

6. I. IF YOU ARE SEPARATED, PLEASE TELL US THE REASON YOU ARE SEPARATED (Illness, work, etc.). MEDICAL REASON.

7. H. START DATE. Enter 4 digit year.

7. H. START DATE. Enter 2 digit day.

7. H. WHAT ARE THE DATES OF YOUR PREVIOUS MARRIAGE? START DATE. Enter 2 digit Month.

7. C. END DATE. Enter 4 digit year.

7. C. END DATE. Enter 2 digit day.

7. C. WHAT ARE THE DATES OF YOUR PREVIOUS MARRIAGE? END DATE. Enter 2 digit Month.

10E2. PAID TO (Name of Provider, Insurance Company, etc.).

10J5. PAYMENT FREQUENCY. MONTHLY.

10J4. DATE COSTS PAID. Enter 4 digit year.

10J4. DATE COSTS PAID. Enter 2 digit day.

10J4. DATE COSTS PAID. Enter 2 digit Month.

10J1. WHOSE EXPENSES WERE PAID? (Select one). VETERAN.

10J(1). Child (Specify).

10I3. PURPOSE (Insurance premium, medical supplies, etc.).

10E2. PAID TO (Name of Provider, Insurance Company, etc.).

10B. 3. IF THIS IS AN IN-HOME CARE PROVIDER, WHAT IS THE RATE PER HOUR? 3 digits.

10B. 6. AMOUNT YOU PAY BASED ON FREQUENCY SELECTED. First 3 digits.

Page 14 14 fields

11B. TYPE OF ACCOUNT (Check the appropriate box and provide the account number or simply write "Established," if you have a direct deposit

SECTION 11: DIRECT DEPOSIT INFORMATION (MUST COMPLETE). Read information above. 11. A. NAME OF FINANCIAL INSTITUTION (Please provide the

11. D. ACCOUNT NUMBER. 15 characters max.

12. C. DATE SIGNED. Enter 4 digit year.

12. C. DATE SIGNED. Enter 2 digit day.

12. C. DATE SIGNED. Enter 2 digit Month.

13. B. ADDRESS OF FIRST WITNESS.

13. D. PRINTED NAME OF SECOND WITNESS.

13. D. ADDRESS OF SECOND WITNESS.

13. B. PRINTED NAME OF FIRST WITNESS.

11. C . ROUTING NUMBER (The first nine numbers located at the bottom left of your check).

14. B. DATE SIGNED. Enter 2 digit Month.

14. B. DATE SIGNED. Enter 2 digit day.

14. B. DATE SIGNED. Enter 4 digit year.

Page 16 40 fields

WORKSHEET FOR AN ASSISTED LIVING, ADULT DAYCARE, OR A SIMILAR FACILITY. Read Note above. 1. WHO ARE YOU COMPLETING THIS WORKSHEET FOR?

1. WHO ARE YOU COMPLETING THIS WORKSHEET FOR? (Name of Care Recipient, either the Claimant or Dependent). Enter Last Name. 18 characters

2. WHO IS COMPLETING THIS WORKSHEET? (Name of Provider, either an Administrator or Licensed Medical Professional). Enter Last Name. 18

2. WHO IS COMPLETING THIS WORKSHEET? (Name of Provider, either an Administrator or Licensed Medical Professional). Enter First Name. 12

3. WHAT ROLE OR POSITION DO YOU PERFORM AT THE FACILITY? 30 characters max.

4. WHAT IS THE NAME OF THE FACILITY? (As shown on facility license or official website). 30 characters max.

5. WHAT IS THE FACILITY TELEPHONE NUMBER? First 3 Numbers.

5. WHAT IS THE FACILITY TELEPHONE NUMBER? Second 3 Numbers.

5. WHAT IS THE FACILITY TELEPHONE NUMBER? Last 4 Numbers.

6. WHAT IS THE MAILING ADDRESS OF THE FACILITY'S ADMINISTRATIVE OFFICE? Enter Number and Street. 25 characters max.

6. WHAT IS THE MAILING ADDRESS OF THE FACILITY'S ADMINISTRATIVE OFFICE? Enter City. 18 characters max.

6. WHAT IS THE MAILING ADDRESS OF THE FACILITY'S ADMINISTRATIVE OFFICE? Enter State / Province. 2 characters max.

6. WHAT IS THE MAILING ADDRESS OF THE FACILITY'S ADMINISTRATIVE OFFICE? Enter first 5 digits of Zip Code.

6. WHAT IS THE MAILING ADDRESS OF THE FACILITY'S ADMINISTRATIVE OFFICE? Enter last 4 digits of Zip Code.

7. WHAT IS THE FACILITY'S WESITE ADDRESS? 22 characters max.

8. F. AMBULATING WITHIN HOME OR LIVING AREA.

8. E. USING THE TOILET.

8. D. DRESSING.

8. C. TRANSFERRING IN OR OUT OF BED OR CHAIR.

8. B. BATHING / SHOWERING.

8. PLEASE SELECT EACH ACTIVITY OF DAILY LIVING (A. D L) THAT THE FACILITY IS PROVIDING TO THE CARE RECIPIENT. 8. A. EATING.

10. DOES THE FACILITY'S STAFF PROVIDE THE CARE RECIPIENT WITH HEALTH CARE OR CUSTODIAL CARE OR BOTH. (Custodial Care is regular assistance

13. PLEASE PROVID THE MONTHLY CHARGES THE CARE RECIPIENT STAYING AT THE FACILITY IS RESPONSIBLE FOR PAYING. First 2 digits.

5. International Phone Number (If applicable).

6. WHAT IS THE MAILING ADDRESS OF THE FACILITY'S ADMINISTRATIVE OFFICE? Enter Apartment or Unit Number. 5 characters max.

11. PLEASE PROVIDE THE DATE OF ADMISSION FOR THE CARE RECIPIENT STAYING AT THE FACILITY. Enter 4 digit year.

11. PLEASE PROVIDE THE DATE OF ADMISSION FOR THE CARE RECIPIENT STAYING AT THE FACILITY. Enter 2 digit day.

11. PLEASE PROVIDE THE DATE OF ADMISSION FOR THE CARE RECIPIENT STAYING AT THE FACILITY. Enter 2 digit Month.

12. ON WHAT DATE DO YOU EXPECT THIS CARE TO END? Enter 4 digit year.

12. ON WHAT DATE DO YOU EXPECT THIS CARE TO END? Enter 2 digit day.

12. ON WHAT DATE DO YOU EXPECT THIS CARE TO END? (Select "Indefinite" if the care you provide is not temporary.). Enter 2 digit Month.

15. DATE SIGNED. Enter 4 digit year.

15. DATE SIGNED. Enter 2 digit day.

15. DATE SIGNED. Enter 2 digit Month.

6. WHAT IS THE MAILING ADDRESS OF THE FACILITY'S ADMINISTRATIVE OFFICE? Enter Country. 2 characters max.

9. D. IS THE SIZE OF THE LOT ON WHICH THE PRIMARY RESIDENCE SITS OVER 2 ACRES (87,120 SQUARE FEET)? YES.

10B. 5. PAYMENT FREQUENCY. MONTHLY.

Page 17 44 fields

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Frequently asked questions

What is the difference between Veterans Pension and disability compensation?

Compensation pays for disabilities connected to your service regardless of income. Pension is needs-based: it requires wartime service and limited income and net worth, but the disability does not have to be service-connected. You generally cannot receive both at the same time; VA pays the greater benefit.

What counts toward the net worth limit?

VA counts your and your spouse's assets plus annual income, minus certain deductions such as unreimbursed medical expenses. Your primary home and vehicle are generally excluded. The limit changes each year, so check the current figure at va.gov before you file.

Can I get extra pension if I need help at home?

Yes. Aid and Attendance and Housebound are increased pension amounts for veterans who need help with daily activities or are largely confined to home. Most claims include VA Form 21-2680 completed by a physician as medical evidence.

VA Form 21P-527EZ, Application for Veterans Pension

What is VA Form 21P-527EZ?

Who files VA Form 21P-527EZ?

How to fill out VA Form 21P-527EZ

Quick fill VA Form 21P-527EZ on this page

Frequently asked questions

Related forms

VA Form 21-526EZ, Application for Disability Compensation

VA Form 21P-534EZ, Application for DIC, Survivors Pension, and/or Accrued Benefits

VA Form 21-2680: Examination for Housebound Status or Permanent Need for Regular Aid and Attendance