Form VA 21-4138 Statement In Support of Claim

INSTRUCTIONS : STATEMENT IN SUPPORT OF CLAIM (VA Form 21-4138)

A VA Form 21-4138 is the Veteran Affairs Statement in Support of a Claim form that is used to support a claim for benefits. This form is used to provide requested information by Veteran’s Affairs while they are evaluating your claim.

The VA Form 21-4138 is available on the United States Department of Veteran Affairs website.

The first blank boxes require your basic identification information.

1. In the top box, you must provide the name, social security number, and the claims file number of the veteran who is making the claim.

Next, the large box on the first page requires a statement made in connection with the applied for claims.

2. This is the most important section of your VA Form 21-4138.

3. It is important that you write a well thought out statement that supports your claims.

4. Write a draft of your statement.

5. Ensure that your draft includes a very detailed explanation addressing all of the required additional information the Department of Veteran’s Affairs requires. Also ensure that you cover all of your claims.

6. Once you have a completed draft, you can either handwrite your explanation in the box or print it from a computer and attach it. You must also attach any supporting documents you may require.

Finally, you must certify your VA Form 21-4138.

7. Sign and date the VA Form 21-438 at the bottom of the page.

8. Supply your address and phone number contacts

If your statement will not fit in the box on the first page, you may continue your statement in the box on the second page. You may also attached additional pages for your form if you so require.

9. Submit your VA Form 21-4138 to the Department of Veteran Affairs by mailing it to the address provided, ensuring that it gets to the office it needs to be reviewed.

Form DD-214 Certificate of Release of Discharge from Active Duty

INSTRUCTIONS : CERTIFICATE OF RELEASE OF DISCHARGE FROM ACTIVE DUTY (Form DD-214)

A DD-214 Form is a Department of Defense form used as a certificate of release or discharge from active duty. It is the final papers a military member receives and is very important for receiving veterans benefits.

The DD-214 Form is available on the Department of Defense documentation website or can be supplied through the chain of command. When requesting a completed DD-214 Form, you must contact the National Personnel Records Center.

In order to properly fill out a DD-214 Form, you must first start with the basic information of the individual.

1. In boxes 1 through 6, you must fill in the military member's name, department, social security number, grade at time of discharge, pay grade, date of birth, and reserve obligations.

2. Box 7 requires some basic historical information about the military member, including their place of entry into the service and home of record at the time of entry.

3. Box 8 requires the last duty assignment as well as last station when separated.

If the military member is being transferred to another department or branch, box 9 is used to indicate where the transfer is to take place.

Boxes 11 through 14 will give a history of the military member's career and service records.

4. Box 11 requires specialties, listed in order with dates and length of specialty service. Additional space may be needed, so an addendum may be added if all specialties do not fit inside the box.

5. Box 12 will indicate the record of service, specifically breaking down the time periods of active duty, separation dates, prior active and inactive service time, foreign service, sea service, and effective pay rate dates.

6. Boxes 13 and 14 further expand on the military career of the subject of the DD-214 Form. Awards, education, and commendations will be listed in these boxes. Additional sheets may be added.

Box 16 will indicate the days accrued pays leave, if any are applicable.

Box 18 will have any additional remarks that involve the separation from the military. This box may be left blank, unless there are clear remarks of the individual's military service that should be commented on.

7. Boxes 19 through 22 are the contact information for the military member at the time of separation and the certification by both the separated member and the authorization officer.

Form VA 21-526 Veteran’s Application for Compensation and/or Pension

INSTRUCTIONS : VETERAN’S APPLICATION FOR COMPENSATION AND/OR PENSION(VA Form 21-526)

A VA Form 21-626 is the Veteran Affairs Application for Compensation or Pension form that is used to make a claim for benefits. This form is used to claims for benefits that arise from disability or injuries sustained during military service or for benefits for qualifying retired military members.

The VA Form 21-526 is available on the United States Department of Veteran Affairs website.

Boxes 1 and 2 require that you identify the compensation you are applying for and any previous applications for compensation.

1. In box 1, you should seek compensation if you have suffered an injury or illness while in the military.

2. You should seek a pension claim if you are over 65 years old with a disability, served on active duty during at least one day of a period of war, and your income and net worth does not exceed the limits outline by the Veterans Affairs office.

Next, boxes 3 through 9 require your basic identification information.

Boxes 10 through 18 require information about past benefits applications, a history of your injuries, and your medical treatment history.

3. You should provide a detailed history of all medical events that occurred during your military service.

4. Ensure that you give as much specific information as possible in box 11. You can add additional information in the blank box at the end of the form if you need more space.

Parts III through V require that you supply your service information.

5. Part V requires that you supply your military retired and severance pay.

Part VI requires your marital status and dependency information, which will be used to determine the type of benefits you are entitled.

6. Ensure that you include all of your marriage history and all dependents for which you support in the appropriate boxes.

Parts VII through X require your financial information for evaluation of your benefits.

7. In Parts VII, VIII and IV, do not leave any boxes blank, even if they do not apply to you or your spouse. Fill in a zero if you do not receive the benefit.

Complete the form by certifying all of the information in Part XII and consent to the release form that allows Veterans Affairs to review your information.

8. Send in the VA Form 21-526 to the address supplied by the VA.

Form DD 1149 Requisition and Invoice Shipping Document

INSTRUCTIONS : REQUISITION AND INVOICE SHIPPING DOCUMENT (Form DD 1149)

A DD Form 1149 is a Department of Defense form used for requisition, invoice, and shipping of materials between shipping and receiving parties who are under the Department of Defense.

The DD Form 1149 is available on the Department of Defense documentation website or can be supplied through the chain of command.

The first step in filling out this form is to identify the shipping address and the receiving address for which the materials will be transported between.

1. Boxes 1 and 2 should be filled in with the entire shipping address of both the shipper and receiver, respectively.

2. Box 3 can be used to specify who at the receiving address the package is intended for. For example, if the shipment is received at a military installation, you must specify the particular party receiving the item at that installation.

Box 4 is to be used for any appropriations for the shipping and the amount.

Boxes 5 through 9 should be filled out providing the particular information about the requisition that is taking place.

3. Provide any dates, requisition numbers, priority, authority, or purposes regarding the shipment.

For boxes 12 through 15, you must indicate the method of shipment and provide the necessary details to record how the materials were shipped.

4. You must include the date shipped, mode of shipment, a bill of lading number, and the air freight or port designations.

Next, you must provide an itemized list of all materials to be shipped in the requisition that is occurring.

5. You must provide a stock number, description, coding, and units, and cost for each item to be shipped.

6. If you need additional items to be listed, a supplemental page is provided that can be used for listing additional items. All supplemental pages must be properly marked and attached to the front page of the DD Form 1149.

Boxes 16 and 17 can be used for supplying special handling instructions or charges.

The bottom grid is to be filled out for the recapitulation of shipment.

7. Provide the total amount of containers received, the types of containers, a description of each with a total weight.

Once the DD Form 1149 is completed, the shipment can be made and the form will be signed and certified by the receiver. Both shipper and receiver must keep a copy of the DD Form 1149.

Form DA 2062 Hand Receipt Annex/Components Receipt

INSTRUCTIONS : HAND RECEIPT ANNEX/COMPONENTS RECEIPT (DA Form 2062)

A DA Form 2062 is the Army’s form for assigning responsibility and accountability for an Army issued item or piece of equipment that has component pieces. It is commonly referred to as a hand receipt.

The DA Form 2062 is available on the United States Army website or will be supplied to a military member who is taking possession of Army issued equipment.

The top boxes require identification of the parties involved in the transfer of equipment and the items to exchange hands.

1. In the top box, you must provide the original holder of the property and identify the individual who is taking possession of the item in the transfer.

2. The second line is for use by the annexor only. If you are the annexor, you must identify the item stock number, the item’s description, the publication number, publication date, and quantity of items.

In the following grid, you must supply the item numbers and item descriptions for each issued equipment that is being transferred to the new holder.

3. You must provide the required information about each item, including the detailed information needed in the boxes on the right of the description lines.

4. Complete the DA Form 2062 by filling in the grid for every piece of issued equipment that is being transferred.

Box c in the grid will require a different identification number depending on how the form is being used.

5. If the DA Form 2062 is being used as a hand receipt, this box will be the hand receipt annex number.

6. If the DA Form 2062 is being used for the issue of quarter’s furniture, you must include condition codes for each piece of furniture.

If the DA Form 2062 is being used as a components receipt, enter the accounting requirements code in each corresponding box.

Form DD 200 Financial Liability Investigation of Property Loss

INSTRUCTIONS : FINANCIAL LIABILITY INVESTIGATION OF PROPERTY LOSS (Form DD 200)

A DD Form 200 is a Department of Defense form used for the investigation of financial liability from the loss of department of defense property. Its primary purpose is to assess financial charges for lost, damaged, or destroyed equipment or items.

The DD Form 200 is available on the Department of Defense documentation website or can be supplied through the chain of command.

The investigating official must first fill out the basic information of the investigation that the form will cover.

1. Boxes 1 and 2 must indicate the date the investigation is initiated as well as the investigation number.

Boxes 3 through 10 are to be used for providing information obtained about the property lost.

2. In the corresponding boxes, you must indicate the date of loss, the national stock number, a description of the property, quantity, and costs.

3. Box 9 is to be used for a description of how the property was lost. Most likely, you will need to attach a corresponding narrative to describe the circumstances of the loss in detail.

4. Box 10 is to be used for the actions that will be taken due to the loss. Again, you will most likely need to further expand on the future action in a narrative attached to the DD Form 200.

The individual conducting the investigation is to provide their information in box 11 and certify the form with their signature.

5. the responsible officer or reviewing authority must be identified in box 11, with the proper authorizing signature attached.

The appointing and approving authority, if any, are to fill out boxes 13 and 14, providing any additional comments about the property loss.

6. Additional sheets may be necessary for each of these authorities to provide reports of the event and future recommendations.

Box 15 is for the financial liability officer to fill out.

7. The financial liability officer will supply his or her report on the loss of property. Included in this report will be their findings and recommendations, the estimated monetary loss, and liability to be incurred for the loss.

If an individual is charged with the loss, they must sign the DD Form 200 with an attached acceptance or objection to the findings.

Once completed, the form should be filed with the proper accounting authorities, and a copy distributed to all parties involved.

Form DA 705 Army Physical Fitness Test Scorecard

INSTRUCTIONS : ARMY PHYSICAL FITNESS TEST SCORECARD (DA Form 705)

A DA Form 705 is the Army Physical Fitness Test scoring and evaluation form. The DA Form 705 is used to calculate whether a soldier passes the Army’s physical fitness requirements.

The DA Form 705 is available on the United States Army website or can be supplied by the U.S. Army personnel division administering the physical fitness test.

The top box requires the basic soldier identification information who is taking the physical fitness test.

1. The top box only requires the soldier’s name, gender, and unit.

2. The same information must be supplied on any additional pages, if the soldier is completing the physical fitness test more than 4 times in their career.

Each test has its own individual box, which must be fully completed before submission.

3. The top line of boxes requires identification of the soldier at the date of the testing. You must include the grade and age of the soldier.

4. Next, you must fill in the physical characteristics of the soldier, including height, weight and body fat.

The next boxes record the scores of the soldier taking the physical fitness test.

5. A separate score must be kept for the push ups, sit-ups, two mile run, and alternative aerobic event.

6. A raw score must be recorded as well as the points given for that score. A standards chart is also provided with the DA Form 705 which provides the proper scoring for each physical fitness test. Refer to this chart when filling out the points section for each test.

Finally, the supervising officer must sign off on the tests and can provide any additional comments necessary for the DA Form 705.

7. Once the physical fitness test is completed and properly recorded, copies must be kept by the officers conducting the tests as well as the soldier who has taken the physical fitness test.

Form DA 2166-8-1 NCOER Counseling and Support

INSTRUCTIONS : NCOER COUNSELING AND SUPPORT FORM

A DA Form 2166-8-1 is a United States Army form required for an NCO evaluation report. An NCO evaluation report is used for a yearly evaluation of a non-commissioned officer in the United States Army. The form is to be filled out by supervising officers. The DA Form 2166-8-1 is now referred to as a “counseling and support form”, instead of just previously being an evaluation report.

The DA Form 2166-8-1 is available on the United States Army documentation website or can be supplied through the Army chain of command.

Part I requires the basic administrative data about the NCO that is to be evaluated.

1. Include the name, social security number, rank, contact information, and the appropriate rates and codes that identify the NCO.

After completion of the basic information, you must fill out Part II.

2. Part II requires the evaluating officer to provide their own information for the DA Form 2166-8.

3. Boxes B and C require the information from any senior raters or reviewer who is also submitting the evaluation report for the NCO.

4. All raters and reviewers must sign off on the final evaluation report before it is to be sent out. The form also requires that the NCO being reviewed initials this box to affirm his or her superiors.

Parts III and IV are the actual evaluation information to be supplied in the DA Form 2166-8.

5. The duties of the NCO must be supplied, along with descriptions of special emphasis and appointed duties in which the NCO covered over the evaluating year.

6. The evaluation then must take into consideration the NCO’s compliance with the Army’s core values. The evaluating officer will determine whether the NCO has exceeded, met, or failed to meet the standard, as well as provide comments.

On the second page, Part IV continues, and the evaluator must report on 5 specific areas of the NCO’s abilities.

7. The five areas are competence, physical fitness, leadership, training, and responsibility and accountability.

8. The evaluator must state if the NCO exceeds the standard, meets the standard, needs some improvement or needs much improvement in these 5 areas.

Upon completion, the evaluation is ready for submission to the appropriate use through the chain of command.

Form DA 4187 Personnel Action

INSTRUCTIONS : PERSONNEL ACTION (DA Form 4187)

A DA Form 4187 is the United States Army’s form for requesting a personnel action. This form can be used for numerous personnel actions, so it is recommended that you have available as much information about your specific action before completing the form.

The DA Form 4187 is available on the United States Army website or can be supplied by the U.S. Army personnel division administering the physical fitness test.

Section I requires the basic soldier identification information who is requesting the personnel action.

1. You must identify the solider with their name, rank, and social security number.

If the soldier is having a change of duty, then Section II must be filled out.

2. You must supply the soldier’s former duty, new duty, and the effective date and time the change and duty will take place.

If a different personnel action request is being made, then it must be checked off in Section III.

3. You can request more than one personnel action on a single DA Form 4178.

4. Check the appropriate personnel action for which you are requesting. If your request does not appear as an option, you will need to write the request in the “other” column and give a description.

5. Sign and date Section III.

In Section IV, you may provide any remarks regarding your request.

6. In drafting your remarks, it is important that you provide a reason for the request and supply as much information as will be helpful for the deciding department of officer who will make the decision.

Finally, in Section V, your request must supply a certification and also have a recommendation from a commanding officer or authorized representative.

7. The authorized representative can either provide verification, a recommendation, or approval regarding the soldier’s request.

8. The authorized representative then must sign the DA Form 4178 before the form can be sent to the appropriate agency or department.

Form DA 5500 Body Fat Content Worksheet

INSTRUCTIONS : BODY FAT CONTENT WORKSHEET (DA Form 5500)

A DA Form 5500 is a United States Army form used to record the body fat of a male military member. The form is used for evaluating soldiers who are enrolled in the Army Weight Control Program and is filed to detail their body fat through their progression in the program.

The DA Form 5500 is available on the United States Army documentation website or can be supplied through the Army chain of command.

The first lines require only the name and rank of the soldier for whom the form is for.

1. Additionally, you must include the current height, weight, and age of the military member.

Next, the military member must be tested for body fat, using the fat content guidelines.

2. The guidelines can be found in Army Regulation 600-9.

3. The Army member must be measured around the abdomen at the level of the naval and then measured at the neck around the larynx.

4. These measurements must be made 3 times with the average measurement recorded in the final box.

The final averages of the two measurements types must be recorded in boxes 3 and 4.

5. The circumference value of boxes 3 and 4 must be entered in box 5.

6. The height of the Army member is to be written in inches on box 6.

Using the chart supplied with the form, compare the circumference value and height on the grid that corresponds to the body fat percentage.

7. Record the body fat percentage in box 7.

Any additional remarks can be written in the box below the recorded values.

8. In the next corresponding box, the testing individual should check whether the Army member is in compliance with Army body fat standards or not in compliance with such standards.

Finally, the preparer of the DA Form 5500 must provide their name, rank, and date while a supervisor likewise approves the Form 5500.

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