VA Form 21-0966 - Link

The Intent to File (ITF) form notifies the U.S. Department of Veterans Affairs (VA) that you intend to submit a claim for benefits. Filing an Intent to File may protect your effective date and preserve potential retroactive benefits for up to one year while you gather the information and evidence needed to complete your claim.

Completing the Form

Section I – Veteran/Claimant Information

• All applicants should complete Section I with the Veteran's personal information, including name, Social Security Number, VA file number (if applicable), date of birth, and contact information.

Section II – Dependent Information (DIC Claims Only)

• If you are a surviving spouse, dependent child, or dependent parent intending to file a claim for Dependency and Indemnity Compensation (DIC), Survivors Pension, or accrued benefits, you should also complete Section II with your personal information.
• For survivor claims, Section I should contain the Veteran's information and Section II should contain the dependent's information.

Selecting the Benefit Type

Please select the benefit category that best matches your intended claim:

Compensation

• Disability Compensation is a tax-free monthly benefit paid to Veterans for illnesses, injuries, or conditions that were caused or aggravated by military service.

Pension

• Veterans Pension is a needs-based benefit available to wartime Veterans who meet certain age, disability, income, and net worth requirements.

Dependency and Indemnity Compensation (DIC), Survivors Pension, and Accrued Benefits

• DIC is a tax-free monthly benefit paid to eligible surviving spouses, dependent children, or dependent parents of Service Members who died in the line of duty or Veterans whose death was related to a service-connected condition.
• Survivors Pension is a needs-based benefit available to qualifying low-income surviving spouses and dependent children of wartime Veterans.
• Accrued Benefits are certain unpaid VA benefits that may be payable to eligible survivors after a Veteran's death.

Signature

After reviewing the form and ensuring all applicable sections are complete, please sign and date the certification section. Unsigned forms cannot be processed by the VA.

Once completed, please submit the form and any supporting documentation to VACVSO@cookcountyil.gov. A member of our Veterans Benefits Services team will review your submission and contact you to schedule an appointment if additional assistance is needed.