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VA Form 21P-0969

Form name: Income and Asset Statement for Pension or Parents’ Dependency and Indemnity Compensation (DIC) Claims
Form revision date: November 2023
Related to: Disability, Family member benefits, Pension, Service member benefits

When to use this form

Use VA Form 21P-0969 when you’re instructed to while completing VA Forms 21P-527EZ or 21P-534EZ.

You can also submit it when you need to verify or update your income or net worth. If you need to report changes over multiple years, submit a separate VA Form 21P-0969 each year.

Downloadable PDF

Online tool

You can submit this form online instead of filling out and sending us the paper form.

  • VA Form 21P-534EZ

    Form name: Application for DIC, Survivors Pension, and/or Accrued Benefits

    Use this application if you’re the surviving spouse or child of a Veteran and want to apply for survivors benefits. You can also submit evidence with your application to get a faster decision.

  • VA Form 21P-527EZ

    Form name: Application for Veterans Pension

    Use VA Form 21P-527EZ if you’re a wartime Veteran and want to file a pension claim.

Helpful links related to VA Form 21P-0969

  • As the surviving spouse, child, or parent of a service member who died in the line of duty, or the survivor of a Veteran who died from a service-related injury or illness, you may be eligible for DIC payments.

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