U.S. Department of Veterans Affairs · Federal form
Fill out Form 21-526EZ
Application for Disability Compensation and Related Compensation Benefits JAN 2026
VA says: “Use VA Form 21-526EZ when you want to apply for VA disability compensation (pay) and related benefits.” Source
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Pension and survivor claims use other forms. For veterans non service-connected pension benefits, use VA Form 21P-527EZ, Application for Pension. For survivor benefits, use VA Form 21P-534EZ, Application for DIC, Death Pension, and/or Accrued Benefits. Source
Facts from the official source
Quoted or closely restated from the U.S. Department of Veterans Affairs' own pages and PDFs, checked .
| Fact | What the source says | Source |
|---|---|---|
| Issued by | U.S. Department of Veterans Affairs | About VA Form 21-526EZ (VA) |
| Edition | JAN 2026 | VA Form 21-526EZ (JAN 2026), official PDF with notice and instructions VA Form 21-526EZ, page 2 footer (repeated on pages 2 to 15). |
| Current revision | VA lists January 2026 as the form revision date of the VA Form 21-526EZ it publishes. | About VA Form 21-526EZ (VA) About VA Form 21-526EZ, form details, "Form revision date". |
| Where to send it | Send the application and supporting evidence by mail to Department of Veterans Affairs, Evidence Intake Center, PO Box 4444, Janesville, WI 53547-4444, or submit online (VA.gov: www.va.gov; Direct Upload: AccessVA). | VA Form 21-526EZ (JAN 2026), official PDF with notice and instructions VA Form 21-526EZ (JAN 2026), page 3, 4. Where to Send Information and Evidence. |
| Evidence submission period | Under the Standard Claim Process, you have up to one year from the date VA receives the claim to submit the information and evidence necessary to support it. | VA Form 21-526EZ (JAN 2026), official PDF with notice and instructions VA Form 21-526EZ (JAN 2026), page 2, table "FDC Program (Optional Expedited Process) / Standard Claim Process", Standard Claim Process column. |
| How to complete it | The form may be completed online or by hand. If completed by hand, print in ink, neatly and legibly, one letter per box, and completely fill in each applicable check box. | VA Form 21-526EZ (JAN 2026), official PDF with notice and instructions VA Form 21-526EZ (JAN 2026), page 9, Section I. |
| Signature | Complete and sign the application; the veteran/service member signature in item 33A is required. | VA Form 21-526EZ (JAN 2026), official PDF with notice and instructions VA Form 21-526EZ (JAN 2026), page 1, Submitting a Claim, 1. How to Submit a Claim; page 13, item 33A "VETERAN/SERVICE MEMBER SIGNATURE (REQUIRED)". |
| Alternate signer | An alternate signer's signature is accepted only if a valid VA Form 21-0972, Alternate Signer Certification, is of record or attached. | VA Form 21-526EZ (JAN 2026), official PDF with notice and instructions VA Form 21-526EZ (JAN 2026), page 14, Section XI: Alternate Signer Certification and Signature. |
| Power of attorney signature | A power of attorney's signature is accepted only if, at submission, a valid VA Form 21-22 or VA Form 21-22a naming the appropriate POA is of record with VA. | VA Form 21-526EZ (JAN 2026), official PDF with notice and instructions VA Form 21-526EZ (JAN 2026), page 14, Section XII: Power of Attorney (POA) Signature. |
| Pension and survivor claims use other forms | For veterans non service-connected pension benefits, use VA Form 21P-527EZ, Application for Pension. For survivor benefits, use VA Form 21P-534EZ, Application for DIC, Death Pension, and/or Accrued Benefits. | VA Form 21-526EZ (JAN 2026), official PDF with notice and instructions VA Form 21-526EZ (JAN 2026), page 1, When to Use this Form. |
| Sections required for a non-original claim | If the claim is not an original claim, only Section I, Section IV (if applicable), Section V and a signature are required. | VA Form 21-526EZ (JAN 2026), official PDF with notice and instructions VA Form 21-526EZ (JAN 2026), page 9, Section I. |
| Official instructions | The PDF opens with VA's notice of the evidence necessary to substantiate the claim and the instructions (pages 1 to 8); the application is attached after them. | VA Form 21-526EZ (JAN 2026), official PDF with notice and instructions VA Form 21-526EZ (JAN 2026), page 1, When to Use this Form. |
| Prior edition | This edition supersedes VA Form 21-526EZ, NOV 2022. | VA Form 21-526EZ (JAN 2026), official PDF with notice and instructions VA Form 21-526EZ (JAN 2026), page 1 and page 9 footer. |
What is on the form
- Item 1: Claim program/process
- FDC Program, Standard Claim Process, IDES or BDD Program claim. VA Form 21-526EZ, page 9
- Section I: Veteran's Identification Information
- Name, Social Security number, prior VA claim and file number, date of birth, service number, BDD release date, telephone, mailing address, e-mail and VA employee check box (items 2 to 12). VA Form 21-526EZ, page 9
- Section II: Change of Address
- Type of address change, new address and effective dates (items 13A to 13C). VA Form 21-526EZ, page 9
- Section III: Homeless Information
- Homeless or at-risk status, living situation and point of contact (items 14A to 14F). VA Form 21-526EZ, page 10
- Section IV: Exposure Information
- Toxic exposure claims, Gulf War hazard and herbicide locations with dates, other exposures and additional dates (items 15A to 15E). VA Form 21-526EZ, page 10
- Section V: Claim Information
- Current disabilities or symptoms claimed, related exposure/event/injury, explanation and approximate dates (item 16); VA medical centers and DoD treatment facilities with treatment dates (item 17). VA Form 21-526EZ, pages 10 and 11
- Section VI: Service Information
- Other names served under, branch and component, active service dates and place of separation, combat zone service, Reserves/National Guard details, federal activation and prisoner-of-war dates (items 18A to 23B). VA Form 21-526EZ, page 12
- Section VII: Service Pay
- Military retired pay, retired status, the item 26 election, separation or severance pay received, and the item 28 training pay election (items 24A to 28). VA Form 21-526EZ, pages 12 and 13
- Section VIII: Direct Deposit Information
- No-account certification, account number and type, financial institution and routing number (items 29 to 32). VA Form 21-526EZ, page 13
- Section IX: Claim Certification and Signature
- Veteran/service member signature and date signed (items 33A and 33B). VA Form 21-526EZ, page 13
- Section X: Witnesses to Signature
- Witness signatures, printed names and addresses when the veteran signed with an "X" (items 34 and 35). VA Form 21-526EZ, page 13
- Section XI: Alternate Signer Certification and Signature
- Alternate signer signature and date (items 36A and 36B). VA Form 21-526EZ, page 14
- Section XII: Power of Attorney (POA) Signature
- POA/authorized representative signature and date (items 37A and 37B). VA Form 21-526EZ, page 14
- Section XIII: Claim Information (Addendum)
- Additional claimed disabilities, related exposure/event/injury, explanation and approximate dates (rows 1 to 20). VA Form 21-526EZ, page 15
Checked by PDF Tower: the official PDF has 15 pages and 388 fillable fields (292 text, 93 checkbox or radio, 3 signature), 1.8 MB. SHA-256 48d87f2b679f61e4…, computed .
Edition and revisions
- Edition on this page: JAN 2026.
Sources
- About VA Form 21-526EZ (VA) Retrieved .
- VA Form 21-526EZ (JAN 2026), official PDF with notice and instructions Retrieved .
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