Veterans Benefits Apportionment Claim Form

Veterans Benefits Apportionment Claim Form
Complete this form to request apportionment of veterans benefits and provide the information needed to review the claim.
Claimant Information
Claimant Full Name
First NameMiddle NameLast Name
Relationship to Veteran
Mailing Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Veteran and Claim Details
Veteran's Full Name
First NameMiddle NameLast Name
Branch of Service
Claim Basis for Apportionment
Currently Living with Claimant?
Veteran's Current Known Location or Mailing Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Supporting Claim Information
Monthly Household Income
Monthly Household Expenses
Number of Dependents
Brief Explanation of Financial Hardship or Support Need
Should be Empty: