DescriptionReginfo. gov/public/do/PRAMain. If desired you can call 1-800-827-1000 to get information on where to send comments or suggestions about this form. VA FORM FEB 2012 21P-8416 SUPERSEDES VA FORM 21P-8416 DEC 2011 WHICH WILL NOT BE USED. I certify that the above information is true. 22A. SIGNATURE OF CLAIMANT Do NOT print 22B. DATE PENALTY The law provides severe penalties which include fine or imprisonment or both...
Form was Filled by