VA 21-0960N-1 2012 free printable template
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OMB Control No. 2900-0778 Respondent Burden: 15 minutes EAR CONDITIONS (INCLUDING VESTIBULAR AND INFECTIOUS CONDITIONS) DISABILITY BENEFITS QUESTIONNAIRE IMPORTANT THE DEPARTMENT OF VETERANS AFFAIRS
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How to fill out VA 21-0960N-1
01
Download the VA Form 21-0960N-1 from the VA website.
02
Fill in your personal information at the top of the form, including your name, Social Security number, and claim number.
03
Specify the condition you are claiming and describe how it affects your daily life.
04
Provide details of treatment received, including dates, locations, and names of medical providers.
05
Complete the section regarding any functional limitations caused by the condition.
06
Sign and date the form at the bottom.
07
Submit the completed form to your local VA regional office or as instructed.
Who needs VA 21-0960N-1?
01
Veterans seeking disability compensation for conditions related to their service.
02
Individuals whose conditions require the evaluation of a specific muscle or joint impairment.
03
Veterans who have been referred for a Compensation and Pension (C&P) examination.
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What is VA 21-0960N-1?
VA Form 21-0960N-1 is a standardized form used by Veterans Affairs to evaluate the severity of a veteran's disabilities related to their health.
Who is required to file VA 21-0960N-1?
Veterans who are seeking benefits or a disability rating from the Department of Veterans Affairs must file VA Form 21-0960N-1.
How to fill out VA 21-0960N-1?
To fill out VA Form 21-0960N-1, the veteran must provide personal information, details about their medical condition, and any relevant medical documentation or supporting evidence.
What is the purpose of VA 21-0960N-1?
The purpose of VA Form 21-0960N-1 is to collect information necessary for the VA to assess a veteran's health status and determine the level of benefits or compensation they are entitled to.
What information must be reported on VA 21-0960N-1?
The form requires the reporting of personal identification information, specifics about the claimed medical condition, treatment history, and any functional limitations resulting from the condition.
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