Yes! You can use AI to fill out VA Form 29-357, Claim for Disability Insurance Benefits (Government Life Insurance)

VA Form 29-357 is an official Department of Veterans Affairs application for veterans who have Government Life Insurance and become totally disabled before age 65, to claim disability insurance benefits and request waiver of premiums (and, in some cases, premium refunds). The form collects identifying information, policy and claim details, disability onset and work history, and requires a medical report (Part II) completed by a hospital official or licensed practitioner to substantiate the disability. Submitting a complete and accurate form helps VA evaluate eligibility and process the claim efficiently, including any supporting evidence such as a Social Security disability award letter. Today, this form can be filled out quickly and accurately using AI-powered services like Instafill.ai, which can also convert non-fillable PDF versions into interactive fillable forms.
VA Form 29-357 has a complex Form Complexity Index of 66/100 — 122 fillable fields across 3 pages. Instafill’s AI completes it accurately in under a minute.

Form specifications

Form name: VA Form 29-357, Claim for Disability Insurance Benefits (Government Life Insurance)
Number of fields: 122
Number of pages: 3
FCI: Complex (66/100)
Field instructions: VA Form 29-357 Instructions
Language: English
Our AI automatically handles information lookup, data retrieval, formatting, and form filling.
It takes less than a minute to fill out VA Form 29-357 using our AI form filling.
Securely upload your data. Information is encrypted in transit and deleted immediately after the form is filled out.
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How to Fill Out VA Form 29-357 Online for Free in 2026

Are you looking to fill out a VA FORM 29-357 form online quickly and accurately? Instafill.ai offers the #1 AI-powered PDF filling software of 2026, allowing you to complete your VA FORM 29-357 form in just 37 seconds or less.
Follow these steps to fill out your VA FORM 29-357 form online using Instafill.ai:
  1. 1 Go to Instafill.ai and upload VA Form 29-357 (or select it from the form library) and let the AI detect the fields.
  2. 2 Enter the insured veteran’s personal and policy details in Part I (name, policy number, mailing address, SSN, date of birth, phone, and claim number).
  3. 3 Provide disability and employment information in Part I (date disability prevented employment, any return-to-work date, education/training, benefits applied for, and the condition causing total/permanent disability).
  4. 4 Add treatment sources and work history (hospitals, licensed practitioners, and employment records for the year prior to disability through present), and upload supporting documents (e.g., SSA award letter, medical evidence, statements).
  5. 5 Review the consent/authorization language and complete the signature and date fields for the insured or authorized representative, then have Instafill.ai run validation checks for missing items and formatting.
  6. 6 Send Part II to the attending licensed practitioner/hospital official to complete the medical report section (history, diagnosis, objective findings, functional capacity, prognosis, and signature), using Instafill.ai sharing/export tools if available.
  7. 7 Download the completed packet and submit it to the VA Insurance Center (or upload via VA’s Insurance document upload service), keeping a copy of the final submission for your records.

Our AI-powered system ensures each field is filled out correctly, reducing errors and saving you time.

Why Choose Instafill.ai for Your Fillable VA Form 29-357 Form?

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Frequently Asked Questions About VA Form 29-357

VA Form 29-357 has a Form Complexity Index of 66 out of 100, placing it in the complex complexity tier. This score is calculated deterministically from the form’s own structure using Instafill’s published Form Complexity Index methodology, so it can be reproduced and independently verified — it is not a subjective estimate.

For VA Form 29-357 specifically, the score reflects 122 fillable fields across 3 pages, grouped into 25 sections, and 1 conditional fields that only apply depending on earlier answers, 3 tables or repeating lists. The number of fields is the largest factor in the base score (weighted 36%), followed by how difficult those fields are to complete based on their type, where free-text and signature fields count for more than simple checkboxes (26%). The number of pages that actually contain fields (15%), the amount of conditional “fill-only-if” logic (16%), and how many sections the form is divided into (7%) account for the rest of the base. On top of that base, the index adds points for tables and repeating lists, bundled instruction pages, and dense page layouts — capturing difficulty the base alone can miss.

In practical terms, a complex score means the form is demanding, with many fields, multiple pages and branching rules that are easy to get wrong. Instafill removes that effort entirely: our AI reads your information, maps each value to the correct field — including the conditional ones — and completes VA Form 29-357 accurately in under a minute, with every field available for you to review before you download. See exactly how the Form Complexity Index is calculated.

VA Form 29-357 is used to claim Disability Insurance Benefits (including a waiver of premiums) under Government Life Insurance when an insured veteran becomes totally disabled.

This application is for veterans who have Government Life Insurance and became totally disabled. Part I is completed by the insured veteran (or someone acting on the veteran’s behalf if the veteran is unable).

Total disability means an impairment of mind or body that makes it impossible for the veteran to be gainfully employed. The total disability must begin before the veteran’s 65th birthday.

Part I contains the veteran’s personal, insurance, disability, treatment, and employment information. Part II must be completed by a hospital official or the veteran’s attending licensed practitioner of the healing arts and provides medical details supporting the disability.

No. If there will be a delay in preparing Part II, you should send Part I immediately and submit Part II as soon as it is completed.

If you have been granted Social Security Administration disability benefits, attach a copy of your SSA award letter. If hospital summaries or other medical evidence are available, include them as well—especially if you are explaining a delayed filing due to mental disability.

Premium refunds are generally limited to one year prior to the date the claim is filed. If total disability began more than one year before you filed and you believe a mental disability prevented earlier filing, include a separate statement and supporting medical evidence.

No. The form states that lack of knowledge of the waiver provision is not considered a circumstance beyond the veteran’s control for extending the premium refund period.

Complete a separate VA Form 29-357 for each policy number. This helps VA process each policy’s disability/waiver determination correctly.

List your employment for one year prior to the date total disability began through the present, including self-employment. Provide dates of employment, last day worked, hours and earnings (weekly), occupation, employer name/address, and reason for termination.

Item 8 should be the date your disability began or the date it prevented you from being gainfully employed. Item 9 should be completed only if you later returned to gainful employment, using the date you resumed that work.

Mail the claim to: Department of Veterans Affairs, Insurance Center, P.O. Box 5209, Janesville, WI 53547-5209. The fastest and most secure option is the VA Insurance document upload service at https://insurance.va.gov/home/IDU.

The estimated public reporting burden is about 1 hour and 45 minutes, including reviewing instructions, gathering records, completing the form, and reviewing it.

Yes. AI form-filling services like Instafill.ai can help auto-fill form fields accurately using the information you provide, which can save time and reduce missed fields—though you should still review everything for accuracy before signing and submitting.

You can upload the PDF to Instafill.ai, provide your details (policy number, disability dates, treatment providers, employment history, etc.), and have the tool populate the fields for review and download. If the PDF is flat/non-fillable, Instafill.ai can convert it into an interactive fillable form before auto-filling.

Compliance VA Form 29-357
Validation Checks by Instafill.ai

1
Insured Full Name Completeness and Character Validation
Validates that the insured’s name (first, middle, last) is present and not left blank or entered as initials-only (e.g., “J D”). It should allow common name characters (letters, spaces, hyphens, apostrophes) and reject numeric-only or symbol-heavy entries. This is important for identity matching across VA insurance records and medical documentation. If validation fails, the submission should be flagged for correction because the claim may not be matchable to the correct insured.
2
Insurance Policy Number Format and Single-Policy Rule
Checks that the insurance policy number is provided and matches expected formatting rules (e.g., includes required letter prefix if applicable, preserves dashes/letters, and is not truncated). Also validates that only one policy number is represented per submission, since the form instructs a separate form for each policy. This prevents misrouting and incorrect association of disability waiver decisions to the wrong policy. If validation fails, the system should reject or route to manual review and request a separate submission per policy.
3
Mailing Address Completeness (Street/City/State/ZIP) and ZIP Format
Ensures the mailing address includes street or PO box/rural route, city, state, and ZIP code, and that the ZIP is valid (5 digits or ZIP+4). A complete address is required for official correspondence, premium waiver decisions, and refund communications. Missing or malformed address data can cause returned mail and delays in benefits processing. If validation fails, prompt the user to complete missing components or correct the ZIP format.
4
Social Security Number (SSN) 9-Digit and Disallowed Values Check
Validates that the SSN, if provided, is exactly 9 digits (optionally allowing standard dash formatting) and is not an obviously invalid value (e.g., all zeros, 123456789). Although SSN disclosure is described as voluntary, when supplied it must be usable for identity resolution and record matching. Invalid SSNs can lead to mismatched records or processing errors. If validation fails, the system should request correction or allow submission without SSN only if business rules permit.
5
Date of Birth Format and Age-Based Eligibility (Disability Before 65)
Checks that the date of birth is a valid calendar date and not in the future. Then verifies the rule stated on the form: total disability must start before the veteran’s 65th birthday by comparing DOB to the ‘Date Disability Prevented Employment’ (Item 8). This is critical because claims outside eligibility criteria may be denied. If validation fails, the system should flag the claim as potentially ineligible and require confirmation or supporting explanation before submission.
6
Daytime Telephone Number Format and Minimum Contactability
Validates that the daytime phone number contains a valid number of digits (e.g., 10 digits for US numbers, or E.164-compatible if country code is included) and is not placeholder text. Reliable contact information is needed to resolve missing evidence, clarify employment history, or coordinate medical documentation. Incorrect phone numbers increase processing time and can lead to denial for failure to respond. If validation fails, prompt for a corrected phone number or an alternate contact method if supported.
7
Claim Number Presence and Format Consistency
Ensures the claim number field is not blank and conforms to expected VA claim number patterns (e.g., alphanumeric length constraints, no illegal characters). The claim number is used to associate the submission with an existing VA claim record and correspondence. Incorrect claim numbers can cause misfiling or duplicate claim creation. If validation fails, the system should request correction or route to manual indexing.
8
Disability Onset Date (Item 8) Validity and Not After Signature Date
Validates that the ‘Date Disability Prevented Employment’ is a real date and is not in the future relative to the date of signature/submission. This date is central to determining eligibility, waiver start, and potential premium refund windows. A future onset date indicates data entry error or misunderstanding of the question. If validation fails, block submission until corrected or require an attestation/explanation if the system allows exceptions.
9
Return to Gainful Employment Date (Item 9) Logical Consistency
If a return-to-work date is provided, checks that it is on or after the disability onset date and not before the last day worked in the employment records. This prevents contradictory timelines (e.g., returning to work before disability prevented employment). Consistent dates are necessary to evaluate total disability duration and waiver/refund periods. If validation fails, prompt the user to correct the date or clarify that they have not returned to gainful employment.
10
Education Level Selection: Exactly One Highest Year Completed
Validates that the education section (Item 10A) has exactly one “highest year completed” selection across grade school, high school, and college options, and that mutually exclusive boxes are not simultaneously checked. This ensures the data represents a single highest completed level rather than multiple conflicting levels. Education can be relevant to employability assessments and claim context. If validation fails, require the user to select only one highest year completed.
11
Specialized Training (Item 10B) Conditional Requirement and Minimum Detail
If the applicant indicates specialized training/education beyond the basic highest year completed (or if the workflow explicitly asks for it), validate that Item 10B is not blank and includes minimally useful detail (e.g., training name and provider or dates). This information can support employability and vocational context in disability determinations. Empty or vague entries (e.g., “training”) reduce evidentiary value. If validation fails, prompt for additional details or allow “None” explicitly.
12
Disability Benefits Selection (Item 11) and SSA Award Letter Attachment Prompt
Validates that at least one checkbox is selected if the applicant answers “yes” to receiving/applying for benefits, and that selections are limited to the provided options (VA compensation, VA pension, SSA disability). If Social Security Disability is selected, the system should require an attachment indicator or prompt for the SSA award letter as instructed. This helps corroborate disability status and speeds adjudication. If validation fails, request corrected selections and/or prompt for the missing SSA documentation.
13
Cause of Disability (Item 12) Non-Empty and Not Placeholder Text
Ensures the disease or injury causing total/permanent disability is provided and contains meaningful content (e.g., not “N/A”, “unknown”, or a single character). This field is essential for medical evaluation, matching to practitioner reports, and determining whether the condition aligns with the claimed disability timeline. Missing or non-informative entries can stall medical development. If validation fails, require a brief description or diagnosis statement.
14
Hospitalization Entries: Paired Fields and Admission/Release Date Order
For each hospital listed, validates that name, address, admission date, and release date are provided together (no orphaned dates without facility identification). Also checks that admission date is on/before release date and that both are valid calendar dates. Accurate hospitalization history supports medical evidence gathering and timeline verification. If validation fails, prompt to complete missing fields or correct date ordering.
15
Licensed Practitioner Entries: Required Pairing and Treatment Date Sequence
For each practitioner listed, validates that name and address are present when any treatment dates are entered, and that ‘date treatment began’ is on/before ‘date of last treatment.’ This ensures VA can request records and that the treatment timeline is coherent. Incomplete practitioner information can prevent evidence collection and delay adjudication. If validation fails, require completion of missing practitioner identifiers or correction of date sequences.
16
Employment History Completeness and Numeric Range Checks (Hours/Earnings)
For each employment record provided, validates that employer name/address, occupation, dates (from/to), last day worked, hours worked (weekly), earnings (weekly), and reason for termination are present when the record is used. Hours and earnings must be numeric and within reasonable bounds (e.g., hours 0–168; earnings non-negative), and date ranges must be consistent (from ≤ to; last day worked within the employment period). Employment history is required to evaluate gainful employment and confirm when disability prevented work. If validation fails, the system should flag the specific row and require correction before submission.
17
Signature and Date of Signature Presence and Date Validity
Validates that the insured (or authorized fiduciary/official) signature is present and that the date of signature is a valid date not in the future. The signature certifies truthfulness and authorizes release of information, which is necessary for obtaining medical/employment records. Missing signatures or invalid dates can make the submission legally insufficient and unprocessable. If validation fails, block submission until a valid signature and date are provided.

Common Mistakes in Completing VA Form 29-357

Using the wrong form version or submitting an outdated copy

People often download an older saved PDF (e.g., AUG 2022) or reuse a prior packet, not realizing the form has been superseded (DEC 2025). Using an outdated version can delay processing or trigger a request to resubmit on the current form. Always confirm the edition date (DEC 2025) and that the OMB control number is valid before completing. If you only have a flat, non-fillable PDF, Instafill.ai can convert it into a fillable version and help ensure you’re using the correct, current template.

Entering an incomplete or incorrect insurance policy number (missing letter prefix/characters)

Applicants frequently omit the letter prefix, dashes, or other characters, or they enter a different VA/insurance identifier instead of the policy number. This causes record-matching problems and can delay or misroute the claim, especially if the veteran has multiple policies. Copy the policy number exactly as shown on the policy (including any letters and punctuation) and complete a separate form for each policy. Instafill.ai can help by validating the expected policy-number format and flagging missing prefixes.

Confusing the VA claim number with the insurance policy number (or leaving the claim number blank)

Because the form asks for both a policy number (Item 2) and a claim number (Item 7), people often swap them or assume they are the same. This can lead to delays while VA clarifies identifiers or requests additional documentation. Use the claim number exactly as it appears on VA correspondence/award letters, and keep it distinct from the insurance policy number. AI-powered tools like Instafill.ai can map data to the correct fields and reduce mix-ups between similar identifiers.

Incorrect disability onset date or inconsistent work-stop dates (Items 8, 9, and Part II dates)

A very common issue is listing a disability date that doesn’t match the “stopped working” date in Part II, or entering the last day worked in the employment section that conflicts with Item 8. Inconsistencies can trigger follow-up requests, slow adjudication, or raise questions about whether the disability prevented gainful employment. Use one consistent timeline: onset/when disability prevented employment (Item 8), last day worked, and any return-to-work date (Item 9), and ensure Part II matches. Instafill.ai can cross-check dates across sections and flag conflicts before submission.

Not addressing the age-65 requirement for total disability start

Some applicants provide dates showing total disability began after the veteran’s 65th birthday, or they leave dates vague, not realizing the form requires total disability to start before age 65. This can result in denial or a request for clarification/evidence about when total disability actually began. Verify the date of birth (Item 5) and ensure the disability start date (Item 8 and Part II) clearly falls before the 65th birthday. Instafill.ai can automatically compare DOB and onset dates and warn you if the timeline appears ineligible.

Leaving “Date Returned to Gainful Employment” blank or entering “N/A” incorrectly

Applicants who have not returned to work often leave Item 9 empty without clarifying, while others enter ambiguous text that doesn’t fit the date field. Missing or non-date entries can cause processing delays because VA may need to confirm whether the veteran resumed gainful employment. If you have not returned to work, follow the form’s expectations by leaving it blank only if allowed by the form instructions/system, or provide a clear note if the submission method permits (some systems require a date). Instafill.ai can enforce date-only formatting and prompt for a consistent “not returned” handling based on the form’s rules.

Incomplete treatment history (missing hospitals/practitioners, addresses, or treatment dates)

People often list a hospital or doctor name but omit full addresses, admission/release dates, or treatment start/last treatment dates. Incomplete provider information makes it harder for VA to request records and can slow the medical review. Provide complete facility/provider names, full mailing addresses, and specific dates for each entry (Items 13–14), adding additional sheets if needed. Instafill.ai can standardize addresses, ensure required subfields are filled, and keep date formats consistent.

Submitting Part I without arranging for Part II (medical report) or forgetting Part II signatures

Because Part II must be completed by a hospital official or licensed practitioner, applicants sometimes submit only Part I and never follow up, or the provider returns Part II without a signature/title/date. Missing Part II (or an unsigned report) can stall the claim until VA receives adequate medical certification. If Part II will be delayed, send Part I immediately as instructed, but coordinate with the provider to complete Part II promptly and ensure it is signed, dated, and includes the preparer’s title. Instafill.ai can generate a provider-ready packet and checklist to reduce missing signature/date/title errors.

Not attaching the Social Security Disability award letter when applicable

The form specifically requests a copy of the SSA award letter if the veteran has been granted SSA disability benefits, but many applicants forget to include it. Missing attachments can lead to additional evidence requests and longer processing times. If you checked Social Security Disability in Item 11 (or you have an award), attach the award letter with the submission. Instafill.ai can prompt for required attachments based on your answers and help package documents for upload.

Employment history section completed with gaps, wrong time window, or non-weekly figures

Item 15 asks for employment for one year prior to total disability to the present (including self-employment), but people often list only their last job, omit self-employment, or provide monthly/annual earnings instead of weekly. Gaps or mismatched earnings/hours can create questions about “gainful employment” and may require clarification. List each employer (or self-employment) covering the required period, include dates (From/To), last day worked, weekly hours, weekly earnings, occupation, and reason for termination. Instafill.ai can normalize earnings to weekly amounts and flag missing periods in the timeline.

Missing or improper signature/date/authority when someone signs on the veteran’s behalf

Part I must be signed and dated (Items 16–17), and if someone completes it for the insured, they must be an appropriate official/fiduciary; people sometimes forget the date, use a typed signature, or fail to indicate proper authority. Unsigned or improperly signed forms are commonly returned and delay benefits. Ensure a handwritten (or accepted e-signature if permitted by the submission channel) signature is provided, the date is entered, and the signer’s role/authority is clear when not the insured. Instafill.ai can highlight signature/date requirements and reduce omissions before you submit.
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government life insurance forms VA Form 29-357, Claim for Disability Insurance Benefits (Government Life Insurance)
insurance claim forms Continental American Insurance Company (CAIC) / Aflac Group Critical Illness Claim Form (with Attending Physician’s Statement, HIPAA Authorization to Obtain Information, and Electronic Funds Transaction Authorization), Assurity Life Insurance Company Disability Claim Form — Attending Physician’s Statement, CMS-1500 (02-12), Health Insurance Claim Form (NUCC Approved) (OMB 0938-1197), VA Form 29-357, Claim for Disability Insurance Benefits (Government Life Insurance), Standard Health Insurance Claim Form - Part B, DWC002, Employer’s report for reimbursement of voluntary payment, Form BWC-1141, Request for Medical Information, Lincoln Financial Group Requesting a distribution, Bajaj Allianz Overseas Travel Insurance Claim Form, CMS-1500 Health Insurance Claim Form (OMB-0938-0999), ACORD 160, Property Loss Notice
insurance forms Form 1095-A, Health Insurance Marketplace Statement, Form SSA-4-BK, Application for Child's Insurance Benefits, Form SSA-10, Application for Widow's or Widower's Insurance Benefits, Form 1095-C, Employer-Provided Health Insurance Offer and Coverage, National Integrity Life Insurance Company Ownership Change Request Form (NI-77-0039-2505), Record of Advice and Needs Analysis (Non-Life Insurance — Personal and Commercial Lines), Form 7206 (2025), Self-Employed Health Insurance Deduction, ACORD 25 (2016/03), Certificate of Liability Insurance, Continental American Insurance Company (CAIC) / Aflac Group Critical Illness Claim Form (with Attending Physician’s Statement, HIPAA Authorization to Obtain Information, and Electronic Funds Transaction Authorization), Prudential Group Disability Insurance – Education and Employment History Form (GL.2009.009, Ed. 06/2017), acord-25-201603-certificate-of-liability-insurance-1, Brotherhood Mutual Insurance Company Ministry Driver Screening Form (A99), Assurity Life Insurance Company Disability Claim Form — Attending Physician’s Statement, Amateur Sports / Activities Accident Insurance Quote Request Form (Philadelphia Insurance Companies), Martial Arts Studio General Liability and Property Application (Fitness and Wellness Insurance / Philadelphia Insurance Companies) (03/2011), The Prudential Insurance Company of America Group Disability Insurance – Education and Employment History Form (GL.2009.009, Ed. 06/2017), CMS-1500 (02-12), Health Insurance Claim Form (NUCC Approved) (OMB 0938-1197), Prudential Group Disability Insurance – Education and Employment History Form (GL.2009.009, Ed. 06/2017), HDFC ERGO General Insurance Company Limited – Request for Cashless Hospitalisation for Health Insurance (Policy Part – C), VA Form 29-357, Claim for Disability Insurance Benefits (Government Life Insurance) · + 73 more →
life insurance forms National Integrity Life Insurance Company Ownership Change Request Form (NI-77-0039-2505), Record of Advice and Needs Analysis (Non-Life Insurance — Personal and Commercial Lines), Assurity Life Insurance Company Disability Claim Form — Attending Physician’s Statement, VA Form 29-357, Claim for Disability Insurance Benefits (Government Life Insurance), Beneficiary Designation/Change - Principal Life Insurance Company, Principal Life Insurance Company UCTIE INTERNATIONAL UNION 401(K) SAVINGS PLAN Enrollment Form, Principal Life Insurance Company Death Notification Form, Principal Life Insurance Company Form PG4701, In-Plan Roth Conversion – No Spousal Consent Needed, Principal Life Insurance Company Administration Guide, Principal Life Insurance Company Small Amounts Benefit Election, Principal Life Insurance Company Beneficiary Designation/Change Form (GP34795-14), Transamerica Life Insurance Company - New Business Cover Sheet, Transamerica Life Insurance Company Individual Whole Life Insurance Application, Transamerica Life Insurance Company Beneficiary Designation Form (TOB 306M-0809), Beneficiary Designation Form For Life Insurance Policies, Transamerica Life Insurance Company Beneficiary Designation Form, TIAA Life Insurance Beneficiary Designation Form, Fidelity Investments Beneficiaries — Term Life Insurance, American Fidelity Change of Beneficiary Form, PruLife Private Placement VUL and Private Placement Variable Annuity Purchaser Questionnaire and Agreement · + 2 more →
UK government forms United Kingdom (UK) State Pension claim form, Form 1099-G, Certain Government Payments, Town of Horizon City Public Information Request (Texas Government Code, Chapter 552), National Apartment Association (NAA) Rental Application for Residents and Occupants (Virginia) and Supplemental Rental Application for Units Under Government Regulated Affordable Housing Programs, VA Form 29-357, Claim for Disability Insurance Benefits (Government Life Insurance), Z83, Application for Employment in the Republic of South Africa Government Department, Incoming Transfer/Direct Rollover Governmental 457(b) Plan, Incoming Transfer/Direct Rollover Governmental 457(b) Plan, City of Torrance Deferred Compensation Plan, Oklahoma Pathfinder 457 Plan Incoming Transfer/Rollover Request Governmental 457(b) Plan, Beneficiary Account Withdrawal Request Governmental 457(b) Plan, Empower Beneficiary Designation Governmental 457(b) Plan, Request for Distribution from Your 457(b) Governmental Plan, DCMA Guidebook for Government Contract Property Administration, Alcoholic Beverages License Application, Unified Government of Athens-Clarke County, Georgia
VA claim forms Form OWCP-915, Claim for Medical Reimbursement, Form 8862, Information To Claim Certain Credits, Form CA-7, Claim for Compensation, Form CA-5, Claim for Compensation, Form SC-100, Plaintiff's Claim and ORDER to Go to Small Claims Court, Form 20-0995, Decision Review Request: Supplemental Claim, Form 104, List of Creditors 20 Largest Unsecured Claims, VA Form 20-0995, Decision Review Request: Supplemental Claim, Form 941-X (Rev. April 2023), Adjusted Employer’s QUARTERLY Federal Tax Return or Claim for Refund, Judicial Council of California Form SC-104, Proof of Service (Small Claims), Immigration and Refugee Board of Canada (IRB) – Refugee Protection Division (RPD) Basis of Claim Form (for persons claiming refugee protection in Canada) (RPD.02.01), SC-108, Request to Correct or Cancel Judgment and Answer (Small Claims), Judicial Council of California Form SC-105, Request for Court Order and Answer (Small Claims), SC-120, Defendant’s Claim and ORDER to Go to Small Claims Court (Small Claims), Judicial Council of California Form SC-104, Proof of Service (Small Claims), Continental American Insurance Company (CAIC) / Aflac Group Critical Illness Claim Form (with Attending Physician’s Statement, HIPAA Authorization to Obtain Information, and Electronic Funds Transaction Authorization), Judicial Council of California Form SC-108, Request to Correct or Cancel Judgment and Answer (Small Claims), SC-105, Request for Court Order and Answer (Small Claims), Judicial Council of California Form SC-120, Defendant’s Claim and ORDER to Go to Small Claims Court (Small Claims), Small Claim and Notice of Small Claim (ORS 46.425) (OJD Official) (Jan 2026) · + 83 more →
VA forms Ankle Conditions Disability Benefits Questionnaire, Shoulder and Arm Conditions Disability Benefits Questionnaire, VA Form 10-7959f-2, Foreign Medical Program (FMP) Claim Cover Sheet, VA Form 20-0995, Decision Review Request: Supplemental Claim, VA Form 21-0781a, Statement in Support of Claim for Service Connection for Post-Traumatic Stress Disorder (PTSD) Secondary to Personal Assault, VA Form 21-0788, Information Regarding Apportionment of Beneficiary's Award, VA Form 21-4138, Statement in Support of Claim, Wrist Conditions Disability Benefits Questionnaire (DBQ), VA Form 21-0781, Statement in Support of Claimed Mental Health Disorder(s) Due to an In-Service Traumatic Event(s), VA Form 21-686c, Declaration of Status of Dependents, VA Form 29-357, Claim for Disability Insurance Benefits (Government Life Insurance), Form 4852, Substitute for Form W-2, Wage and Tax Statement, or Form 1099-R, Form #170, Voluntary Account Withdrawal Request Form, Meritain Health Claim Form (Health Claim Form), Form 4852, Substitute for Form W-2 or 1099-R, Meritain Health Claim Form (Health Claim Form), PSA Form/K/II/052025 - Formulir Pembukaan Rekening / Account Opening Form, Form WH-347, Davis-Bacon and Related Acts Weekly Certified Payroll Form, Vanguard IRA Distribution Kit (including IRA Distribution Form RRDFT and Form W-4R), Davis-Bacon and Related Acts Weekly Certified Payroll Form (Form WH-347) · + 44 more →