File this BEFORE gathering evidence — it protects your effective date

The 1-year clock starts immediately, so don't wait too long to file the full claim

Veterans Affairseasy

Intent to File a Claim

VA 21-0966 · VA

Preserves the effective date for a VA benefits claim while gathering evidence. Provides 1 year to submit the formal claim.

Form Details

Total fields: 12
Auto-fillable: 10 (83%)
Time without BeneFill: 10 minutes
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Time saved: 7 minutes
Filled by: patient
Frequency: as needed

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Where to Submit This Form

🌐

VA.gov

https://www.va.gov/supporting-forms-for-claims/intent-to-file-form-21-0966/

Takes 2 minutes online.

📬

Mail

Department of Veterans Affairs Evidence Intake Center PO Box 4444 Janesville, WI 53547-4444

📠

Fax

Fax: 844-531-7818

Filing Deadline

No deadline to file — but your effective date starts when VA receives this form. You then have 1 year to submit the actual claim.

Processing Time

Immediate. Your intent-to-file date is established when VA receives the form.

What Happens Next

You have exactly 1 year to file your full disability claim (VA 21-526EZ). Your benefits will be backdated to this intent-to-file date.

Tips for This Form

✓ File this BEFORE gathering evidence — it protects your effective date
✓ The 1-year clock starts immediately, so don't wait too long to file the full claim

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Disclaimer: BeneFill™ provides form-filling assistance and informational guidance only. It is not affiliated with, endorsed by, or sponsored by the VA or any government agency. The information provided is for general informational purposes and does not constitute legal, medical, financial, or tax advice. Always verify form requirements and submission details directly with the issuing agency.