Components

Label

Use: Deployed

A list of standardized form labels that appear on VA.gov forms. This list is a continued work in progress as each form is unique and has specific labels and questions. As we migrate more forms online, we'll continue to add plain-language labels to this list.

Applicant information

Applicant information labels
Plain-language label or question	Followup label or question	Form notes
Your first name
Your middle name
Your last name
Suffix
Mother's maiden name		appears on Health care app
Your date of birth
Your place of birth
Social Security number
VA file number
Which categories best describe you?	Spanish Hispanic Latino American Indian or Alaskan Native Black or African American Native Hawaiian or other Pacific Islander Asian White	Appears on Health care app
What is your race, ethnicity, or origin? (Please check all that apply.)	American Indian or Alaskan Native Asian Black or African American Hispanic, Latino, or Spanish origin Native Hawaiian or other Pacific Islander White Another race or ethnicity Prefer not to answer	Coronavirus research volunteer list
Which of these best describe you?	Veteran Active-duty service member Member of the National Guard or Reserve VA employee Family member or caregiver of a Veteran or service member Enrolled in VA health care or CHAMPVA None of the above	Coronavirus research volunteer list
What is your gender? (Please check all that apply.)	Man Woman Transgender man Transgender woman Non-binary Prefer to self-describe Prefer not to answer

Contact information

Contact information labels
Plain-language label or question	Followup label or question	Form notes
Address	Country, Street address, Street address line 2, Street address line 3, City, State, Postal code	For forms, we use postal code to account for non-U.S addresses
Home address		These are the labels used in VA.gov profile
Mailing address		These are the labels used in VA.gov profile
State or territory
Email address
Confirm email address		Appears as Re-enter email address on some forms
Primary email address		appears on Pension app only
Secondary email address		appears on Pension app only
Home phone number
Mobile phone number
How should we get in touch with you?
How should we contact you if we have questions about your application?	Mail, Email, Home phone, Mobile phone
To update your contact information for all of your VA accounts, please [go to your profile page].
To update your address for all of your VA accounts, please [go to your profile page].
I would like to receive text messages from VA about my [benefit type] benefits.

Military address

Plain-language label or question Followup label or question Form notes

I live on a U.S. military base outside of the country. [Additional info component] U.S. military bases are considered a domestic address and a part of the United States.

Marriage information

Marriage information labels
Plain-language label or question	Followup label or question	Form notes
What's your marital status?
Spouse's first name
Spouse's middle name
Spouse's last name
Spouse's suffix
Spouse's Social Security number
Where did you get married?	City, State
When did you get married?
When did your marriage end?
Why did your marriage end?
Where did your marriage end?	City, State
Type of marriage	Ceremonial, Common-law, Proxy, Tribal, Other
How many times have you been married?

Caregiver information

Caregiver information labels
Plain-language label or question	Followup label or question	Form notes
Primary Family Caregiver's first name	label is same for Secondary Family Caregiver	Caregiver form
Primary Family Caregiver's middle name
Primary Family Caregiver's last name
Primary Family Caregiver's Social Security or tax identification number
Primary Family Caregiver's date of birth
Primary Family Caregiver's sex
Primary Family Caregiver's current street address
Primary Family Caregiver's primary phone number (including area code)
Primary Family Caregiver's alternate phone number (including area code)
What's the Primary Family Caregiver's relationship to the Veteran?
Does the Primary Family Caregiver applicant have health care coverage, such as Medicaid, Medicare, CHAMPVA, Tricare, or private insurance?

Service history

Service history labels
Plain-language label or question	Followup label or question	Form notes
Last branch of service		appears on Health care app
Branch of service
Sponsor's branch of service
Service start date
Service end date
Character of service		This could also be Character of discharge
Service history
Type of service	Active duty, drilling reservist, National Guard, IRR
Are you currently on active duty?
Did you serve under another name?
Place of last or anticipated separation from service	City, State, or Foreign country
Are you currently on federal active duty in the National Guard?
Are you currently activated on federal orders?
Activation start date
Expected separation date		This could also be Anticipated separation date
Obligation start date
Obligation end date
Most recent entry date
Are you a former POW?
Start of confinement?
End of confinement?
Have you received any type of severance or separation pay?
Do you have any periods of service that began before 1978?
Unit name
Military Service number

Dependent information

Dependent information labels
Plain-language label or question	Followup label or question	Form notes
Do you have any dependents to report?
Do you have any dependent children?
What's your dependent's relationship to you?
Dependent's first name
Dependent's middle name
Dependent's last name
Dependent's suffix
Dependent's Social Security number
Dependent's date of birth
When did they become your dependent?
Does your child or dependent live with you?
Was your dependent permanently and totally disabled before the age of 18?
If your dependent is between 18 and 23 years old, did they attend school during the last calendar year?
Expenses your dependent paid for college, vocational rehabilitation, or training
Has your child ever been married?
Did your dependent live with you last year?
Do you have the same address as your spouse?
Do you have the same address as your dependent?

Income information

Income information labels
Plain-language label or question	Followup label or question	Form notes
Annual income
What's your gross annual income from employment?
What's your net income from your farm, ranch, property, or business (if applicable)
Do you have any other income?
What's your spouse's gross annual income from employment?
What's your spouse's net income from your farm, ranch, property, or business? (if applicable)
Does your spouse have any other income?
Amount you or your spouse paid in non-reimbursable medical expenses this past year
Amount you paid in funeral or burial expenses for a deceased spouse or child this past year
Amount you paid for anything related to your own education (college or vocational) this past year. You don't need to list your dependents’ educational expenses.
Account type
Bank account number
Bank routing number
Bank accounts, investments, and property
Social Security or other pensions (gross income)
Do you have any medical, legal, or other unreimbursed expenses?
Amount paid
Are you receiving military retired pay?
Expected income	This is any income you didn't already report in this form that you expect to receive in the next 12 months.
Which type of VA compensation do you currently receive?

Health care information

Health care information labels
Plain-language label or question	Followup label or question	Form notes
Are you eligible for Medicaid?
Are you enrolled in Medicare Part A (hospital insurance)?
Are you covered by health insurance? (Including coverage through a spouse or another person)
Provider's name
Policyholder's name
Policy number (This or the group code is required)
Group code (This or the policy number is required)
I'm enrolling to get minimum essential coverage under the Affordable Care Act
Please choose your preferred VA medical facility
Do you want VA to contact you to schedule your first appointment?

Education information

Education information labels
Plain-language label or question	Followup label or question	Form notes
Which benefit have you used or are currently using?	Post-9/11 GI Bill (Chapter 33) Fry Scholarship (Chapter 33) Montgomery GI Bill (MGIB-AD, Chapter 30) Montgomery GI Bill Selected Reserve (MGIB-SR, Chapter 1606) Transfer of Entitlement Program (TOE) Post-Vietnam Era Veterans’ Educational Assistance Program (VEAP, Chapter 32)
Are you applying for the Edith Nourse Rogers STEM Scholarship?
Are you enrolled in a STEM undergraduate degree program?
What's the name of your STEM degree?
Name of the school where you're planning on using the Rogers STEM Scholarship?
Name of school, university, or training facility you're attending
Type of education or training
Your school student ID number
Your school email address (This email address usually ends with .edu.)
Education or career goal	(For example, “I want to get a bachelor’s degree in criminal justice” or “I want to get an HVAC technician certificate” or “I want to become a police officer.”)
Are you getting, or do you expect to get any money (including, but not limited to, federal tuition assistance) from the Armed Forces or public health services for any part of your coursework or training?
Are you getting benefits from the U.S. government as a civilian employee at the same time you’re requesting VA benefits?
When did you stop taking classes or participating in the training program? (Future dates are ok.)
Why did you stop taking classes or participating in the training program? (For example, “I graduated” or “I moved” or “The program wasn’t right for me.”)
When did you earn your high school diploma or equivalency certificate?
Hours completed
Type of hours
Degree, diploma, or certificate received
What did you study?
If you have any FAA flight certificates, please list them here
Have you ever held a license of journeyman rating (for example, as a contractor or plumber) to practice a profession?
Main job
Number of months worked
Is student's tuition or education allowance being paid by the Survivors’ and Dependents’ Educational Assistance (DEA), the Federal Compensation Act, or any U.S. government agency or program?

Burial information

Burial information labels
Plain-language label or question	Followup label or question	Form notes
What expenses did you incur for the Veteran's burial?
Type of burial allowance requested
Date of death
Date of burial (includes cremation or interment)
Is there anyone currently buried in a VA national cemetery under your eligibility?

Disability information

Disability information labels
Plain-language label or question	Followup label or question	Form notes
What type of disability claim are you filing?
Did you serve in a combat zone after Sept. 11, 2001?
Do you have any new conditions you want to add to your claim?
What caused this service-connected disability?
Do you need help buying or modifying your home?
Do you need help buying or modifying your car?
Are you confined to your home or need help with everyday activities?
Does your disability prevent you from holding down a job that you could otherwise do? (This doesn’t include being retired.)
What is your work situation?
Please tell us where VA treated you for your disability
Name of VA medical facility
After we review your disability claim and supporting evidence, we may ask you to have a claim exam (also known as a C&P exam) if we need more information to decide your claim.
We’ll use the results of this exam, in addition to your supporting evidence, to rate your disability.
Is there any evidence you’d like us to review as part of your claim?
What type of evidence do you want us to review as part of your claim?
Are you terminally ill?

Pension information

Pension information labels
Plain-language label or question	Followup label or question	Form notes
Are you currently on federal active duty in the National Guard?
Have you had a job (including self-employment) from 1 year before you became disabled to now?
Employer's name
Employer's address
Job title
What disabilities prevent you from working?
Date your disability began
Have you been treated at a VA medical center for this disability?
How many days were lost due to your disability?

Housing information

Housing information labels
Plain-language label or question	Followup label or question	Form notes
Are you currently homeless?		Disability compensation form
Please describe your current living situation	I'm living in a homeless shelter I'm living somewhere other than a shelter (For example, I'm living in a car or a tent.) I'm living with another person I need to quickly leave where I currently live Other (Please describe)
Please describe your current living situation	I'm losing my housing in 30 days I'm leaving a publicly funded homeless shelter soon Other (Please describe)
Are you currently at risk of becoming homeless?
Please provide the name and number of a person we can call if we need to get in touch with you

Review and submit content

Review and submit content labels
Plain-language label or question	Followup label or question	Form notes
Please review the information below to ensure that it's correct before you submit your application. This is especially important if you worked on your application over several days.
Do you want to apply under the Fully Developed Claim program?

Last updated: 3/11/2021

Plain-language label or question	Followup label or question	Form notes
Sponsor's first name
Sponsor's middle name
Sponsor's last name
Sponsor's suffix
Sponsor's Social Security number
Sponsor's VA file number
Sponsor's date of death or date listed MIA or POW
Where did your sponsor die?	City, State
Is your sponsor on active duty?
What's your relationship to the service member whose benefit is being transferred to you?