employees containing red ink. Out-based facility with fewer than five employees and sites conducting Transition Assistance and Disabled Transition Assistance briefings pre-discharge activities Integrated Disability Evaluation System (IDES) activities, and field examiner activities manual date stamp containing red ink. site conducting outreach activities manual date stamp containing red ink. Important: The employee receiving documents at outreach events must also sign their name below the red date stamp. centralized mail (CM) scanning vendor electronic date stamp containing black ink. Notes: Use of red ink for mail received at out-based locations assists the RO employees performing claims-establishment functions to identify the proper date of claim (DOC), and avoid potential confusion when this mail is subsequently received at the RO. References: For more information on RO and intake site responsibilities for pre-discharge claims, see M21-1, Part III, Subpart i, 2.B.1, and CM vendor date stamping and receipt dates, see M21-1, Part III, Subpart ii, 1.E.1.c. b. Handling Documents Processed Without a Date Stamp Use the guidance in the table below when attempting to determine the date the VA received a document processed without a date stamp. If receipt of the document by VA is determined to be ... Then ... the current date stamp the document with an official date stamp. prior to the current date hand-write the date of receipt on the document. unknown hand-write the best estimate for the date of receipt, and identify it as an estimate on the document.
a. Signature by X Mark or Thumbprint Accept signatures by X mark or thumbprint only if any one of the following individuals (or group of individuals) witness the mark or thumbprint two persons who give their addresses a VA employee a Veterans Service Organization (VSO) representative an attorney an accredited agent a notary public, or a person having the authority to administer oaths for general purposes. References: For more information on signatures by X mark or thumbprint, see , and appointing a POA, see M21-1, Part I, 3.A.2. b. Signature by Pencil Accept signatures (or an X mark as a signature) that a claimant makes by pencil. c. Low Quality Scanned Signatures In the event a low quality scanned document is received, claims processors will interpret poor quality signatures as belonging to the proper claimant. Note: Development for a duplicate signature is not appropriate when based solely upon the scanning quality of the signature received on a document. d. Individuals Authorized to Sign on Behalf of a Claimant Public Law (PL) 112-154, Section 502, amended to authorize VA to accept an alternate signature on behalf of claimants or beneficiaries who are under age 18 lack the mental capacity to provide substantially accurate information needed to complete a form or to certify that the statements made on a form are true and complete, or are physically unable to sign a form. References: For more information on requirements for alternate signers, see M21-1, Part III, Subpart ii, 1.C.2.e, and actions to take upon receipt of a form or application with an alternate signature, see M21-1, Part III, Subpart ii, 1.C.2.f. e. Requirements for an Alternate Signer requires an alternate signer be at least one of the following a court-appointed representative an individual responsible for the care of the claimant or beneficiary, including a spouse or other relative
an attorney-in-fact or agent authorized to act on behalf of the claimant or beneficiary under a durable POA, or agent including the manager or principal officer acting on behalf of an institution caring for the claimant. f. Actions Upon Receipt of a Form or Application With an Alternate Signature When an alternate signer certifies or represents that he or she is an appropriate signer under the criteria set forth in , VA will generally accept the alternate signature in the absence of discrepant information. Upon discovery of any discrepant information, send a development letter to the claimant and/or alternate signer for clarification, to include the sample language provided in M21-1, Part III, Subpart ii, 1.C.2.h. Reference: For more information on the requirements for an alternate signer, see M21-1, Part III, Subpart ii, 1.C.2.e. g. Actions Upon Receipt of VA Form With an Alternate Signature VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits, includes an alternate signer certification and acknowledgement paragraph. Send a development letter to the claimant and/or alternate signer for clarification, to include the sample language in M21-1, Part III, Subpart ii, 1.C.2.h, when a completed VA Form 21-526EZ is received that does not contain the required certification, and the evidence or information before VA is unclear as to whether an alternate signer is appropriate under PL 112-154 and . h. Sample Development Language for Alternate Signer Develop to the alternate signer, claimant and/or beneficiary using the sample language below if the signature on the form clearly belongs to someone other than the claimant or beneficiary, and there is not a completed VA Form that includes the required alternate signer certification, and there is no evidence or information of record that would allow VA to ascertain the basis for the alternate signer designation, or there is discrepant information that is questionable or conflicting in establishing the authority of the alternate signer of the form. Please contact us and tell us the basis for signing the form on behalf of the claimant or beneficiary. VA allows for alternate signers to sign a form or application on behalf of claimants and beneficiaries who: have not attained the age of 18 years,
Restricted- Access Mail VA employees and contractors family members of VA employees and contractors VSO employees VA interns participants in VA work-study programs, and high-ranking government officials. Reference: For more information about identifying individuals requiring restricted-access handling, see M21-1, Part III, Subpart ii, 4.A.4. b. Who Has Jurisdiction Over Mail With few exceptions, mail related to claims filed by employees and their relatives require restricted-access handling by the St. Paul Restricted Access Claims Center (RACC) for compensation claims, and by the Philadelphia RACC for pension claims. Reference: For additional information on claims handled by RACCs, see M21-1, Part III, Subpart ii, 4.A.4. c. Use of the RACC Cover Sheet for Proper Mail Routing Mail routing within the CM portals is normally based upon the zip code from which correspondence originated. RACC employees attach cover sheets to all outgoing correspondence. Additionally, Public Contact teams at all RO’s provide these cover sheets to employee/family member claimants upon request. The cover sheets override zip codes and automatically route the incoming mail to the appropriate RACC CM queue. In cases where non-RACC ROs receive RACC mail, they will reassign the mail within their CM queues to the appropriate RACC CM queue per instructions found in M21-1 Part III, Subpart ii, 1.E.5.c, Step 2. References: For additional information on claims handled by RACCs, see M21-1, Part III, Subpart ii, 4.A.4 initial screening of mail, see M21-1, Part III, Subpart ii, 1.A, and reassigning mail to other RO’s CM work queues, see M21-1, Part III, Subpart ii, 1.E.5. d. RACC Mail Handling Responsibilities When a RACC receives mail from an employee or an employee’s relative listed in M21-1 Part III, Subpart ii, 4.A.4.a from another RO, it must review the claims folder to determine whether a claim is pending, and (if necessary) continue any claims processing activities initiated by the other RO.
21-4142a General Release for Medical Provider Information to the Department of Veterans Affairs (VA) June 2014 N/A c. Acceptable Outdated Versions of Common Pension Forms See the table below for a listing of outdated versions of some commonly used pension forms that VA will accept. VA Form Number Form Name Current Version Available Older Version Dates Accepted by VA (ALL EVRS ending in All Eligibility Verification Reports (EVRs) February 2012 June 2004 Fully Developed Claim (Express Pension Claim) June 2014 August 2011 21P-527 Income net worth and employment statement July 2014 July 2012 21P-530 Application for burial benefits June 2014 May 2012 21P-534 Application for DIC, death pension and accrued benefits by a surviving spouse or child June 2014 March 2009 Fully Developed Claim (Express Survivors Benefits) June 2014 December 2012 21P-534a Application for Dependency and Indemnity Compensation By a Surviving Spouse or Child-In Service Death Only June 2014 October 2011 21P-535 Application for DIC by parents (including accrued benefits and death compensation) June 2014 February 2012 21P-601 Application for reimbursement from accrued amounts due a deceased beneficiary June 2014 December 2010 21P-8416 Medical Expense Report February 2012 December 2011 21P-0847 Request of Substitution of Claimant Upon Death of Claimant June 2009 N/A d. Rejecting an Outdated Version of a VA Form If a VA form needs to be rejected return the form to the Veteran and POA, if necessary, provide the Veteran and POA, if necessary, a copy of the current form, and