Form 21-8951-2 Notice of Waiver of VA Compensation or Pension to Receiv

OMB Approved No. 2900-0463
Respondent Burden: 10 minutes
VA REGIONAL OFFICE

NOTICE OF WAIVER OF VA
COMPENSATION OR PENSION
TO RECEIVE MILITARY PAY AND
ALLOWANCES
NAME AND ADDRESS OF VETERAN

VA FILE NUMBER

SOCIAL SECURITY NUMBER

DAYTIME TELEPHONE NUMBER (Include Area Code)

EVENING TELEPHONE NUMBER (Include Area Code)

Active or inactive duty training pay cannot legally be paid concurrently with VA disability compensation or pension benefits
(10 U.S.C. 12316 and 38 U.S.C. 5304(c)).
You may elect to keep the training pay you received from the military service department. However, to be legally entitled to keep
your training pay, you must waive VA benefits for a number of days equal to the number of days for which you received training
pay. In most instances, it will be to your advantage to waive benefits and keep your training pay.

Please enter the number of days for which you received training pay below:

FISCAL YEAR:

TRAINING DAYS

NOTE: A fiscal year runs from October 1 through September 30. For example, fiscal year 1999 runs from October 1, 1998
through September 30, 1999.

Please note that reserve components are to report the number of days during the fiscal year for which a reservist/guardsman receives
training pay as one full day’s duty pay for each 4-hour training assembly attended. Therefore, you might be credited with 4 days
training pay on a drill weekend. Most members will be paid for approximately 63 training days during a fiscal year. This normally
consists of 48 armory drills or training sessions and 15 days active training.

If you waive VA benefits to receive training pay, VA will adjust your VA award to withhold future benefits for the same total
number of days waived and at the monthly rate in effect for the fiscal year for which you received training pay. No overpayment will
be created in your account and your normal VA rate will be restored when a sufficient number of days’ benefits have been withheld.

VA FORM
AUG 2011

21-8951-2

EXISTING STOCKS OF VA FORM 21-8951-2, MAR 2005,
WILL BE USED.

(Continued on Reverse)

Please fully complete this form, sign it, secure the signature of your unit commander or designee, and return it to the VA
regional office address where your VA claims file is located. If you do not know where your VA claims file is located,
return the form to the nearest VA regional office. Keep a photocopy of the completed form for your records.
Please check only one of the following blocks:
I elect to waive VA benefits for the days indicated on the front of this form in order to retain my training pay.

I elect to waive military pay and allowances for the days indicated on the front of this form in order to retain my
VA compensation or pension. NOTE: Checking this option will give most veterans LESS money.

I received no military pay and allowances during the last fiscal year.

SIGNATURE OF RESERVIST/GUARDSMAN

DATE SIGNED

To the best of my knowledge, the information shown on the front of the form concerning the member’s training days is correct.

SIGNATURE OF UNIT COMMANDER OR DESIGNEE

DATE SIGNED

NAME AND MAILING ADDRESS OF RESERVE/GUARD UNIT

UNIT TELEPHONE NO. (Including Area Code)

NOTE: In the past you may have filed a one-time waiver of disability benefits which was to remain in effect until your reserve/guard
status changed or you withdrew the waiver. That waiver is no longer valid. Annual waivers are again required.
If you have any questions about the information contained on this form or if you need assistance in completing the form, please call
VA’s toll-free number 1-800-827-1000.
PRIVACY ACT INFORMATION: The VA will not disclose information collected on this form to any source other than what has
been authorized under the Privacy Act of 1974 or Title 38, Code of Federal Regulations 1.576 for routine uses (i.e., civil or criminal
law enforcement, congressional communications, epidemiological or research studies, the collection of money owed to the United
States, litigation in which the United States is a party or ahs an interest, the administration of VA programs and delivery of VA
benefits, verification of identity and status, and personnel administration) as identified in the VA system of records, 58VA21/22/28,
Compensation, Pension, Education, and Vocational Rehabilitation and Employment Records - VA, published in the Federal Register.
Your obligation to respond is voluntary. Giving us your SSN account information is mandatory. Applicants are required to provide
their SSN unless the disclosure of the SSN is required by a Federal Statute of law in effect prior to January 1, 1975, and still in effect.
The requested information is considered relevant and necessary to determine maximum benefits under the law. The responses you
submit are considered confidential (38 U.S.C. 5701). Information submitted is subject to verification through computer matching
programs with other agencies.
RESPONDENT BURDEN: We need this information to determine whether you choose to waive your VA compensation
or pension or your military pay and allowances for the days for which you received training pay (10 U.S.C. 12316 and 38
U.S.C.5304(c). Title 38, United States Codek, allows us to ask for this information. We estimate that you will need an average of
10 minutes to review the instructions, find the information, and complete this form. VA cannot conduct or sponsor a collection of
information unless a valid OMB control number is displayed. You are not required to respond to a collection of information if t
his number is not displayed. Valid OMB control numbers can be located on the OMB Internet Page at
www.reginfo.gov/public/do/PRAMain . If desired, you can call 1-800-827-1000 to get information on where to send comments or
suggestions about this form.
PENALTY: The law provides severe penalties which include fine, imprisonment, or both for the willful submission of any statement
or evidence of a material fact, knowing it to be false, or for the fraudulent acceptance of any payment to which you
are not entitled.
VA FORM 21-8951-2, AUG 2011