Form 26-8261a Request for Certificate of Veteran Status

OMB Control No. 2900-NEW
Respondent Burden: 10 Minutes

MAIL THIS FORM TO:

VA Eligibility Center
P.O. Box 20729
Winston-Salem, NC 27120

REQUEST FOR CERTIFICATE OF VETERAN STATUS

Privacy Act Notice: This form provides information that is used in determining whether VA can issue a Certificate of Veteran Status which may be beneficial when
obtaining a FHA insured loan. 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. authorize release of information to Congress when requested on behalf of a lender) as identified in
the VA system of records, 55VA26, Loan Guaranty Home, Condominium and Manufactured Home Loan Applicant Records, Specially Adapted Housing Applicant
Records and Vendee Loan Applicant Records - VA, and published in the Federal Register. Your obligation to respond is required to obtain or retain benefits. Giving us
your SSN account information is voluntary. Refusal to provide your SSN by itself will not result in the denial of benefits 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.
Respondent Burden: This information is needed to help determine your qualifications for the desired benefit. Title 38, United States Code, allows us to ask for this
informaiton. 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 this number is not
displayed. Valid OMB control numbers can be located on the OMB Internet Page at www.whitehouse.gov/omb/library/OMBINV.VA.EPA.html#VA. If desired, you
can call 1-800-827-1000 to obtain information on where to send comments or suggestions about this form.

INSTRUCTIONS: Read carefully before completing form. Use typewriter or print legibly. Complete all applicable items.
A. Mail this completed form, along with proof of service, to the VA Eligibility Center at P.O. Box 20729, Winston-Salem, NC 27120.
B. Attach to this request all your discharge or separation papers from the periods of active service in the Armed Forces of the U.S. listed in Item 4.
C. If you lack proper discharge or separation papers, any Veterans Service Representative will assist you in procuring such papers. If you are in doubt regarding the
proper documents to be submitted with this request, you should contact the nearest VA Office for that information.
1. NAME (Last, First, Middle) 0F VETERAN

2. ADDRESS OF VETERAN (Number, Street, City, State, and ZIP Code)

3. DATE OF BIRTH

MILITARY SERVICE DATA
I request that I be issued a Certificate of Veteran Status which I may furnish to a lender when applying for a HUD-insured loan under section
203(b)(2) or 220(d)(a) of the National Housing Act, as amended. (Begin on line 4A and enter your latest period of service followed by preceding
service, if any, on line 4B, continuing on reverse if necessary.)
4. PERIOD OF ACTIVE SERVICE
ITEM
NO.

NAME
(Show your name exactly as it appears on your
discharge papers for each period of service)

DATE
FROM

TO

SERVICE NUMBER OR
SOCIAL SECURITY NUMBER

BRANCH OF
SERVICE

A
B
5. VA CLAIM NUMBER

C-

NOTE: If upon your release from the latest period of active military duty, you received DD Form 214,
NAVPERS Form 553, or similar form or form letter in lieu of a discharge, complete Items 6A and 6B.

6A. ARE YOU NOW ON ACTIVE MILITARY DUTY?
YES

NO

6B. WERE YOU ON ACTIVE MILITARY DUTY ON THE DAY FOLLOWING THE DATE
OF SEPARATION INDICATED IN THE PAPERS SUBMITTED?
YES

FOR VA USE ONLY
DATE CERTIFICATE OF VETERANS STATUS ISSUED

DISCHARGE OR SEPARATION PAPERS RETURNED TO:

NO

I CERTIFY THAT the statements herein are true to the best of my knowledge and belief.
7. SIGNATURE OF VETERAN

8. DATE

IMPORTANT INSTRUCTIONS: If the Certificate is to be sent to the veteran, the complete mailing address should be shown in Item 11. If it is
desired that the certificate be sent to other than the veteran, the name and address of such person or firm should be shown in Item 11. Items 9 and 10
need be completed only when the certificate is being sent to other than the veteran.
DO NOT DETACH
TRANSMITTAL OF CERTIFICATE OF VETERAN STATUS
9A. NAME OF VETERAN

10. FILE REFERENCE

9B. SERVICE NUMBER/SOCIAL SECURITY NUMBER OF VETERAN

The discharge or separation papers returned herewith will not be required again unless
requested.

FOR VA USE ONLY
DATE

11. RETURN TO:
ENCLOSURES
CERTIFICATE OF VETERAN STATUS
DISCHARGE OR SEPARATION PAPERS
OTHER (Specify)

VA FORM
SEP 2009

26-8261a

SUPERSEDES VA FORM 26-8261a, SEP 2004, AND HUD-92950, 9/04,
WHICH WILL NOT BE USED.