Form VA Form 21-0307 VA Form 21-0307 Award Attachment for Certain Children with Disabilities

OMB Approved 2900-0577
Respondent Burden: 10 minutes
Expiration Date: XX/XX/XXXX

AWARD ATTACHMENT FOR CERTAIN CHILDREN WITH DISABILITIES
BORN OF VIETNAM AND CERTAIN KOREA SERVICE VETERANS
VA HEALTH CARE
As a person who has been determined to have a covered birth defect, you may receive care from any health
care provider licensed or otherwise authorized to deliver health care related services in your state. VA will pay
for health care relating to your disability or a condition associated with it, but not for other conditions. Payments
are made directly to the health care provider based on an itemized bill submitted to the VA Health Administration
Center in Denver, Colorado. The Health Administration Center will review and authorize payments.
Pre authorization is required for durable medical equipment, professional counseling, mental health services,
training, substance abuse treatment, dental services, transplantation services and travel other than by privately
owned vehicles.
Pre-approval may be obtained by contacting the VA Health Administration Center at the number listed below.
If your disability is spina bifida, the Shriners Hospitals for Children have signed an agreement with VA to provide
care for eligible children at no cost to VA or the family. If you are interested in receiving care at a Shriners
hospital, you should contact the nearest Shriners Hospital for Children at the VA Health Administration Center.
VOCATIONAL TRAINING PROGRAM
You may be eligible for vocational training and related services and assistance to help you get or keep a good
job. Under this program, VA will pay all the costs of any training, including tuition, fees, books, supplies, and
equipment. To learn if you are eligible, you need to apply for this benefit. When we receive your application
letter, we will arrange an appointment for you to come in for an evaluation of whether it is reasonably feasible for
you to achieve a vocational goal.
To apply for vocational training, simply write a letter to the Vocational Rehabilitation and Employment Service at
the nearest VA regional office. In this letter, you need to include the following:
• A statement that you want to take part in vocational training for children with disabilities.
• Your full name, address, and a telephone number where we can reach you during the daytime.
• Your VA file number, if you have one.
• The full name and VA file number, if any, of the parent on whom you based your claim for an monetary
allowance for a disability.
• Your signature and date.
WHERE TO CALL FOR MORE INFORMATION
If you have any questions or need additional information please call toll free at 1-888-820-1756.
NONASSIGNABILITY AND EXEMPT STATUS OF BENEFITS
Benefit payments are exempt from taxation and are exempt from claims of creditors. With certain exceptions,
payments are not assignable and are not subject to attachment, levy, or seizure except as to claims of the
United States.
CHANGE OF ADDRESS NOTICE
Please notify this office immediately of any change of address.

VA FORM
XXX XXXX

21-0307

SUPERSEDES VA FORM 21-0307, MAR 2004,
WHICH WILL NOT BE USED.

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CONDITIONS AFFECTING RIGHT TO PAYMENTS
1. Your award of benefits is subject to adjustment when VA receives evidence showing a change in the level
of disability.
2. Monthly payments may be reduced if you fail to furnish evidence as requested, or if you fail to cooperate
or submit to a VA examination when requested.
3. Monthly payments may be stopped if you furnish VA, or cause to be furnished, any false or fraudulent
evidence. The law provides severe penalties, which include fine or imprisonment, or both, for the fraudulent
acceptance of any payment to which you are not entitled.

INFORMATION ABOUT DIRECT DEPOSIT
Direct Deposit Information: The Department of Treasury requires all Federal benefit payments be made by electronic
funds transfer (EFT), also called direct deposit. Please attach a voided personal check or deposit slip to enroll in direct
deposit. If you do not have a bank account, you must receive you payment through Direct Express Debit MasterCard. To
request a Direct Express Debit MasterCard you must apply at www.usdirectexpress.com or by telephone at
1-800-333-1795. If you elect not to enroll, you must contact representatives handling waiver requests for the Department
of Treasury at 1-888-224-2950. They will encourage your participation in EFT and address any questions or concerns you
may have.

VA Form 21-0307, XXX XXXX

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