26-8937 Verification Of Va Benefits

OMB Control No. 2900-0406
Respondent Burden: 5 Minutes
Expiration Date: XXXXXXXX

VERIFICATION OF VA BENEFITS
PRIVACY ACT NOTICE: 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 5, Code of Federal Regulations 1.576 for routine uses (i.e., information concerning a veteran's indebtedness to the United States by virtue of a person's
participation in a benefits program administered by VA may be disclosed to any third party, except consumer reporting agencies) 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. You are required to respond 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. The VA will not deny an individual benefits for refusing to provide his or her
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.
TO: NAME AND ADDRESS OF LENDER (Complete mailing address including ZIP Code)

1. NAME OF VETERAN (First, middle, last)

INSTRUCTIONS TO LENDER
The veteran/applicant should complete this form ONLY
if he or she:
is receiving VA disability payments; or
has received VA disability payments; or
would receive VA disability payments but
for receipt of retired pay; or
has filed a claim for VA disability benefits prior
to discharge from active duty service; or
is surviving spouse of a veteran and in receipt of
DIC payments.
Complete Items 1 through 10. Send the completed form
to the appropriate VA Regional Loan Center where it
will be processed and returned to the Lender. The
completed form must be retained as part of the lender's
loan origination package.

2. CURRENT ADDRESS OF VETERAN

3. DATE OF BIRTH

4. VA CLAIM FOLDER NUMBER (C-File No., if

5. SOCIAL SECURITY NUMBER 6. SERVICE NUMBER (If different from Social Security

known)

7. I HEREBY CERTIFY THAT I
information listed below.

DO

8. I HEREBY CERTIFY THAT I

HAVE

Number)

DO NOT have a VA benefit-related indebtedness to my knowledge. I authorize VA to furnish the
HAVE NOT filed a claim for VA disability benefits prior to discharge from active duty service.

9. SIGNATURE OF VETERAN (Sign in ink)

10. DATE SIGNED

FOR VA USE ONLY (Complete in ink)
The above named veteran does not have a VA benefit-related indebtedness
The veteran has the following VA benefit-related indebtedness
TYPE OF DEBT(S)

VA BENEFIT-RELATED INDEBTEDNESS (If any)
AMOUNT OF DEBT(S)

TERM OF REPAYMENT PLAN (If any)
Veteran is exempt from funding fee due to receipt of service-connected disability compensation of $
monthly. (Unless checked,
the funding fee receipt must be remitted to VA with VA Form 26-1820, Report and Certification of Loan Disbursement)
Veteran is exempt from funding fee due to entitlement to VA compensation benefits upon discharge from service.
Veteran is not exempt from funding fee due to receipt of non service-connected-connected pension of $
APPLICATION WILL REQUIRE PRIOR APPROVAL PROCESSING BY VA.

monthly. LOAN

Veteran has been rated incompetent by VA. LOAN APPLICATION WILL REQUIRE PRIOR APPROVAL PROCESSING BY VA.
Insufficient information. VA cannot identify the veteran with the information given. Please furnish more complete information, or a copy of a
DD Form 214 or discharge papers. If on active duty, furnish a statement of service written on official government letterhead, signed by the adjutant,
personnel officer, or commanding officer. The statement should include name, birth date, service number, entry date and time lost.
SIGNATURE OF AUTHORIZED AGENT (Sign in ink)

DATE SIGNED

RESPONDENT BURDEN: We need this information to determine, establish, or verify your eligibility for VA Loan Guaranty Benefits and to determine if you are
exempt from paying the VA Funding Fee. Title 38, United States Code, allows us to ask for this information. We estimate that you will need an average of 5 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.reginfo.gov/public/do/PRAMain.
VA FORM
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26-8937

SUPERSEDES VA FORM 26-8937, JUN 2016,
WHICH WILL NOT BE USED.