0918b Application for Monthly Assistance Allowance For Veteran

OMB Number: 2900-0760
Exp. Date: July 31, 2024
Respondent Burden: 10 minutes

APPLICATION FOR MONTHLY ASSISTANCE ALLOWANCE FOR VETERANS IN
CONNECTION WITH PARALYMPICS AND OLYMPICS IN THE UNITED STATES
PRIVACY ACT: The information requested on this form is solicited under the authority of Title 38, U.S.C., and Sections 1710, 1712, and 1722. It is being collected to
enable us to determine your eligibility for benefits and will be used for that purpose. The information you supply may be verified through a computer matching program
at any time and information may be disclosed outside the VA as permitted by law. VA may make a routine use disclosure of the information as outlined in the Privacy
Act system of records identified as 58VA21/22/28, Compensation, Pension, Education and Vocational Rehabilitation and Employment Records - VA, published in the
Federal Register. Your obligation to respond is voluntary; however, the information is required in order for us to determine your eligibility for the benefit for which you
have applied. Failure to furnish the information will have no adverse affect on any other benefits to which you may be entitled.
VA BURDEN STATEMENT: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a
currently valid OMB control number. The OMB control number for this project is 2900-0760, and it expires 07/31/2024. Public reporting burden for this collection of
information is estimated to average 10 minutes per respondent, per year, including the time for reviewing instructions, searching existing data sources, gathering and
maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate and any other aspect of this
collection of information, including suggestions for reducing the burden, to VA Reports Clearance Officer at VACOPaperworkReduAct@va.gov. Please refer to OMB
Control No. 2900-0760 in any correspondence. Do not send your completed VA Form 0918b to this email address.

SECTION A - IDENTIFYING DATA

.

.

1. NAME AND MAILING ADDRESS OF APPLICANT

1A. HAVE YOU RECEIVED A VA-RATING FOR
A SERVICE CONNECTED DISABILITY?
YES

NO

2. VETERANS SOCIAL SECURITY NO.
(Last 4-digits only)

SECTION B - UNITED STATES PARALYMPICS AND OLYMPICS SPORT TRAINING
3. NAME OF SPORT

4. NAME OF GOVERNING ORGANIZATION

5. LOCATION OF TRAINING

SECTION C - DECLARATION OF DEPENDENT STATUS
VETERAN'S MARRIAGES
6A. HOW MANY TIMES HAVE YOU BEEN MARRIED? (Including current marriage)

6B. DATE AND PLACE
OF MARRIAGE
(City,/State or Country)

6C. TO WHOM MARRIED
(First, middle, last name)

6D. SPOUSE
SSN
(Last 4-digits only)

6E. HOW
MARRIAGE
TERMINATED
(Death, Divorce)

6F. DATE AND PLACE
TERMINATED
(City/State or Country)

MOST RECENT MARRIAGE

month day year

month day year

Place:

Place:

PREVIOUS MARRIAGE 1

month day year

month day year
Place:

Place:
PREVIOUS MARRIAGE 2

month day year

month day year
Place:

Place:
7. DO YOU LIVE WITH YOUR SPOUSE? (If "yes", skip to Item 10, if "no", answer Items 8 and 9)
YES

NO

8. WHAT IS YOUR SPOUSE'S ADDRESS?

9. HOW MUCH DO YOU CONTRIBUTE MONTHLY TO YOUR
SPOUSES SUPPORT?
$

VA FORM
JUL 2024

0918b

VETERAN'S UNMARRIED CHILDREN

Note: In Items 10A through 10I, check all boxes that apply. . If you have more than six dependents that should be listed in Items 10A
through 10I, attach all applicable data for the additional dependents on a continuation sheet and submit with the VA Form 0918b.
10A.
NAME OF CHILD
(first, middle initial, last)

10B.
DATE AND PLACE OF
BIRTH
(city, state or country)

10C.
SOCIAL
SECURITY
NUMBER
(Last 4-digits only)

10D.
BIO LOGICAL

10E.
ADOPT ED

10F.
STEP CHILD

10G.
10I.
10H.
18-23 YRS.
CHILD
SERIOUSLY
OLD AND IN
PREVIOUSLY
DISABLED
SCHOOL
MARRIED

mo day yr
PLACE:

mo day yr
PLACE:

mo day yr
PLACE:

mo day yr
PLACE:

mo day yr
PLACE:

mo day yr
PLACE:

Note: If any of the children listed above don't live with you, complete Items 11A through 11C.
11A. NAME OF CHILD (First, middle initial, last)

11B. CHILD'S COMPLETE ADDRESS

11C. NAME OF PERSON THE CHILD LIVES
WITH (If applicable)

12. I hereby certify that the information given above is true and correct to the best of my knowledge and belief.
13A. SIGNATURE OF CLAIMANT (Ink signature required)

14. TELEPHONE NUMBER

VA FORM 0918b, JUL 2024, page 2

13B. DATE SIGNED

15. E-MAIL ADDRESS