Service Work

Per Chapter 35B.6 subsection 1 of the Code of Iowa, Service Work is, but is not limited to the following:
Service work can be as simple as giving out the 1-800 number for the VA Regional Office in Des Moines or as complicated as filing a 21-526 form for a non-service connected pension with Aid & Attendance benefits. Along with this form, the service officer must review to see what state and or county benefits the client may be eligible for.

VA Form 21-526 takes a minimum of 2 hours to complete, but normally takes 3-4 hours (at different scheduled appointments). This form is four pages with a fifth page attached as a release of information. To complete this form, you need to obtain a discharge, birth certificate(s), marriage certificate(s), divorce decree(s), income verification, doctor’s statement, and the cost of the nursing home. This form is also used to file for a non-service-connected pension and service-connected compensation.


The following is a sample list of VA forms we can assist the veteran and/or spouse complete.

10-10Application for Medical Benefits
10-10d Application for Medical Benefits for Dependents or Survivors - CHAMPVA
10-10fFinancial Worksheet
10-583Claim for Payment of Cost of Unauthorized Medical Services
180-106Request Pertaining To Military Records
21-0515-1Improved Pension Eligibility Verification Report (Veteran with no dependents)
21-0516-1Improved Pension Eligibility Verification Report (Veteran with spouse)
21-0517-1Improved Pension Eligibility Verification Report (Veteran with Children)
21-0518-1Improved Pension Eligibility Verification Report (Surviving Spouse with no children)
21-0571-6Application For Exclusion Of Children’s Income
21-4100Statement of Income and Net Worth
21-4138Statement In Support of Claim
21-4142Authorization For Release of Information
21-4170Statement of Marital Relationship
21-4171Supporting Statement Regarding Marriage
21-4185Report of Income From Property of Business
214WSCertificate of Release or Discharge From Active Duty
21-526Veteran’s Application For Compensation or Pension
21-527Income - Net Worth and Employment Statement
21-530Application for Burial Benefits
21-534Application for Dependency and Indemnity Compensation or Death Pension by a Surviving Spouse or Child (Including Accrued Benefits and Death Compensation)
21-535Application for Dependency and Indemnity Compensation by Parent(s)
21-601Application for Reimbursement from Accrued Amounts Due a Deceased Beneficiary
21-674Request for Approval of School Attendance
21-686cDeclaration of Status of Dependents
21-6897Statement of Income and Net Worth - Disability
21-8416Request for Information Concerning Medical, Legal or Other Expenses
21-8416aRequest for Information Concerning Unreimbursed Family Medical Expenses
21-8918-1Improved Pension Eligibility Verification Report (Widower with no children)
21-8940Veteran’s Application for Increased Compensation Based on Unemployability
22-1990Application for Education Benefits
2-22aAppointment of Attorney or Agent as Claimant’s Representative
22-5490Application for Survivors’ and Dependents’ Educational Assistance
22-8932Application for Certificate of Eligibility
23-22Appointment of Veterans Service Organization as Claimant’s Representative
23-8800Request for VA Forms and Publications
26-1880Request for Determination of Eligibility and Available Loan Guaranty Entitlement
28-1900Disabled Veterans Application for Vocational Rehabilitation
29-1546Application for Cash Surrender Value
29-336Designation of Beneficiary
29-4125Claim For One Sum Payment
40-1330Application for Standard Government Headstone or Marker for Installation in a private or local cemetery
4-5655Financial Status Report
582-1002Armed Forces Graves Registration Record
90-2008Application for United States Flag for Burial Purposes
149Applications for Correction of Military Record Under The Provisions of Title 10, U.S. Code, Section 1552
293Application for the Review of Discharge or Dismissal From the Armed Forces of the United States
500Instructions for Completing CHAMPUS/CHAMPVA Claim form 500
572Request for Change of Address
2168Application for Discharge of Member or Survivor of Member of Group Certified to have Performed Active Duty with the Armed Forces of the United States.

By completing these forms, federal dollars are brought into the pockets of Black Hawk County veterans and/or spouses.










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