VA Form 119 Printable, Fillable in PDF

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VA Form 119 Printable, Fillable in PDF – The Department of Veterans Affairs (VA) Form 119, Report of Contact, is an official form that must be completed and sent to the VA (VA). The form was last updated on and superseded VA Form 21-0820, which was previously available (Report of General Information). According to VA policy, the primary objective of the Report of the Contact form is to capture talks between VA staff and claimants, their representatives, or other persons that may include potentially problematic topics.

Furthermore, this document is utilized to record crucial facts or information that a VA employee has learned or gained. This information is used to complement the veteran’s previous military service record. Alternatively, if a person claims in the future that a VA employee has provided erroneous or inadequate information, this form may be used to rebut the claim. Here is the link to the fillable VA Form 119, which you may download.

Instructions For Completing VA Form 119

It is customary to utilize the VA Report of Contact in one of the following situations:

If further material relevant to a particular contested matter is acquired;
When a complaint concerning a lack of service or acts done by a VA employee is made, a check should be performed;
When a veteran is not happy with any disallowances or other judgments, the VA is required to offer explanations and comments.
If the beneficiary’s death has not been reported to the VA in any other manner, the VA will get the initial notification of the death.
To explain the facts that led to either a positive or a negative determination about the individual’s eligibility for certain VA benefits.

The check must be initiated immediately under certain circumstances. Examples include:

When information is obtained from the claimant over the phone or in person, the form may be used to capture the details of the conversation. It is necessary to send an original of the VA Form 119 to the claimant’s representative and make a note on the claimant’s file copy indicating the original has been transferred to the power of attorney. If the claimant has power of attorney, a copy of the VA Form 119 must be given to the representative. Using this form as a written request for information is strictly prohibited. In this scenario, a formal letter should be issued to the individual concerned.

The VA Form 119: What to Do When You Have a Question

VA Form 119 of the Veterans Administration must be completed in ink or on a typewriter. Because the filled form becomes a permanent record and is included in the veteran’s file, forms completed with a pencil will not be accepted. This section of the VA report of contact has the following fields:

Office of the Veteran’s Administration. Please include the phone number for the VA regional office; and
In the Identification Number field, provide the claim payee’s identification number using the sample supplied in the form.
Veteran’s last name, first name, and middle name are all capitalized. Provide the name in its entirety in the format specified;
The date on which the contact was made. Input the current date and time;
The Veteran’s mailing address. Please include the veteran’s postal address.
Veteran’s contact information (phone number). If appropriate, include both the veteran’s home and work phone numbers in the message. When inputting phone numbers, remember to include the area code.
A person has been contacted. Identify the individual with whom you have spoken about the situation;
Contacts of a certain kind. Select the appropriate checkbox;
The name and address of the person who was contacted. Input the name and address of the individual who has been in touch with you about the situation;
The telephone number of the person who was contacted. You must provide the phone number of the person you have spoken with. Don’t forget to include the area code in your message.
A succinct statement of the information requested and provided. Provide a succinct summary of the information you’ve sought as well as the pertinent information you’ve gathered;
Division or Section are terms used to refer to a group of people. Specify the division or sector you belong to.
The work was carried out by Filling up the blanks with your signature and title.
Be mindful of the need to properly explain the circumstances or scenario that arose during the encounter on each VA Form 119. In addition, it must include the steps done by the VA employee as a consequence of the encounter with the customer.