Veteran Profile & VA Demographics

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Status: ACTIVE ACCESS

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📋 Official VA Form Demographics (Used to Pre-Populate Claims)

Enter the exact demographic header information required across all official Department of Veterans Affairs forms (VA Form 21-526EZ, 21-4138, 21-0781, 21-0966, etc.).

SECTION I: VETERAN IDENTIFICATION

FIRST NAME

MIDDLE NAME

LAST NAME

SUFFIX

SOCIAL SECURITY NUMBER (SSN) (ONLY REQUIRED FOR OFFICIAL VA FORMS) 🔒 Privacy Rule: SSN is never required for AI chat or account registration. It is strictly used to pre-fill Box 2 on official VA Form 21-526EZ / 21-4138 PDF packets.

VA FILE NUMBER / C-FILE

DATE OF BIRTH (MM/DD/YYYY)

GENDER / SEX

SECTION II: MAILING ADDRESS & CONTACT

STREET ADDRESS

APT / SUITE / UNIT

CITY

STATE

ZIP CODE

PRIMARY PHONE NUMBER

SECONDARY PHONE NUMBER

SECTION III: MILITARY SERVICE RECORD HEADER

BRANCH OF SERVICE

RANK / PAYGRADE

SERVICE NUMBER / EDIPI

CHARACTER OF DISCHARGE

ACTIVE DUTY ENTRY DATE

SEPARATION DATE