Dependents Info

Dependents Info

The VA considers a dependent to be any family member who relies on the Veteran for financial support which typically includes; spouse, children under the age of 18, children of any age who became permanently disabled before the age of 18, or Parents who have been provided with significant financial support by the Veteran.
Your Name*

First NameMiddle NameLast Name
Who are you working with at OSDRI?*
Are you currently married?*
Do you have dependent children?*
Do YOU have any prior marriages?*

Spouse Info

These questions are for spouse information ONLY.
‼️IMPORTANT‼️ To complete this section you will need:

✅ A copy of your Marriage certificate (civil or religious)

✅ Social Security number of spouse

✅ Dates and locations of the veteran's prior marriages (if any)

✅ Dates and locations of the veteran's spouse and his or her prior marriages

✅ Divorce decrees or death certificates for all prior marriages of both veteran and spouse
Spouse Full Name

First NameMiddle NameLast Name
Spouse's Date of Birth

MonthDayYear
Date
Spouse's Social Security Number
xxx-xx-xxxx
Date of Marriage

MonthDayYear
Date
HOW were you married?
Explain if you selected other.
Place of Marriage

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is your spouse also a veteran?
Do you currently live together?
If you do not currently live together, provide a reason for separation.
i.e. Marital problems, job requirements, health etc...
Current Mailing Address of Spouse (if different than your address)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Does YOUR SPOUSE have any prior marriages?*

Dependent #1
Dependent's Name #1*

First NameMiddle NameLast Name
Relationship to Veteran*
Dependent's Social Security Number*
Date of Birth*

MonthDayYear
Date
City and State of Birth*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Does this child live with you full time or most of the time?*
Does the veteran provide substantial financial support to this dependent?
Financial support includes if you pay child support, school registration, tax returns, etc.
Name of person the child resides with

First NameMiddle NameLast Name
Physical address where child resides

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is the stepchild the biological child of your spouse?
Date stepchild entered veteran's household

MonthDayYear
Generally, this will be the date of marriage
Do you have another dependent?

Dependent #2
Dependent's Name #2

First NameMiddle NameLast Name
Relationship to Veteran*
Dependent's Social Security Number
Date of Birth*

MonthDayYear
Date
City and State of Birth*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Does this child live with you full time or most of the time?*
Does the veteran provide substantial financial support to this dependent?
Financial support includes if you pay child support, school registration, tax returns, etc.
Name of person the child resides with

First NameMiddle NameLast Name
Physical address where child resides

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is the stepchild the biological child of your spouse?
Date stepchild entered veteran's household

MonthDayYear
Generally, this will be the date of marriage
Do you have another dependent?

Dependent #3
Dependent's Name #3

First NameMiddle NameLast Name
Relationship to Veteran*
Dependent's Social Security Number
Date of Birth*

MonthDayYear
Date
City and State of Birth*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Does this child live with you full time or most of the time?*
Does the veteran provide substantial financial support to this dependent?
Financial support includes if you pay child support, school registration, tax returns, etc.
Name of person the child resides with

First NameMiddle NameLast Name
Physical address where child resides

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is the stepchild the biological child of your spouse?
Date stepchild entered veteran's household

MonthDayYear
Generally, this will be the date of marriage
Do you have another dependent?

Dependent #4
Dependent's Name #4

First NameMiddle NameLast Name
Relationship to Veteran*
Dependent's Social Security Number
Date of Birth*

MonthDayYear
Date
City and State of Birth*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Does this child live with you full time or most of the time?*
Does the veteran provide substantial financial support to this dependent?*
Financial support includes if you pay child support, school registration, tax returns, etc.
Name of person the child resides with*

First NameMiddle NameLast Name
Physical address where child resides*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is the stepchild the biological child of your spouse?*
Date stepchild entered veteran's household*

MonthDayYear
Generally, this will be the date of marriage
Do you have another dependent?*

Dependent #5
Dependent's Name #5

First NameMiddle NameLast Name
Relationship to Veteran*
Dependent's Social Security Number
Date of Birth*

MonthDayYear
Date
City and State of Birth*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Does this child live with you full time or most of the time?*
Does the veteran provide substantial financial support to this dependent?*
Financial support includes if you pay child support, school registration, tax returns, etc.
Name of person the child resides with*

First NameMiddle NameLast Name
Physical address where child resides*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is the stepchild the biological child of your spouse?*
Date stepchild entered veteran's household*

MonthDayYear
Generally, this will be the date of marriage

Spouse Info