Enter the name and relationship to the deceased veteran of the claimant named in the application for Title II benefits.

For example:

• •

  when the widow applies for benefits for herself and children, enter in Item 2A only the widow's name and check “widow” in Item 2B; or

• •

  when the claimant is filing only for child's benefits, enter in Item 2A the name of all children mentioned in the application, and check the “child” block in Item 2B.

NOTE: If all the children’s names do not fit in Item 2A, enter the names in the “Remarks” block.

Enter the VA file number for any prior applications filed by the veteran or survivors if provided by the claimant. Identify VA file numbers as follows:

• •

  a veteran’s VA file number begins with the letter “C;” and

• •

  a survivor’s VA file number begins with the letters “XC.”

NOTE: Do not complete Items 6A through 6D when the claimant furnishes a “C” or “XC” VA file number.

When the claimant furnishes the veteran's service number, enter it in Item 6B. Do not complete Items 6A, 6C, or 6D.

When the claimant cannot provide the veteran’s service number, or a “C” or “XC” file number, enter as much of the service history in 6A, 6C, and 6D as the claimant can provide. A complete and accurate service history will expedite the VA’s handling of the claim.

If the claimant is unsure of the veteran’s service dates, check the Veterans Benefits Administration Query (VBAQ), earnings record, and the Disability, Railroad, Alien and Military Service (DRAMS) file to help provide as much information as possible. Enter “unknown” for any service history information the claimant cannot provide.

For information on the VBAQ, see MSOM QUERIES 003.020. For information on DRAMS, see MSOM QUERIES 005.003.

Enter the address of the field office sending the VA form 21-4182 to the VA.

Enter the Title II survivor application filing date in the box on the application marked “DO NOT WRITE IN THIS SPACE.” For information on the application filing date, see GN 00204.007.