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GovBenefits.gov - Your Benefits Connection
GovBenefits.gov - Your Benefits Connection Group of potential benefit recipients
 
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>> Locate Federal Benefits >> U.S. Department of Veterans Affairs

AM I ELIGIBLE: QUESTIONNAIRE


A maximum number of 10 question(s) remaining.
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Answer questions and review all benefits you may be eligible to receive.

Depending on your answers, you may be presented with additional questions. To ensure the most accurate results, you should answer all the questions listed. You may click the 'Stop and View Results' button at any time to review results based on the answers you already submitted. Your answers are used only to determine potential eligibility. GovBenefits.gov does not keep any data you enter. 		Stop and view results

1.
Describe your current and past professional experiences.(check all that apply)
Agricultural producer / Farmer
Aquaculture operator
Clinical research
Coal miner
Dairy farmer
Educator (teaching, training)
Elected official
Emergency response worker
Federal employee
Firefighter
Fisherman
Health care professional
Law enforcement officer
Long shore or harbor worker
Migrant or seasonal farm worker
Military
Musician
Post-doctoral research
Practicing artist
Published writer / Poet
Railroad worker
Rancher
Translator
2.
Indicate if you or any of your family/household members have a disability.
Child(ren)
Spouse
Parent
Self
None of the above
3.
What is your current military status?
Active
Previously active
Reserve
Veteran
No Answer
4.
On what date(mm/dd/yyyy) did you, your parent or your spouse begin military service?
5.
Did you complete at least 24 continuous months of active duty service?
Yes
No
No Answer
6.
If you or a family member were in the active military service, what was the discharge status of the individual? (skip if not applicable)
Dishonorable
General
Honorable
No Answer
7.
Do you or your family member have a military service-connected disability, injury, or disease?
Yes
No
No Answer
8.
Do you or any of your family/household members have any of the following conditions?(check all that apply)
Blindness
Hereditary blood disorder
Drug or alcohol dependency
HIV or AIDS
Limb differences
Limb loss
Mental illness
Paralysis
Permanently (rated 100%) disabled from a service-connected condition
Pregnancy
End-stage Renal Disease (permanent kidney failure requiring dialysis or a transplant)
Spina Bifida(not including spina bifida occulta)
9.
Have you been discharged from the military within the past 12 months for a disability incurred or aggravated in the line of duty?
Yes
No
No Answer
10.
Are you receiving or do you need Veterans' assistance or medical care?
Yes
No
No Answer
Answer more questions Stop and view results
 
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