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DOCUMENTATION REQUIRED - READ CAREFULLY
Please submit photocopies of documents because they will not be returned.
A. Documentation of Service and Separation.
Any official document or statement from the Armed Forces showing
separation, discharge or release from active duty is under honorable
conditions (Honorable or General Discharge). Note: Only the branch of
service in which the individual served can certify active duty service
was performed “Under Honorable Conditions.” Such documents
include, but are not limited to:
• DD-214, “Certificate of Release or Discharge from Active Duty”
• Retirement or separation orders
• Documents showing transfer to any of the reserve corps of the Armed
Forces
• Certification: any written document from the armed forces that certifies
the service member is expected to be discharged or released from
active duty service in the armed forces under honorable conditions not
later than 120 days after the date the certification is signed.
• Official statement from military personnel records center
B. Documentation of Non-Compensable Service-Connected Disability
(less than 10%); Purple Heart, and Nonservice-Connected Disability
Pension. Such documents include, but are not limited to:
• An official statement, dated 1991 or later, from the Department of
Veterans Affairs or from a branch of the Armed Forces, certifying to the
present existence of the veteran's service-connected disability of less
than 10%.
• An official citation, document, or discharge certificate, issued by a
branch of the Armed Forces, showing the award to the veteran of the
Purple Heart.
•. An official statement, dated 1991 or later, from the Department of
Veterans Affairs, certifying that the veteran is receiving a nonservice-
connected disability pension.
C. Documentation of Compensable Service-Connected Disability
(10% or more). Such documents include, but are not limited to:
• An official document, dated 1991 or later, from the Department of
Veterans Affairs, or from a branch of the Armed Forces, certifying that
the veteran has a service-connected disability of 10% or more.
• An official document or retired orders from a branch of the Armed
Forces, showing that the veteran was retired due to a service-
connected disability or has been transferred to a Disability Retirement
List with a service-connected disability of at least 10% or more.
For spouses and mothers of disabled veterans, who checked item 7 or
9, submit the following:
An official statement, dated 1991 or later, from the Department of
Veterans Affairs, or from a branch of the Armed Forces, certifying:
• the present existence of the veterans service-connected disability;
• the percentage and nature of the service-connected disability or
disabilities (including the combined percentage); and
• a notation as to whether or not the service-connected disability is
rated as permanent and total.
D. Documentation of Veteran's Death
• If death occurred while not on active military duty, submit certified
copy of death certificate.
• When a veteran dies on active duty, the family does not receive a DD
Form 214; the family receives a DD Form 1300, Report of Casualty, on
which there is no place to record the character of service. Thus, when
a veteran dies on active duty, his or her service should be presumed to
be under honorable conditions unless the military service specifically
indicates otherwise.
E. Documentation of Service or Death During a War, in a Campaign or
Expedition for which a Campaign Badge is Authorized, or During
the Period Authorized, or During the Period of April 28, 1952
through July 1, 1955.
Submit documentation of service or death during a war or during the
period April 28, 1952, through July 1,1955, or during a campaign or
expedition for which a campaign badge is authorized.
F. Documentation of Deceased or Disabled Veteran's Mother's Claim
for Preference because of Her Husband's Total and Permanent
Disability.
Submit a statement from husband's physician showing the prognosis
of his disease and percentage of his disability.
G. Documentation of Annulment of Remarriage by Widow or Widower
of Veteran.
Submit either:
• Certification from the Department of Veterans Affairs that entitlement to
pension or compensation was restored due to annulment; or
• A certified copy of the court decree of annulment.
H. Documentation of Veteran's Inability to Work Because of a Service-
Connected Disability.
Answer questions 1-7 below:
1. Is the veteran currently working? If No, go to Item 3.
2. If currently working, what is the veteran's present occupation?
Yes
No
3. What was the veteran's occupation, if any, before military service?
4. What was the veteran's military occupation
at the time of separation?
5. Has the veteran been employed, or is he/she now employed, by the Federal civil service or D.C. Government?
Yes
No
A. Title and Grade of position most recently, or currently, held B. Name and address of agency C. Dates of employment
From:
To:
6. Has the veteran resigned from, been disqualified for, or separated from a position in the Federal civil service or D.C. Government
along the lines of his/her usual occupation because of service-connected disability?
If Yes, submit documentation of the resignation, disqualification, or separation.
Yes
No
7. Is the veteran receiving a civil service retirement pension?
If Yes, give the Civil Service annuity (CSA) or Federal employee retirement annuity number.
Yes
No
CSA#
Standard Form 15
Revised October 2013
All other previous editions are unusable.
