14B Enter the relationship between the RELATIONSHIP beneficiary and the individual listed in Item 14A. 14C Enter the telephone number of the TELEPHONE NUMBER (If of individual listed in Item 14A. record) 15A If different from the information NAME AND ADDRESS OF in item 14A, enter the name and PERSON HAVING CUSTODY address of the individual having OF MINOR OR custody of the INCOMPETENT (If different from Item 14A) incompetent beneficiary, or child. If Item 15A requires an entry, the following items also be must completed 15B, and RELATIONSHIP, 15C, TELEPHONE NUMBER. If Item 15A does require an not entry, go to Item 16A. 15B Enter the relationship between the RELATIONSHIP beneficiary and the individual named in Item 15A. 15C Enter the telephone number of the TELEPHONE NUMBER (If of individual named in Item 15A. record) 16A Enter the amount of VA benefits AMOUNT OF BENEFITS the beneficiary is entitled to but is ENTITLED TO BUT UNPAID unpaid to date. TO DATE If no entitlement Important: exists, enter in the item field. 0.00 16B the monthly amount of VA MONTHLY benefits the beneficiary receives PAYMENTS/EFFECTIVE and the effective date(s). DATES Notes: If there are two or more children entitled to equal shares, show only the total monthly payment for all children and the effective date. When, as in awards of DIC, the total amount payable for all the children is not or will be equally divided among not them, show the amount payable to each child.
14B RELATIONSHIP Enter the relationship between the beneficiary and the individual listed in Item 14A. 14C TELEPHONE NUMBER (If of record) Enter the telephone number of the individual listed in Item 14A. 15A NAME AND ADDRESS OF PERSON HAVING CUSTODY OF MINOR OR INCOMPETENT (If different from Item 14A) If different from the information in item 14A, enter the name and address of the individual having custody of the incompetent beneficiary, or child. If Item 15A requires an entry, the following items must also be completed 15B, RELATIONSHIP, and 15C, TELEPHONE NUMBER. If Item 15A does not require an entry, go to Item 16A. 15B RELATIONSHIP Enter the relationship between the beneficiary and the individual named in Item 15A. 15C TELEPHONE NUMBER (If of record) Enter the telephone number of the individual named in Item 15A. 16A AMOUNT OF BENEFITS ENTITLED TO BUT UNPAID TO DATE Enter the amount of VA benefits the beneficiary is entitled to but is unpaid to date. Important: If no entitlement exists, enter 0.00 in the item field. 16B MONTHLY PAYMENTS/EFFECTIVE DATES the monthly amount of VA benefits the beneficiary receives and the effective date(s). Notes: If there are two or more children entitled to equal shares, show only the total monthly payment for all children and the effective date. When, as in awards of DIC, the total amount payable for all the children is not or will not be equally divided among them, show the amount payable to each child.
1-25-16_Key%20Changes_M21-1III_v_9_SecA.docx