Failure to Provide Claim Information
This letter concerns your recent claim for Department of Veterans Affairs benefits.
Before final action could be taken on your claim, we needed (Evidence). This evidence was requested in our letter dated (Date). Our records do not show we have received this evidence, therefore, we have disallowed your claim.
This disallowance does not mean that you cannot submit the requested evidence. You can do so at any time. However, if the evidence is not received before (Date), which is one year from the date of our first letter, benefits, if entitlement is established, cannot be paid before the date of receipt of the evidence.
If you disagree with this disallowance and believe the evidence now of record is sufficient for us to award you benefits, please refer to the enclosed VA Form 1-4107, Notice of Procedural and Appellate Rights, which explains your rights to appeal.
We wrote to you on [date], for information to help us with your claim for [benefits]. We’ve closed your file for now because we haven’t received the information.
What we needed
We asked you to send us:
- A certified copy of your marriage license [example only]
- A certified copy of Ronnie’s birth certificate [example only]
- Mary’s and Ronnie’s Social Security numbers [example only]
We’ve closed your file for now, but you still have time to send in the information we need. We may be able to [pay benefits/raise your benefits] back to [date], if we receive this information by [date].
If you think we’re wrong
If you think we shouldn’t have turned down your claim, you should write and tell us. We’ve attached a form which explains your rights.
If you have any questions, you may call us toll-free by dialing 1-800-827-1000. Our TDD number for the hearing impaired is 1-800-829-4833. If you call, please have this letter with you.