NIFV Veteran Client Intake

Start your veteran intake securely.

Provide your basic contact, address, military-service, and VA claim-history information. Your submission will be placed in our intake team's Call Calendar for follow-up. It does not create a duplicate VDAC account automatically.

Veteran Intake Application

Fields marked * are required.

Please enter information as it appears on your official records.

About You

Basic identification and contact information.

First name *

Middle name

Last name *

Title / suffix

Date of birth *

Gender

Email address *

We check this email against existing VDAC accounts to prevent duplicates.

Primary phone *

Social Security number *

Enter numbers only. Your SSN is never copied into the Call Calendar notes.

Current Mailing Address

Country selection controls the available state, province, or territory list.

Street address

Apt / unit

City *

Country *

State / province / territory *

Change the country to reload this list.

ZIP / postal code *

Military Service

Enter your primary or most recent period of military service.

Branch of service *

Service component / type

Date entered *

Date released / exited

Leave blank if you are currently serving in this period.

Discharge type

Required when a release / exit date is entered.

VA Claim & Military Retirement

These answers carry into the VDAC account if your intake proceeds.

Have you ever filed a claim with VA? *

Are you receiving military retirement pay? *

Branch retired from *

I certify that the information I entered is accurate to the best of my knowledge and I authorize NIFV to contact me regarding this intake. I understand that submitting this form does not itself file a VA claim or automatically create a VDAC account.

Duplicate protection checks the email address and Social Security number against existing VDAC veteran records before a new intake is accepted.

Before submitting, review your email address, SSN, address, branch, service dates, discharge type, VA claim history, and retirement information. These items are used by the intake team to begin your record accurately.