Government Veteran & Service-Family Administration

VSA-INT-1 — Veteran / Service-Family Administrative Intake

Controlled paper reference: PPR-VETERANS-SERVICE-____________-YYYYMMDD-______

Record the PPR number in the bound register before routing. Keep protected fields under the marked privacy classification and record source-dependent facts only against their competent-source references.

Request type: □ service-history reference □ general inquiry □ record correction □ assistance/program intake □ recognition/benefit source reference □ transition/support referral □ memorial record

Relationship / role (asserted by submitter only): □ self/service member □ self/veteran □ family □ survivor □ representative □ researcher □ other

Protected contact details

Person / record / memorial subject label (PROTECTED)

Matter summary and administrative help requested

Existing source owner/reference, if supplied

Submitter attestation: I submit these details for administrative handling. Signature: ____________________ Date: ______________

Routing, custody and reconciliation

Reconciliation discrepancy / correction note

□ Original paper receipt time preserved separately from digital creation/reconciliation time. □ PPR reference written back to the bound register. □ Paper original retained under the owning record schedule. □ Protected information remains protected.

Government Veteran & Service-Family Administration

VSA-HIST-2 — Service-History / Status Source-Reference Record

Controlled paper reference: PPR-VETERANS-SERVICE-____________-YYYYMMDD-______

Record the PPR number in the bound register before routing. Keep protected fields under the marked privacy classification and record source-dependent facts only against their competent-source references.

Use this form to record a source reference for verification.

Reference class: □ service history □ veteran-status source □ correction/superseding source

Source owner: □ Government □ I.U.S.C. □ other competent source

Source label as supplied (PROTECTED where necessary)

Correction-of prior source-reference record, if any

Source-owner verification result/reference

□ Keep the source-dependent fact in source review until the competent source confirms it. □ I.U.S.C. records remain under I.U.S.C. source ownership.

Routing, custody and reconciliation

Reconciliation discrepancy / correction note

□ Original paper receipt time preserved separately from digital creation/reconciliation time. □ PPR reference written back to the bound register. □ Paper original retained under the owning record schedule. □ Protected information remains protected.

Government Veteran & Service-Family Administration

VSA-SUP-3 — Assistance / Program / Transition-Support Referral

Controlled paper reference: PPR-VETERANS-SERVICE-____________-YYYYMMDD-______

Record the PPR number in the bound register before routing. Keep protected fields under the marked privacy classification and record source-dependent facts only against their competent-source references.

Referral class: □ transition support □ Government Human Services □ Government records □ Government program information □ I.U.S.C. source owner □ other support

Destination owner: □ Government □ I.U.S.C. □ other competent source

Destination office/service label and reference

Protected need/request summary

Administrative routing state: □ recorded □ routed □ response reference recorded □ closed administratively

Response/cross-reference if actually received

Record destination acceptance, eligibility, enrollment, benefit, payment, treatment or other outcome only from the destination or source record actually received.

Routing, custody and reconciliation

Reconciliation discrepancy / correction note

□ Original paper receipt time preserved separately from digital creation/reconciliation time. □ PPR reference written back to the bound register. □ Paper original retained under the owning record schedule. □ Protected information remains protected.

Government Veteran & Service-Family Administration

VSA-REC-4 — Recognition / Award / Benefit Source-Reference Review

Controlled paper reference: PPR-VETERANS-SERVICE-____________-YYYYMMDD-______

Record the PPR number in the bound register before routing. Keep protected fields under the marked privacy classification and record source-dependent facts only against their competent-source references.

Reference class: □ recognition/award source □ benefit/program source □ correction source

Competent source owner: □ Government □ I.U.S.C. □ other competent source

Exact authoritative source/instrument reference

What the source is asserted to establish

Verification adapter / human source-owner verification evidence

Public-safe publication authorization reference, if any

□ Effect-bearing award, recognition or benefit entries require the authoritative source or instrument reference. □ Public projection requires verified competent source and publication authorization.

Routing, custody and reconciliation

Reconciliation discrepancy / correction note

□ Original paper receipt time preserved separately from digital creation/reconciliation time. □ PPR reference written back to the bound register. □ Paper original retained under the owning record schedule. □ Protected information remains protected.

Government Veteran & Service-Family Administration

VSA-MEM-5 — Memorial Record / Correction Request

Controlled paper reference: PPR-VETERANS-SERVICE-____________-YYYYMMDD-______

Record the PPR number in the bound register before routing. Keep protected fields under the marked privacy classification and record source-dependent facts only against their competent-source references.

Request: □ memorial source record □ correction □ removal/review request □ historical inquiry

Person / memorial subject label (PROTECTED until publication is authorized)

Competent source owner and exact source reference for death/service/status/honor facts

Requested memorial text or correction (administrative submission; not yet public)

Source verification / publication authorization evidence

Record death, military service, veteran status, honor or memorial eligibility only from the competent source reference. Public memorial publication also requires separately verified source evidence and authorization.

Routing, custody and reconciliation

Reconciliation discrepancy / correction note

□ Original paper receipt time preserved separately from digital creation/reconciliation time. □ PPR reference written back to the bound register. □ Paper original retained under the owning record schedule. □ Protected information remains protected.

Government Veteran & Service-Family Administration

VSA-RCT-6 — Submitter Receipt / Status / Correction

Controlled paper reference: PPR-VETERANS-SERVICE-____________-YYYYMMDD-______

Record the PPR number in the bound register before routing. Keep protected fields under the marked privacy classification and record source-dependent facts only against their competent-source references.

Submitter receipt copy: The receiving office acknowledges administrative receipt under the PPR reference above. Keep this receipt with the request reference and any later source-verification or status notices.

Safe request class

Current administrative state: □ received □ triage □ information requested □ source review □ routed □ recorded for reference □ closed □ withdrawn

Next administrative step / safe status note

Correction requested by submitter, if any

Correction received date/time / staff initials

Routing, custody and reconciliation

Reconciliation discrepancy / correction note

□ Original paper receipt time preserved separately from digital creation/reconciliation time. □ PPR reference written back to the bound register. □ Paper original retained under the owning record schedule. □ Protected information remains protected.

Government Veteran & Service-Family Administration

VSA-REG-7 — Bound Register Continuation / Digital Reconciliation

Controlled paper reference: PPR-VETERANS-SERVICE-____________-YYYYMMDD-______

Record the PPR number in the bound register before routing. Keep protected fields under the marked privacy classification and record source-dependent facts only against their competent-source references.

Use one line per controlled PPR reference. Never erase or reuse a number; retain void entries with reason/date/initials.

Outage / reconciliation control

Routing, custody and reconciliation

Reconciliation discrepancy / correction note

□ Original paper receipt time preserved separately from digital creation/reconciliation time. □ PPR reference written back to the bound register. □ Paper original retained under the owning record schedule. □ Protected information remains protected.