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Vsd 001 Template

The VSD 001 form is a vital document used by the State of California to verify a veteran's status and any service-connected disabilities. It requires detailed information from the applicant and certification from an authorized County Veterans Service Office (CVSO) representative. To ensure your veteran benefits are properly recognized and to add a veteran designation to your driver's license or ID card, click the button below to fill out your VSD 001 form.

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In the state of California, veterans seeking to verify their status and/or service-connected disability for the purpose of receiving driver license or identification card designations, or applying for disabled veteran license plates, must complete the VSD 001 form. This comprehensive document serves several purposes, ensuring veterans' access to benefits accorded to their service and sacrifice. The form features sections that must be filled out with precision, using blue or black ink, and includes a variety of information such as the applicant’s personal details, a certification of service and discharge status, and an authorization for the County Veterans Service Office (CVSO) to verify documents presented. With the applicant’s certification under penalty of perjury, this form acts as a crucial piece in verifying veteran status directly with the California Department of Motor Vehicles (DMV). Additionally, it outlines the specific criteria for obtaining disabled veteran license plates, detailing the qualifications related to service-induced disabilities. Successful submission and verification through this form enable the inclusion of a veteran designation on California driver licenses or ID cards, as well as the acquisition of disabled veteran license plates, subject to a verification process by authorized CVSO employees or officers. For its part, the DMV mandates a $5 fee for the veteran designation on cards, underscoring the procedural steps veterans must undertake to avail these recognitions and benefits. This form, pivotal for veterans within California, exemplifies the state’s efforts to honor and provide for its veterans through accessible, structured processes.

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State of California

Veteran Status and Service-Connected Disability Verification

SECTION 1 - TO BE COMPLETED BY THE APPLICANT REQUESTING VETERAN STATUS AND/OR SERVICE CONNECTED DISABLITY VERIFICATION PRINT USING BLUE OR BLACK INK

FIRST NAME

MIDDLE NAME

LAST NAME

SUFFIX

DRIVER LICENSE OR IDENTIFICATION NUMBER

STATE OF ISSUANCE

DATE OF BIRTH (MM/DD/YYYY)

EMAIL ADDRESS

DAYTIME TELEPHONE NUMBER

MAILING ADDRESS

CITY

STATE

ZIP CODE

RESIDENCE ADDRESS IF DIFFERENT FROM MAILING ADDRESS ABOVE

CITY

STATE

ZIP CODE

SECTION 2 - APPLICANT CERTIFICATION

I certify (or declare) under penalty of perjury under the laws of the State of California, that I have served in the United States uniformed services and received an other than dishonorable discharge, or served in a Guard or Reserve component and was mobilized for federal active duty. The information I provided is true and correct. I authorize County Veterans Service Office (CVSO) employees, officers, and designees to verify the documents presented.

APPLICANT SIGNATURE

_

DATE

SECTION 3 - TO BE COMPLETED BY AUTHORIZED COUNTY VETERANS SERVICE OFFICE EMPLOYEE, OFFICER, OR DESIGNEE

COUNTY VETERANS SERVICE OFFICE ADDRESS

CITY

STATE

ZIP CODE

PHONE NUMBER

COUNTY

EMAIL ADDRESS

As a representative of the County Veterans Service Office of the above named county, and designee of the California Department of Veterans Affairs, I certify under penalty of perjury under the laws of the State of California, that I have reviewed the documentation required and that the above named individual meets the qualifications noted above.

COUNTY VETERANS SERVICE OFFICE REPRESENTATIVE'S SIGNATURE

DATE

COUNTY VETERANS SERVICE OFFICE REPRESENTATIVE'S PRINTED NAME

TITLE

This form must be submitted in person to the Department of Motor Vehicles along with an application for a driver license or identification card in compliance with California Vehicle Code § 12811 (c)(5) and all requirements must be met prior to the issuance of a driver license or identification card with a veteran designation on the face of the card. In addition to any other fee, a $5 fee must be paid for the veteran designation.

SECTION 4 -

DISABLED VETERAN CERTIFICATION FOR DISABLED VETERAN LICENSE PLATES

 

 

TO BE COMPLETED BY AUTHORIZED COUNTY VETERANS SERVICE OFFICE EMPLOYEE, OFFICER, OR

DESIGNEE

The above named applicant is a disabled veteran who, as a result of injury or disease suffered while on active service with the armed forces of the United States, suffers from one or more of the following disabilities:

Has a disability which has been rated at 100% by the United States Department of Veterans Affairs, due to a diagnosed disease or disorder which substantially impairs or interferes with mobility.

Is so severely disabled as to be unable to move without the aid of an assistant device.

Has lost, or has lost use of, one or more limbs.

Has suffered permanent blindness, as defined in Section 19153 of the Welfare and Institutions Code.

SECTION 5 - TO BE COMPLETED BY AUTHORIZED COUNTY VETERANS SERVICE OFFICE EMPLOYEE, OFFICER, OR DESIGNEE

COUNTY VETERANS SERVICE OFFICE ADDRESS

CITY

STATE

ZIP CODE

PHONE NUMBER

COUNTY

EMAIL ADDRESS

As a representative of the County Veterans Service Office of the above named county, and designee of the California Department of Veterans Affairs, I certify under penalty of perjury under the laws of the State of California, that I have reviewed the documents

for the above named applicant that demonstrate that the applicant meets the qualifications noted above.

COUNTY VETERANS SERVICE OFFICE REPRESENTATIVE'S SIGNATURE

DATE

COUNTY VETERANS SERVICE OFFICE REPRESENTATIVE'S PRINTED NAME

TITLE

If this form is being submitted for an application for disabled veteran license plates only, this form and all other requirements, including acceptable proof of true full name and date of birth, may be submitted in person or by mail . For more information, please visit www.dmv.ca.gov.

FOR DMV USE ONLY

TECHNICIAN'S INITIALS/TECH ID #

DATELINE STAMP

APPLICANT'S DL/ID NUMBER

VSD-001 (Rev. 1/2021)

This form is not transferable

Form Breakdown

Fact Name Description
Form Title State of California Veteran Status and Service-Connected Disability Verification (VSD-001)
Primary Objective To verify veteran status and/or service-connected disability for the issuance of a driver license or identification card with a veteran designation.
Applicable State California
Governing Law Under the penalty of perjury under the laws of the State of California.
Submission Requirement This form must be submitted in person to the Department of Motor Vehicles along with an application for a driver license or identification card.
Additional Fee A $5 fee is required for the veteran designation on the driver license or identification card.
Eligibility Criteria for Disabled Veteran License Plates Must be a disabled veteran suffering from disabilities due to injury or disease sustained while on active service, which includes mobility impairments, limb loss, or permanent blindness as defined in Section 19153 of the Welfare and Institutions Code.
Verification Authority Verification is conducted by an authorized County Veterans Service Office (CVSO) employee, officer, or designee of the California Department of Veterans Affairs.

Guidelines on Filling in Vsd 001

When pursuing veteran status or service-connected disability verification in California, individuals are required to complete the VSD 001 form accurately. This procedure is a crucial step in acknowledging their service and securing the benefits entitled to them. To ensure clarity and prevent any delays in processing, it’s essential to follow the provided guidelines meticulously.

Steps for Filling Out the VSD 001 Form

  1. Start by using blue or black ink to fill out the form. This is critical for ensuring that the document is legible and processed without delay.
  2. Enter your first name, middle name, last name, and any suffix in the designated fields under Section 1.
  3. Provide your driver license or identification number and state of issuance.
  4. Fill in your date of birth in the MM/DD/YYYY format.
  5. Include a current email address and a daytime telephone number where you can be reached.
  6. Write down your mailing address, and if your residence address differs from the mailing address, provide that as well in the specified fields.
  7. Move to Section 2, the Applicant Certification. Read the certification statement carefully, acknowledging your service and the nature of your discharge. By signing this section, you authorize the County Veterans Service Office (CVSO) to verify your documentation.
  8. Sign your name in the space provided and date the document to validate your certification.
  9. Note that Sections 3, 4, and 5 are to be completed by an authorized County Veterans Service Office employee, officer, or designee.
  10. After filling out the form, it must be submitted in person to the Department of Motor Vehicles (DMV) along with an application for a driver license or identification card. Remember to comply with the California Vehicle Code § 12811(c)(5) and meet all requirements for the issuance of a document with a veteran designation.
  11. Be prepared to pay a $5 fee for the veteran designation on your driver license or identification card, which is in addition to any other applicable fees.

This document serves as a bridge for veterans to access certain recognitions and benefits. Once submitted, the Department of Motor Vehicles (DMV) and the County Veterans Service Office will review your application and accompanying documents to verify your veteran status or service-connected disability. This verification process is a vital step in honoring your service and ensuring you receive the benefits you deserve.

Learn More on Vsd 001

What is the VSD 001 form?

The VSD 001 form is a document issued by the State of California that is used to verify a veteran's status and/or service-connected disability for the purposes of obtaining a driver license or identification card with a veteran designation. It must be completed and submitted to the Department of Motor Vehicles (DMV) along with an application for a driver license or identification card.

Who needs to complete the VSD 001 form?

Individuals who have served in the United States uniformed services and received an other than dishonorable discharge, or those who served in a Guard or Reserve component and were mobilized for federal active duty, are required to complete the VSD 001 form if they wish to have their veteran status and/or service-connected disabilities officially recognized on their California driver license or identification card.

What information is needed to fill out the VSD 001 form?

To accurately complete the VSD 001 form, the following information is necessary:

  1. Full name (first, middle, last, suffix)
  2. Driver license or identification number and state of issuance
  3. Date of birth
  4. Email address
  5. Daytime telephone number
  6. Mailing and residence addresses, if different
Additionally, applicants must certify their eligibility under penalty of perjury and authorize the County Veterans Service Office (CVSO) to verify the submitted documents.

What are the steps to submit the VSD 001 form?

To successfully submit the VSD 001 form, follow these steps:

  • Complete the applicant section of the form using blue or black ink.
  • Sign and date the applicant certification to attest to the truthfulness of the information and your eligibility.
  • Take the form to an authorized County Veterans Service Office (CVSO) for certification.
  • Submit the form in person at the DMV along with your driver license or identification card application, and any other required documentation.
Remember, all sections of the form must be filled out correctly, and all steps followed precisely, to obtain the veteran designation.

Is there a fee to obtain the veteran designation on a driver license or identification card?

Yes, in addition to any standard fees associated with obtaining or renewing a driver license or identification card, there is a $5 fee specifically for the veteran designation. This fee must be paid at the time of application at the DMV.

Can the VSD 001 form be submitted for disabled veteran license plates?

Yes, the VSD 001 form can also be submitted for the purpose of obtaining disabled veteran license plates. The form must include certification from an authorized County Veterans Service Office (CVSO) employee, officer, or designee that the applicant is a disabled veteran suffering from a qualifying disability as a result of service. This form, along with other required documents, can be submitted either in person or by mail.

Where can more information be found regarding the VSD 001 form and veteran benefits?

For more detailed information regarding the VSD 001 form, the process for obtaining a veteran designation on your driver license or identification card, or for queries about disabled veteran license plates, please visit the California Department of Motor Vehicles (DMV) official website at www.dmv.ca.gov. Additionally, local County Veterans Service Offices (CVSOs) can provide assistance and information tailored to individual needs and circumstances.

Common mistakes

When filling out the VSD 001 form for the State of California regarding Veteran Status and Service-Connected Disability Verification, applicants often make several common mistakes. These errors can delay the processing of their application or result in outright denial. Understanding and avoiding these pitfalls can streamline the process and ensure that applicants receive the benefits and recognitions they are entitled to.

  1. Not using blue or black ink: The form specifically requires that all entries be made using blue or black ink. Using other colors can cause processing issues.
  2. Incomplete Sections: Many applicants leave certain fields blank, especially if they feel a section does not apply to them. However, all requested information should be provided unless the section is clearly marked as optional.
  3. Illegible handwriting: If the handwriting is hard to read, it can lead to incorrect data entry by the processing staff. This can be avoided by writing clearly or, where possible, typing the information.
  4. Incorrectly filled Section 2: This section requires a certification by the applicant regarding their service and discharge status. Mistakes here can misrepresent an applicant's eligibility.
  5. Failing to sign and date the application: The form requires the applicant's signature to certify the accuracy of the information provided. Unsigned forms will not be processed.
  6. Not authorizing verification: Applicants must authorize the County Veterans Service Office (CVSO) to verify their documents. Failure to do so can halt the verification process.
  7. Submitting without required documentation: The form alone is not sufficient for processing. It must be accompanied by proper documentation as evidence of veteran status and/or disability.
  8. Omitting contact information: It's crucial to provide a reliable way for the CVSO or DMV to reach the applicant. Missing or incorrect contact details can lead to processing delays.
  9. Not understanding the fee requirement: There is a $5 fee for the veteran designation on the driver license or identification card. Ignoring this requirement can prevent the application from being completed.

It is important for all applicants to carefully review their applications before submission to ensure that all information is accurate, complete, and legible. Taking these precautions helps to avoid unnecessary delays and ensures a smoother process in obtaining veteran designations and benefits.

Documents used along the form

When submitting the VSD 001 form, used for veteran status and service-connected disability verification in the State of California, several other forms and documents might be needed to complete various applications or to ensure all benefits and designations are correctly applied for. Understanding these documents can help streamline the process and ensure nothing is overlooked.

  • DD Form 214 (Certificate of Release or Discharge from Active Duty): This document verifies military service and conditions of discharge, crucial for veteran status validation.
  • Application for Disabled Veteran License Plates (REG 195): For those qualifying under the disabled veteran criteria, this form is needed to apply for special license plates.
  • Proof of Service Letter: Sometimes required to prove military service when DD Form 214 is not available or as supplementary documentation.
  • Medical Evaluation from the U.S. Department of Veterans Affairs: This is critical when applying for benefits related to service-connected disabilities, including documentation for disabled veteran license plates.
  • Proof of Identity and Residency: Generally required for any application related to state ID or driver's licenses, these documents can include a state-issued ID card, utility bills, or other government-issued documentation.
  • Application for Veteran Designation on Driver License or ID Card (DL 11): Specifically for the marking of a driver's license or ID card with a veteran designation, which might require the VSD 001 form for verification.
  • Vehicle Registration/Title Application: Necessary for registering a vehicle or when applying for veteran-specific license plates, this document requires personal and vehicle information.
  • Change of Address Form (DMV 14): If a veteran moves, this form is essential to ensure all correspondence related to the application is accurately sent to the new address.

Navigating through the process of acquiring veteran-related designations and benefits involves dealing with multiple forms and documents. Each plays a vital role in verifying eligibility and ensuring that veterans receive the recognitions and benefits they are entitled to. By having a clear understanding of what each form entails and when it is necessary, veterans can ensure a smoother, more efficient application process.

Similar forms

The VSD 001 form, used in the State of California for verification of veteran status and service-connected disabilities, shares similarities with other official forms designed to verify identity, eligibility, or status for specific benefits or services. Here is a list of 9 documents that resemble the VSD 001 form in their purpose or requirements:

  • DD Form 214 - This document, known as the Certificate of Release or Discharge from Active Duty, is similar to the VSD 001 in that it serves as a key document for veterans to prove their military service and conditions of discharge, which are critical for accessing veterans' benefits.
  • VA Form 10-10EZ - Used for application for health benefits through the Department of Veterans Affairs, this form requires veterans to provide detailed personal and service information similar to the VSD 001 form to determine eligibility for health benefits.
  • Standard Form 180 (SF-180) - This form is used to request military service records, similar to how the VSD 001 form requires documentation review to verify veteran status and service-connected disabilities.
  • VA Form 21-526EZ - Application for Disability Compensation and Related Compensation Benefits requires veterans to certify their service and disabilities, akin to the disability certification segment in the VSD 001 form.
  • DD Form 2656 - Data for Payment of Retired Personnel, similar to VSD 001, involves the verification of military service and eligibility for benefits, though focused on retirement pay.
  • VA Form 21-4502 - Application for Automobile or Other Conveyance and Adaptive Equipment requires certification of service-connected disabilities, comparable to the certification for disabled veteran license plates in the VSD 001 form.
  • DMV Disabled Person Parking Placard or Plates (REG 195) - This form, while for a specific use, requires certification of disabilities, sharing the aspect of disability verification present in the VSD 001 form.
  • VA Form 22-1990 - Application for Education Benefits requires veterans to provide service information to determine eligibility for education benefits, similar to the necessity of service verification in the VSD 001 for veterans' service benefits.
  • CA DMV Driver License or Identification Card Application (DL 44) - Similar to the VSD 001, this form is used to apply for an identification document that may include a veteran designation, requiring proof of eligibility.

Each of these documents serves vital roles in certifying aspects of a veteran's service or status, necessary for accessing various benefits or services. Though the context and specific benefits may vary, the underlying requirement for official verification of veteran status and related eligibility criteria remains a consistent theme throughout.

Dos and Don'ts

When filling out the VSD 001 form, the process requires careful attention to certain dos and don'ts to ensure accuracy and compliance with California state requirements. Here are some guidelines to follow:

Do:
  • Use blue or black ink: As instructed on the form, it's important to fill out the form using blue or black ink to ensure readability and prevent any processing issues.
  • Complete all sections thoroughly: Make sure to fill in every required section to avoid delays. Inaccuracies or omissions may lead to the rejection of your application.
  • Review for accuracy: Before submitting the form, double-check all the information you've provided for accuracy to ensure there are no mistakes.
  • Keep a copy for your records: It’s advisable to make a copy of the completed form for your personal records before submitting it.
  • Submit in person if required: Pay special attention to the submission instructions, as some sections of the form may require you to submit it in person.
Don't:
  • Sign before reading: Ensure you carefully read every part of the form, especially the certification sections, before signing to acknowledge your understanding and agreement.
  • Forget the $5 fee for the veteran designation: Remember the additional fee required for adding a veteran designation to your license or ID card, if applicable.
  • Guess on important details: If you’re unsure about any information requested on the form, such as specific dates or addresses, it’s better to verify these details before submitting the form rather than guessing.
  • Use correction fluid: Mistakes should be corrected by neatly crossing out the incorrect information and writing the new information next to it or above it. Avoid using white-out or correction fluid, as it can make the form appear altered.

Misconceptions

Understanding the VSD-001 form, or the Veteran Status and Service-Connected Disability Verification form, is crucial for veterans in California looking to obtain benefits or specific designations. However, there are several misconceptions about this form that need to be clarified:

  • It's only for driver's licenses: While the form is used in the process of applying for a driver license or identification card with a veteran designation, it's also necessary for applying for disabled veteran license plates.
  • Any veteran can sign it: Only veterans who have served in the United States uniformed services and received an other than dishonorable discharge, or served in a Guard or Reserve component and were mobilized for federal active duty, are eligible to complete Section 1.
  • No verification is needed: The applicant's documentation and eligibility are indeed subject to verification by County Veterans Service Office (CVSO) employees or designees, as per the certification in Section 3.
  • Disability rating specifics aren't important: The form specifically requires disabilities to be rated at 100% by the United States Department of Veterans Affairs or meeting other very specific criteria, for the application for disabled veteran license plates.
  • Submission in person is always required: Although the form and all accompanying documentation for a veteran designation on a driver's license or ID must be submitted in person, applications for disabled veteran license plates potentially allow for mail-in submissions.
  • The form is valid indefinitely: The form, along with all other required documentation, must be current and meet all specified criteria at the time of submission. Regulations and forms may change, thus what was accurate at one point may not remain so.
  • A $5 fee is required for all submissions: The additional $5 fee is specifically for the application for a veteran designation on the face of a driver license or identification card, not for the application for disabled veteran license plates.

Correctly understanding and navigating the VSD-001 form is essential for veterans seeking to utilize their entitled benefits in California. Misinterpretations can lead to delays or even denials in receiving the proper designations and plates. Therefore, accurate knowledge and compliance with the instructions and requirements detailed in the VSD-001 form are paramount.

Key takeaways

  • Applicants must use blue or black ink when filling out the VSD 001 form to ensure legibility and compliance with processing requirements.

  • It is necessary for applicants to provide comprehensive personal details, including driver license or identification number, state of issuance, and contact information.

  • The form includes a certification section where the applicant must declare their veteran status and/or service-connected disability under the penalty of perjury according to California law.

  • Verification of the information provided on the form is to be completed by an authorized County Veterans Service Office (CVSO) employee, officer, or designee.

  • The form serves multiple purposes, including applying for a driver license or ID card with a veteran designation, and for disabled veteran license plates.

  • For the veteran designation on a driver license or ID card, the applicant must submit the form in person to the Department of Motor Vehicles (DMV) alongside the relevant application and a $5 fee.

  • The form requires the authorized CVSO representative to certify that the applicant meets the criteria for a veteran designation or disabled veteran license plates, based on documented evidence of service and disability.

  • When applying specifically for disabled veteran license plates, documentation regarding the nature of the disability and eligibility must be reviewed and certified by the CVSO.

  • Detailed guidance on the submission process, including requirements for proving true full name and date of birth, is available on the California DMV website.

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