The Rep for Vets®
5325 Primrose Lake Circle
Tampa, FL 33647
Bold labels and * indicate required information.
Date of Birth
Email:* (Please enter a valid email address)
ZIP (5 digits)
Are you currently receiving service-connected disability benefits?*
If applicable, what is your combined rating?
Did you receive an initial decision?
Did you file a Notice of Disagreement?
If applicable, Date Notice of Disagreement was filed
Are you currently working?
If applicable, is it due to your service-connected disability?
If applicable, Date last worked
Are you receiving Social Security Disability or Supplemental Security Income benefits?
Are you receiving service-connected pension?
What service connected disabilities are you claiming? (Maximum length: 500 characters.)
How Can We help You? How would you like us to assist you with your claim?