Questionnaire Text

Questionnaire form view entire document:  text  image
28.
a) Does this person have a VA service-connected disability rating?
[ ] Yes (such as 0%, 10%, 20%, ... , 100%)
[ ] No ? SKIP to question 29a
Questionnaire instructions view entire document:  text  image
28a. Mark the "Yes" box if the person has a Department of Veterans Affairs (VA) service-connected disability rating.