Free Vsd 001 Template
The VSD 001 form is an essential document for veterans in California seeking to establish their veteran status and/or service-connected disability verification. It is divided into several sections that guide applicants through the necessary information required for submission. The first section focuses on the applicant's personal details, including their name, contact information, and identification numbers. Following this, applicants must certify their military service and discharge status, affirming that they have served honorably. The form also requires verification from a representative of the County Veterans Service Office, who confirms that the applicant meets the qualifications for veteran status. Additionally, there is a section dedicated to disabled veterans, allowing them to certify their disability status, which may qualify them for special license plates. Finally, the form outlines the submission process, which includes in-person delivery to the Department of Motor Vehicles along with any associated fees. Understanding the VSD 001 form is crucial for veterans seeking to access specific benefits and recognitions available to them in California.
Document Specifics
| Fact Name | Details |
|---|---|
| Purpose | The VSD 001 form is used to verify veteran status and service-connected disabilities for California residents. |
| Governing Law | This form is governed by California Vehicle Code § 12811 (c)(5). |
| Submission Method | Applicants must submit the form in person to the Department of Motor Vehicles (DMV) when applying for a driver license or identification card. |
| Fee Requirement | A $5 fee is required for the veteran designation on the driver's license or identification card. |
| Certification Statement | The applicant certifies under penalty of perjury that they have served in the U.S. uniformed services and received an honorable discharge. |
| Disabled Veteran Criteria | The form includes specific criteria for disabled veterans, such as a 100% disability rating or permanent blindness. |
| Contact Information | Applicants must provide personal contact details, including a daytime telephone number and email address. |
Similar forms
- VA Form 21-526EZ: This form is used to apply for disability compensation and related benefits. Like the VSD 001, it requires personal information and verification of military service.
- VA Form 21-4138: Known as the Statement in Support of Claim, this document allows veterans to provide additional information to support their claims. It shares the need for personal certification of service details.
- California DMV Form REG 256: This is the application for a disabled person parking placard. Similar to the VSD 001, it verifies eligibility based on disability status and requires personal information.
- Arizona Residential Lease Agreement: This legal document outlines the rental terms for properties in Arizona and ensures clarity between landlords and tenants. For more information, visit Arizona PDF Forms.
- VA Form 21-534EZ: This form is for surviving spouses or dependents applying for Dependency and Indemnity Compensation. Like the VSD 001, it necessitates proof of military service and personal details.
- California Form DS 699: This is the application for a veteran designation on a driver's license. It parallels the VSD 001 by requiring verification of veteran status and personal identification.
- VA Form 21-22: This form designates a representative to assist with VA claims. It shares the requirement of confirming military service and personal details from the veteran.
- California Form VSD 002: This is the application for a veteran's license plate. Similar to the VSD 001, it verifies veteran status and requires the applicant's personal information.
Vsd 001 Example
State of California
Veteran Status and
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
This form is not transferable |
Understanding Vsd 001
What is the VSD 001 form used for?
The VSD 001 form is used in California to verify an individual's veteran status and service-connected disability. This verification is essential for obtaining a veteran designation on a driver license or identification card, as well as for applying for disabled veteran license plates.
Who needs to complete the VSD 001 form?
Any individual who has served in the United States uniformed services and received an other than dishonorable discharge, or who has served in a Guard or Reserve component and was mobilized for federal active duty, should complete this form. It is also necessary for those seeking to verify their status as a disabled veteran.
What information is required on the VSD 001 form?
The form requires personal details such as your first name, middle name, last name, date of birth, and contact information. You will also need to certify your military service and provide an authorized signature. If you are applying for disabled veteran benefits, additional information regarding your disability will be required.
How do I submit the VSD 001 form?
You must submit the completed VSD 001 form in person to the Department of Motor Vehicles (DMV) along with your application for a driver license or identification card. If you are applying for disabled veteran license plates only, you can submit the form either in person or by mail.
Is there a fee associated with the VSD 001 form?
Yes, there is a $5 fee for the veteran designation when applying for a driver license or identification card. This fee is in addition to any other fees associated with your DMV application.
What if I have a service-connected disability?
If you have a service-connected disability, you will need to have the VSD 001 form completed by an authorized representative of the County Veterans Service Office. They will verify that your disability meets the necessary criteria for disabled veteran license plates or other benefits.
Can I use the VSD 001 form for other purposes?
No, the VSD 001 form is specifically designed for the purposes outlined above. It is not transferable and should only be used for verification of veteran status and service-connected disabilities in relation to DMV applications.
Where can I find more information about the VSD 001 form?
For more details, you can visit the California DMV website at www.dmv.ca.gov. This site provides additional resources and information regarding the form and the application process.
Dos and Don'ts
When filling out the VSD 001 form, there are important guidelines to follow. Here’s a list of things you should and shouldn’t do:
- Do print your information using blue or black ink.
- Do ensure that all personal information, including your name and address, is accurate and complete.
- Do provide a valid email address and daytime telephone number for contact purposes.
- Do sign and date the application to certify the information is true.
- Do submit the form in person to the Department of Motor Vehicles along with your application for a driver license or identification card.
- Don't leave any required fields blank; incomplete forms may delay processing.
- Don't use pencil or any ink color other than blue or black for filling out the form.
- Don't forget to pay the additional $5 fee for the veteran designation.
- Don't submit the form without verifying that all information is correct and all required documents are included.
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