The VSD 001 form is a document used in California to verify veteran status and service-connected disabilities. It is essential for veterans seeking specific designations on their driver licenses or identification cards. To begin the process, fill out the form by clicking the button below.
The VSD 001 form is a critical document for veterans in California seeking verification of their veteran status and service-connected disabilities. This form serves multiple purposes, including facilitating the issuance of a driver license or identification card that features a veteran designation. To initiate the process, applicants must complete Section 1, providing personal details such as their name, date of birth, and contact information. They must also certify their military service and discharge status, affirming the accuracy of the information provided. Authorized representatives from the County Veterans Service Office play a vital role in Sections 3 and 5, where they confirm the applicant's eligibility based on the documentation submitted. Furthermore, for those applying for disabled veteran license plates, Section 4 specifically addresses the qualifications related to disabilities resulting from military service. It is essential to note that a $5 fee is required for the veteran designation, and the completed form must be submitted in person to the Department of Motor Vehicles, in accordance with California Vehicle Code regulations. The VSD 001 form is not only a means of identification but also a recognition of the sacrifices made by veterans in service to the nation.
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
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
PHONE NUMBER
COUNTY
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
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
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.
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
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This form must be filled out using blue or black ink and submitted in person to the DMV. Online submissions are not accepted.
Only individuals who have served in the United States uniformed services and received an other than dishonorable discharge can request this verification.
The VSD 001 form is for both veterans seeking verification of status and those applying for service-connected disability verification.
A $5 fee must be paid when applying for a driver license or identification card with a veteran designation.
Only authorized representatives from the County Veterans Service Office can sign the form to certify the applicant's qualifications.
This form is not transferable and must be submitted with the application for a driver license or identification card at the time of application.
To qualify, the applicant must meet specific criteria related to disabilities resulting from injuries or diseases suffered during active service.
The VSD 001 form is essential for veterans seeking verification of their status and service-connected disabilities in California. Alongside this form, several other documents may be required to complete the application process. Below is a list of common forms and documents that often accompany the VSD 001 form, each serving a specific purpose.
Gathering these documents can streamline the application process and ensure that veterans receive the benefits they deserve. Each form plays a vital role in confirming eligibility and facilitating access to necessary services.