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Service Member Information
Type N/A if Mailing State and Home State are the same
If the Veteran is Married and the Caregiver is the Spouse, select No for this question. The Spouse information is all that is needed in that case.
Spouse Information
Caregiver Information

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The collected demographic information is voluntary and used for research and reporting purposes only. Your responses will not impact any of the services you receive. If you prefer not to answer, simply leave the question blank.
Veteran Demographic Information
Spouse's Demographic Information