RECA Research Request

RECA Research Request

Personal History & Claim Details Form
Contact Information

Please enter your information below
Your Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Mailing Address (where we need to send copies)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Claimant Information

The claimant is the person who was or is sick.
Name

First NameLast Name
Additional names (optional)
Include maiden names or other names they may have been known by.
Claimant's date of birth

MonthDayYear
Family Information

Claimants parents' names and their birth and/or death dates (helpful especially if the claimant was under 18 from 1951-1962)
Claimant's Father

First NameLast Name
Claimants Mother

First NameLast Name
Where did the claimant live, and when did they live there?

Dates listed must be between January 1951 and November 1962.
Town or City
From

MonthDayYear
Start Date
To

MonthDayYear
End Date
Additional Town or City (optional)
From

MonthDayYear
Start Date
To

MonthDayYear
Start Date
Please include any other relevant information.
How are you filing?
Learn how to file electronically
How to file by mail
Should be Empty:

Contact Information