VA Form 40-10007: Application for Pre-Need Determination of Eligibility for Burial in a VA National Cemetery

Enter the Veteran/Servicemember Name in Box 1 (Include Suffix) (Last, First, Middle Name or Initial) and the Name Used During Military Service in Box 2 (If different than Item 1) (Last, First, Middle Name).

Enter the Mailing Address in Box 3 (Street, City, State, and ZIP Code, P.O. Box, Rural Routes, etc.) and the Social Security Number in Box 4.

Enter the Military Service Number in Box 5 (If different from SSN) and the VA Claim Number in Box 6 (If known).

In Box 7, mark FEMALE or MALE (Information will be used for statistical purposes only).

In Box 8, Race or Ethnicity, select one or more (Information will be used for statistical purposes only): American Indian or Alaska Native, Asian or Asian American, Black or African American, Hispanic or Latino, Not Hispanic or Latino, Native Hawaiian or Other Pacific Islander, White.

Enter the Date of Birth (MM/DD/YYYY) in Box 9 and the Place of Birth (City, State or Territory) in Box 10.

In Box 11, mark YES, NO or DON'T KNOW for: is Veteran/Servicemember deceased? In Box 12, enter the Date of Death (If applicable) (MM/DD/YYYY).

In Box 13, mark the Marital Status: Widowed, Single, Separated, Married or Divorced.

In Box 14, Military Status Used to Apply for Eligibility Determination (Check all that apply): A. Veteran, B. Retired Active Duty, C. Died on Active Duty, D. Retired Reserve, E. Retired National Guard, F. Death Related to Inactive Duty Training, G. Other (See instructions).

If eligibility derives from a status not listed, or if the individual is not certain of the status, check “Other” and submit evidence of service and VA will provide appropriate assistance.

Enter the Branch of Service in Box 15, the Date of Entry (MM/DD/YYYY) in Box 16, the Date of Discharge (MM/DD/YYYY) in Box 17, the Discharge - Character of Service (See instructions) in Box 18 and the Highest Rank Attained (No pay grades) in Box 19. In Box 20, enter the State (Abbrev.) (National Guard Service Only).

In Item 18, please indicate one type of “Discharge - Character of Service”: Honorable; General; Entry Level Separation/Uncharacterized; Other Than Honorable; Bad Conduct; or Dishonorable.

In Box 21, mark YES (Complete Item 22), NO (Skip Item 22) or DON'T KNOW (Skip Item 22) for: is there anyone currently buried in a VA national cemetery under this Veteran's/Servicemember's eligibility? In Box 22, enter the Name of Decedent(s) and VA National Cemetery Where Buried.

In Box 23, Supporting Documents Attached, mark YES or NO. VA recommends that you attach photocopies of readily available supporting documents.

In Box 24, enter the Claimant's Name (Last, First, Middle) and, under Who Is (Check one), mark A. the Veteran/Servicemember named in Box 1, B. the Spouse/Surviving Spouse of the Veteran/Servicemember in Box 1, C. an Unmarried Adult Child of the Veteran/Servicemember in Box 1 (Additional documentation required. Please read instructions on reverse carefully if selecting 24C.), or D. Other (Please specify). Each Claimant requires a separate VA Form 40-10007.

Enter the Claimant's Mailing Address in Box 25 (If different from Item 3), the Claimant's Telephone Number in Box 26 (Include Area Code) and the Claimant's Social Security Number in Box 27 (If different from Item 4).

Enter the Date of Birth in Box 28 (If different from Item 9) (MM/DD/YYYY) and the Maiden Name in Box 29 (If applicable).

Enter the Desired VA National or State/Tribal Cemetery in Box 30 (Optional - See instructions) and the Email Address in Box 31.

By signing in Box 32, you certify that you are the Claimant identified in item 24, or an individual signing for the Claimant identified in Item 35. All of the information entered on this form about the Claimant is true and correct to the best of your knowledge. In Box 32, Your Signature: sign it. In Box 33, enter the Date (MM/DD/YYYY).

In Box 34, check one: A. Self (Stop here. Leave Items 35-38 blank), or B. Individual signing for the Claimant who is under 18 years of age, is mentally incompetent, or is physically unable to sign the pre-need application (Complete items 35 through 38).

If you checked B in Box 34, complete items 35 through 38. In Box 35, enter the Name of Individual from Item 34B Completing for the Claimant (Last, First, Middle Name). In Box 36, enter the Mailing Address of the individual. In Box 37, enter the Telephone Number (Include Area Code) (Optional), and in Box 38, the Email Address.

Submit Application and Supporting Documentation to VA by Mail to NCA Intake Center, P.O. Box 5237, Janesville, WI 53547; or by Fax to the National Cemetery Scheduling Office at (855) 840-8299. Pre-Need means before death. Only complete this form if you are applying for a Pre-Need determination of eligibility for burial in a VA national cemetery. Time of Need means time of death. DO NOT complete this form if the individual is already deceased; instead, contact a local funeral home or the National Cemetery Scheduling Office at 1-800-535-1117 to expedite processing.

Before VA can approve a claim for an unmarried adult child, VA will require statements from both the Veteran, spouse of the Veteran, and/or authorized representative AND the current attending physician (on physician's letterhead) stating the nature of the disability, date of onset of the disability, degree of dependency on the Veteran or Veteran's family, and the marital status of the child.

A fraudulent statement that leads to burial in a national cemetery or receiving other benefits from the VA could result in disinterment from that national cemetery and other penalties in accordance with the law.