Va Burial Benefits Details

Va Form 21P 530 is a document that veterans use to apply for pensions. The form can be filled out online or on paper, and it asks for a variety of information about the veteran's service history and current situation. The pension program is designed to help veterans who are no longer able to work because of their military service. The application process can be tricky, so it's important to know what you need to include in order to have the best chance of being approved. This blog post will walk you through the steps of filling out Va Form 21P 530, so you can get the benefits you deserve.

You'll find additional information relating to the va form 21p 530 by looking through the listing we prepared.

QuestionAnswer
Form NameVa Form 21P 530
Form Length4 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min
Other namesva form 21p 530, va form 21p 530 application for burial benefits, veterans burial benefits form 21p 530, va burial benefits for veterans

Form Preview Example

NOTICE OF EVIDENCE NECESSARY TO SUBSTANTIATE A CLAIM

FOR BURIAL BENEFITS (UNDER 38 U.S.C., CHAPTER 23)

This notice provides information regarding the evidence necessary to substantiate a claim for:

Non-service-connected Burial Allowance

Service-connected Burial Allowance

VA Hospitalization Death Burial Allowance

Plot or Interment Allowance

Transportation Reimbursement

Unclaimed Remains of Veteran

When to Use this Form

Use this notice and the attached application to submit a claim for any of the above named burial allowances and related burial benefits. This notice informs you of the evidence necessary to decide your claim. After you submit your claim on the attached application, you will not receive an initial letter regarding your claim. You do not need to submit another application.

If you are filing a claim for new burial benefits or disagree with

Please complete and submit VA Form 21P-530EZ, Application for

an evaluation decided more than one year ago...

Burial Benefits

 

 

If you disagree with a burial decided within the past year and

 

have new and relevant evidence OR

Please complete and submit VA Form 20-0995, Decision Review

 

If you are filing a supplemental claim (a claim after an initial

Request: Supplemental Claim**

 

claim for the same burial benefit(s) previously decided)...

 

 

 

**You may also file a request for a higher-level review or an appeal to the Board of Veterans' Appeals. For additional information on all these different options, please visit https://benefits.va.gov/benefits/appeals.asp.

Want to apply electronically?

You can apply for VA burial benefits online at https://www.va.gov/. You can also upload all supporting evidence you may have and make your claim a Fully Developed Claim (FDC).

NOTE: You may wish to contact an accredited Veterans Service Officer (VSO) to assist you with your application. For a list of accredited Veterans Service Organizations go to https://www.va.gov/vso/. You may also contact your state office of Veterans Affairs at https://www.va.gov/statedva.htm should you need further assistance with the application process.

Want your claim processed faster?

The FDC Program is the fastest way to get your claim processed without any risk to participate! To participate, submit your claim in accordance with the "FDC Criteria" shown below. If you are making a claim for survivor benefits, use VA Form 21P-534EZ, Application for DIC, Survivors Pension, and/or Accrued Benefits. VA forms are available at www.va.gov/vaforms.

NOTE: Participation in the FDC program is optional and will not affect the benefits to which you are entitled. If you file a claim in the FDC Program and it is determined that other records exist and VA needs the records to decide your claim, then VA will simply remove the claim from the FDC Program and process it in the Standard Claim Process. If you wish to file your claim in the FDC Program, see FDC Program (Optional Expedited Process) on page 3. If you wish to file your claim under the process in which VA traditionally processes claims, see Standard Claim Process on page 3.

FEES for claims: Section 5904, Title 38, United States Code (codified in § 14.636, Title 38, Code of Federal Regulations) contains provisions regarding fees that may be charged, allowed, or paid for services provided by a VA-accredited attorney or agent in connection with a proceeding before the Department of Veterans Affairs with respect to a claim for benefits under laws administered by the Department. Generally, a VA-accredited attorney or agent may charge you a fee for assisting in seeking further review of a claim for VA benefits only after VA has issued an initial decision on the claim and the attorney or agent has complied with the applicable power-of-attorney and the fee agreement requirements.

VA FORM

21P-530EZ

SUPERSEDES VA FORM 21P-530, APR 2017

Page 1

NOV 2021

GENERAL INFORMATION

ELIGIBLE CLAIMANTS (Who Should File A Claim):

Check the appropriate box on the form (block 10) regarding your relationship to the veteran to certify your correct claimant eligibility.

VA may grant a claim that any eligible person files. Upon death of the veteran, VA will pay the first living person to file a claim of those listed below:

The veteran's surviving spouse; OR

The survivor of a legal union between the deceased veteran and the survivor; OR

The veteran's children, regardless of age (biological, step and adopted); OR

The veteran's parents or the surviving parent; OR

The executor or administrator of the deceased veteran's estate, or person acting for the deceased veteran's estate. A family member of the veteran who has paid for the burial or funeral expenses will be considered acting for the veteran's estate for burial benefit purposes only.

For purposes of this application, legal union means a formal relationship between the veteran and the survivor that existed on the date of the veteran's death, was recognized under the law of the State in which the couple formalized to relationship and was evidenced by the State's issuance of documentation memorializing the relationship.

If the veteran's remains are unclaimed, VA will pay the person or entity that provided burial services for the remains of an unclaimed veteran.

NOTE: Claimant Social Security Number and date of birth are not required when claiming unclaimed remains, or if the claimant is a firm, corporation, or state agency.

TIME LIMIT FOR FILING A CLAIM: Claim for non-service-connected burial allowance must be filed with VA within 2 years after the date of the veteran's permanent burial or cremation. If a veteran's discharge was corrected after death to "Under Conditions Other Than Dishonorable," the claim must be filed within 2 years after the date of correction. There is no time limit for the service-connected burial allowance, plot or interment allowance, VA hospitalization death burial allowance, or reimbursement of transportation expenses.

BURIAL ALLOWANCE: A one-time benefit payment payable toward the expenses of the funeral and burial of the veteran's remains. Burial includes all legal methods of disposing of the veteran's remains including, but not limited to, cremation, burial at sea and medical school donation. (See evidence table for more information.)

PLOT OR INTERMENT ALLOWANCE: A one-time benefit payment payable toward:

(1)Expenses incurred for the plot or interment if the burial was not in a national cemetery under the jurisdiction of the United States and non-service- connected burial or VA hospitalization death burial allowance is granted; OR

(2)Expenses are payable if non-service-connected burial is granted and veteran was buried in a State-owned cemetery or sub-section used solely for the remains of persons and meets eligibility for burial in a national cemetery.

"Plot" means the final disposition site of the remains, whether it is a grave, mausoleum vault, columbarium niche, or similar place. "Interment" means the burial of casketed remains in the ground or the placement of cremated remains into a columbarium niche.

TRANSPORTATION REIMBURSEMENT: When transportation reimbursement is allowable, VA may pay for expenses relating to the transportation of the veteran's remains. This includes the pickup of the remains and the transportation of the veteran's remains to his or her final resting place. Claims for transportation reimbursement benefits must include a statement of account showing itemized transportation charges.

VA may pay transportation reimbursement only when one of the following eligibility requirements are met:

Service-connected burial allowance granted, or the veteran was in receipt of VA disability compensation and burial was in a national cemetery; OR

Non-service-connected burial allowance granted, and the veteran was in receipt of VA disability compensation and burial was in a national cemetery; OR

Burial for veteran's unclaimed remains granted and burial was in a national cemetery; OR

VA hospitalization death burial allowance granted.

PROOF OF DEATH TO ACCOMPANY CLAIM: Death in a government institution does not need to be proven. In other cases, the claimant must forward a copy of the public record of death. If the proof of death has previously been furnished to VA, it does not need to be submitted again.

Claims for service-connected burial allowance must include the veteran's cause of death.

RESPONSIBLE FOR (LEGALLY INCURRED) EXPENSES: The claimant (you) have already paid or owe the burial expenses for the benefit being claimed and is legally the responsible party for the debt. By checking "Yes" on the form, you are certifying that this statement is true. If filing as an executor of the veteran's estate, by checking "Yes," you certify that the veteran paid the burial prior to his or her death or funds from the estate were used as payment.

SERVICE RECORD: A photocopy of the veteran's DD214 (or equivalent) for all periods of military service will permit prompt processing. You may request a copy of the DD214 through the National Archives' National Personnel Records Center (NPRC) using SF 180 (Nov 2015 version), Request Pertaining to Military Records, (available at https://www.archives.gov/) or through your local public custodian of records. Service documents will not be returned. If the veteran was receiving VA benefits, this is not required with your application.

VA FORM 21P-530EZ, NOV 2021

Page 2

SUBMITTING A CLAIM

When submitting a claim(s) for Burial Benefits the following information tells you what you need to do and what VA will do during the FDC Program (Optional Expedited Process) or the Standard Claim Process:

HOW TO SUBMIT A CLAIM: Submit your claim on a VA Form 21P-530EZ, Application for Burial Benefits (attached). Make sure you complete and sign your application.

WHAT YOU NEED TO DO: The tables beginning on page 3 describes the information and evidence you need to submit based on if you wish to have your claim considered in the FDC Program (Optional Expedited Process) or in the Standard Claim Process. You will need to indicate how you want your claim to be processed by checking the appropriate box in Section VI on page 7 of this form.

FDC Program (Optional Expedited Process)

Standard Claim Process

You must submit:

Please submit a complete signed VA Form 21P-530EZ, Application for

• A signed and FULLY COMPLETE VA Form 21P-530EZ,

Burial Benefits, that includes any required evidence listed in the tables

Application for Burial Benefits

below.

Required evidence for each burial benefit claimed (see tables below)

If you know of any evidence not in your possession and want VA to try to

• Complete veteran and claimant information

get it for you;

• Proof of veteran's death, including the cause of death, if claiming

You must:

service-connected burial allowance. If the veteran was seen outside of

Complete and sign VA Form 21-4142 and VA Form 21-4142a,

the VA, you must include copies of any medical records from a

identifying any private medical records you wish VA to request for

private medical provider or provide a completed VA Form 21-4142,

you

Authorization to Disclose Information to the Department of Veterans

• Give VA enough information about other relevant evidence so that

Affairs (VA) and VA Form 21-4142a, General Release for Medical

Provider Information to the Department of Veterans Affairs (VA),

we can request it from the person or agency that has it

with your application for VA to request the records on your behalf

If the holder of the evidence declines to give it to VA, asks for a fee to

• An itemized statement of account, if claiming transportation

provide it, or otherwise cannot get the evidence, VA will notify you and

reimbursement

provide you with an opportunity to submit the information or evidence. It

NOTE: If you decide to submit your claim through the FDC Program,

is your responsibility to make sure we receive all requested records that

are not in the possession of a Federal department or agency.

please indicate FDC in Section VI of the application on page 7.

 

You must:

You are strongly encouraged to:

Send the above information and any specific evidence listed below

• Send any information or evidence as soon as you can

for the burial benefit(s) claimed along with your claim form

You have up to one year from the date we receive the claim to submit the

 

If you submit additional information or evidence after you submit your

information and evidence necessary to support your claim. If within 30

"fully developed" claim, then VA will remove the claim from the FDC

days, you do not provide any evidence or do not provide us with the

Program (Optional Expedited Process) and process it in the Standard Claim

information requested to assist you with obtaining evidence, we may

Process. If we decide your claim before one year from the date we receive

decide your claim prior to the expiration of the one year period. If we

the claim, you will still have the remainder of the one-year period to submit

decide the claim before one year from the date we receive the claim, you

additional information or evidence necessary to support the claim.

will still have the remainder of the one year period to submit additional

 

information or evidence necessary to support the claim.

 

 

HOW VA WILL HELP YOU OBTAIN EVIDENCE FOR YOUR CLAIM: The table below describes the information and evidence VA will assist you in obtaining based on whether you wish to have your claim considered in the FDC Program (Optional Expedited Process) or in the Standard Claim Process.

FDC Program (Optional Expedited Process)

Standard Claim Process

VA will:

VA will:

• Retrieve relevant records from a Federal facility, such as a VA

• Retrieve relevant records from a Federal facility, such as a VA

Medical Center, that you adequately identify and authorized VA to

Medical Center, that you adequately identify and authorized VA to

obtain.

obtain.

• Provide a medical examination for you, or get a medical opinion, if

• Provide a medical examination for you, or get a medical opinion, if

we determine it is necessary to decide your claim.

we determine it is necessary to decide your claim.

 

• Make every reasonable effort to obtain relevant records not held by a

 

Federal facility that you adequately identify and authorize VA to

 

obtain. These may include records from State or local governments

 

and privately held evidence and information you tell us about, such as

 

a private doctor or hospital records from current or former employers.

 

 

WHERE TO SEND INFORMATION AND EVIDENCE: You may send your application and any evidence in support of your claim by using any of the following methods shown in the table below.

MAIL TO

ONLINE

Department of Veterans Affairs

 

Pension Claims

 

Intake Center

https://www.va.gov/

PO Box 5365

 

Janesville, WI 53547-5365

 

 

 

VA FORM 21P-530EZ, NOV 2021

Page 3

WHAT THE EVIDENCE MUST SHOW TO SUPPORT YOUR CLAIM: The tables below show what evidence you must provide and eligibility information to support your claim for burial benefits.

EVIDENCE TABLES

Non-Service-Connected Burial Allowance

To support a claim for non-service-connected burial allowance, the evidence mush show:

VA received a burial claim for non-service-connected burial allowance no later than two years after the burial or cremation of the veteran; AND

You are an eligible claimant authorized burial benefits; AND

Proof of veteran's death; AND

Statement certifying that the claimant incurred the burial expenses of the deceased veteran, or claimant is the executor of the estate and is applying on behalf of the veteran who incurred the expenses; AND

Verification of veteran's military service (only if veteran was not in receipt of VA benefits at time of death; AND

On the date of death, the veteran:

Was in receipt of VA disability compensation or VA pension; OR

Had a claim pending which would have resulted in entitlement to VA disability compensation or VA pension; OR

Was entitled to receive VA disability compensation or VA pension but decided to receive military retirement or disability pay in place of VA disability compensation check.

Service-Connected Burial Allowance

To support a claim for service-connected burial allowance, the evidence must show:

VA received a burial claim for service-connected burial allowance; AND

You are an eligible claimant authorized burial benefits; AND

Proof of veteran's death including the cause of death; AND

Statement certifying that the claimant incurred the burial expenses of the deceased veteran, or claimant is the executor of the estate and is applying on behalf of the veteran who incurred the expenses; AND

Verification of the veteran's military service (only if the veteran was not in receipt of VA benefits at the time of death; AND

If your claim is based on a service-connected disability established during the veteran's lifetime, the evidence must show:

The veteran had a service-connected disability(ies) that was/were either the principal or contributory cause of the veteran's death; OR

If your claim is based on a disability that was not established as service-connected during the veteran's lifetime or for which the veteran did not file a claim during his or her lifetime, the evidence must show:

An injury or disease that was incurred or aggravated during active military service, or an event in service that caused an injury or disease;

AND

A physical or mental disability that was either the principle and contributory cause of death. This may be shown by medical evidence or by lay evidence of persistent and recurrent symptoms of a disability that were visible or observable; AND

A relationship between the disability associated with the cause of death and an injury, disease, or event in military service. Medical records or medical opinions are generally required to establish this relationship.

VA Hospitalization Death Burial Allowance

In order to support a claim for VA hospitalization death burial allowance, the evidence must show:

VA received a burial claim for VA hospitalization death burial allowance; AND

You are an eligible claimant authorized burial benefits; AND

Statement certifying that the claimant incurred burial expenses of the deceased veteran, or claimant is the executor of the estate and is applying on behalf of the veteran who incurred the expenses; AND

Verification of veteran's military service; AND

Proof veteran's death occurred at VA medical center, State Veterans home, or nursing home under VA contract. For VA hospitalization, for the purpose of this burial benefit, VA hospitalization is met, if at the time of death, the veteran:

Was properly admitted to a VA facility; OR

Was transferred or admitted to a non-VA facility for hospital care under VA contract; OR

Was transferred or admitted to a nursing home for nursing home care at the expense of the VA contract; OR

Was traveling under proper prior authorization to or from a specified place for purpose of examination, treatment or care, at VA expense; OR

Was transferred or admitted to a State nursing home at the expense of the VA, under VA contract; OR

Was a patient in a State Veteran's home; AND

Total cost of the veteran's burial is listed on the form.

VA FORM 21P-530EZ, NOV 2021

Page 4

EVIDENCE TABLES (Continued)

Unclaimed Remains

In order to support a claim for unclaimed remains, the evidence must show:

VA received a burial claim for veteran's unclaimed remains no later than two years after the burial or cremation of the veteran; AND

You are an eligible claimant authorized burial benefits; AND

Proof of veteran's death; AND

Statement certifying that the claimant incurred burial expenses of the deceased veteran; AND

The remains of the deceased veteran have not been claimed by relatives or friends; AND

There are not sufficient resources available in the veteran's estate to cover the burial and funeral expenses.

Plot or Interment Allowances

In order to support a claim for plot or interment allowance, the evidence must show:

VA received a burial claim for plot or interment allowance; AND

You are an eligible claimant authorized burial benefits; AND

Proof of veteran's death; AND

Statement certifying that the claimant incurred plot or interment expenses, or claimant is the executor of the estate and is applying on behalf of the veteran who incurred the expenses; AND

Veterans burial or interment was not in a National cemetery, State Veterans cemetery or other State-owned cemetery.

Transportation Reimbursement

To support your claim for transportation reimbursement, the evidence mush show:

VA received a burial claim for transportation reimbursement; AND

You are an eligible claimant authorized burial benefits; AND

Proof of veteran's death; AND

Statement certifying that the claimant incurred transportation expenses of the deceased veteran, or claimant is the executor of the estate and is applying on behalf of the veteran who incurred the expenses; AND

An itemized receipt or statement, preferably on letterhead that includes the:

Name of the deceased veteran; AND

Specific transportation costs incurred; AND

Date of the services rendered; AND

Name of the individual who paid the costs.

HOW VA DETERMINES THE EFFECTIVE DATE

Burial benefits are based on the date of the veteran's death and the death date we receive your claim. The veteran's death certificate is relevant evidence used in determining the effective date of any benefits we award.

VA FORM 21P-530EZ, NOV 2021

Page 5

OMB Approved No. 2900-0003

Respondent Burden: 30 Minutes

Expiration Date: 10/31/2023

APPLICATION FOR BURIAL BENEFITS

(Under 38 U.S.C. Chapter 23)

IMPORTANT - Please read the Privacy Act and Respondent Burden on page 8 before completing the form. SELECT THE TYPE OF CLAIM PROGRAM/PROCESS (Check the appropriate box. See Instructions pages.)

NOTE: You can either complete the form online or by hand. If you complete the form online, you may submit it at https://www.va.gov/ to expedite processing. If you complete the form by hand, please print the information requested in ink, neatly, and legibly to help process the form.

VA DATE STAMP

(DO NOT WRITE IN THIS SPACE)

SECTION I - PERSONAL IDENTIFICATION OF VETERAN

1. FIRST, MIDDLE INITIAL, LAST NAME OF THE DECEASED VETERAN

2. VETERAN'S SOCIAL SECURITY NUMBER

3. VA FILE NUMBER

CLAIMANT'S PERSONAL INFORMATION

4.CLAIMANT'S NAME (First, middle initial, last)

5.CLAIMANT'S SOCIAL SECURITY NUMBER

6.CLAIMANT'S DATE OF BIRTH (MM/DD/YYYY) (See instructions for exceptions.)

Month

 

 

Day

 

 

 

Year

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7.CURRENT MAILING ADDRESS (Number and street or rural route, P.O. Box, City, State, ZIP Code and Country)

No. &

Street

Apt./Unit Number

 

 

 

 

 

City

 

 

 

 

 

 

 

State/Province

Country

ZIP Code/Postal Code

8.TELEPHONE NUMBER (Include Area Code)

9. E-MAIL ADDRESS

10. RELATIONSHIP OF CLAIMANT TO DECEASED VETERAN (Check one)

SPOUSE OR SURVIVOR OF LEGAL UNION

CHILD

PARENT

EXECUTOR/ADMINISTRATOR OF ESTATE OR PERSON ACTING FOR THE ESTATE

FUNERAL HOME OR CLAIMANT WHO PAID FOR BURIAL OF UNCLAIMED REMAINS

SECTION II - INFORMATION REGARDING VETERAN

11.DATE OF BIRTH (MM/DD/YYYY)

Month

 

 

Day

 

 

 

Year

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

12.DATE OF DEATH (MM/DD/YYYY)

Month

 

 

Day

 

 

 

Year

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

13. DATE OF BURIAL (MM/DD/YYYY)

 

Month

Day

Year

SERVICE INFORMATION (The following information should be furnished for the periods of the VETERAN'S ACTIVE SERVICE)

14A. ENTERED SERVICE

DATE

PLACE

(MM/DD/YYYY)

 

 

 

14B. SERVICE

NUMBER

14C. SEPARATED FROM SERVICE

DATE

PLACE

(MM/DD/YYYY)

 

 

 

14D. GRADE, RANK OR RATING,

ORGANIZATION AND BRANCH OF SERVICE

15. IF VETERAN SERVED UNDER NAME OTHER THAN THAT SHOWN IN ITEM 1, GIVE FULL NAME AND SERVICE RENDERED UNDER THAT NAME

VA FORM

21P-530EZ

SUPERSEDES VA FORM 21P-530, APR 2017

Page 6

NOV 2021

 

 

 

VETERAN'S SSN (Pre-populated from Page 6)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION III - CLAIM FOR BURIAL ALLOWANCE

 

 

 

 

 

 

 

16A. SELECT TYPE OF BURIAL ALLOWANCE YOU ARE CLAIMING

 

16B. WHERE DID THE VETERAN'S DEATH OCCUR? (Check one)

 

 

 

 

 

 

 

(May apply for more than one.)

 

 

 

 

 

 

 

 

 

 

NURSING HOME/FACILITY (NOT PAID BY VA) OR VETERANS RESIDENCE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NON-SERVICE-CONNECTED BURIAL ALLOWANCE

 

 

 

 

 

NURSING HOME/FACILITY (PAID BY VA)*

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SERVICE-CONNECTED BURIAL ALLOWANCE

 

 

 

 

 

 

 

 

 

 

VA MEDICAL CENTER*

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VA HOSPITALIZATION DEATH BURIAL ALLOWANCE*

 

 

 

 

 

STATE VETERANS FACILITY*

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

UNCLAIMED REMAINS OF VETERAN

 

 

 

 

 

 

 

 

 

 

OTHER (Specify place of death.)*

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(If claimed, you must answer question 16B.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

*Please provide veteran's specific place of death including the name and location of the

 

 

 

 

 

 

 

(If VA Hospitalization Death is checked, provide actual burial cost.)

 

nursing home, VA Medical Center or state veteran facility

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

YES

 

 

NO

 

17. IF YOU ARE THE DECEASED VETERAN'S SPOUSE, DID YOU PREVIOUSLY RECEIVE A VA BURIAL ALLOWANCE?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

18A. ARE YOU RESPONSIBLE FOR THE VETERAN'S BURIAL EXPENSES?

 

 

YES

 

 

 

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

18B. DO YOU CERTIFY THE REMAINS OF THE DECEASED VETERAN HAVE NOT BEEN CLAIMED BY RELATIVES OR FRIENDS AND THERE ARE NOT SUFFICIENT

 

 

 

 

 

 

 

RESOURCES AVAILABLE IN THE VETERAN'S ESTATE TO COVER THE BURIAL AND FUNERAL EXPENSES? (Required only if claiming unclaimed remains of veteran.)

 

 

 

 

 

 

 

YES

 

 

 

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION IV - CLAIM FOR PLOT OR INTERMENT ALLOWANCE

 

 

 

 

 

 

 

19. PLACE OF BURIAL PLOT, INTERMENT SITE, OR FINAL RESTING PLACE OF DECEASED VETERAN'S REMAINS

 

 

 

 

 

 

 

 

 

 

 

 

 

CEMETERY/GRAVEYARD

 

 

 

PRIVATE RESIDENCE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MAUSOLEUM/VAULT/TOMB/CRYPT

 

 

 

OTHER (Specify)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

20A. ARE YOU RESPONSIBLE FOR THE VETERAN'S PLOT OR INTERMENT

 

 

 

 

 

 

20B. WAS VETERAN BURIED IN A NATIONAL CEMETERY, OR ONE OWNED BY

 

 

 

 

 

 

 

EXPENSES?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

THE FEDERAL GOVERNMENT?

 

 

 

 

 

 

 

 

 

 

 

 

 

YES

 

 

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

YES

 

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

20C. WAS THE VETERAN BURIED IN A STATE VETERANS CEMETERY?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

YES

 

 

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

21A. DID A FEDERAL/STATE GOVERNMENT OR THE VETERAN'S EMPLOYER

 

 

 

 

 

 

21B. AMOUNT OF GOVERNMENT OR EMPLOYER CONTRIBUTION

 

 

 

 

 

 

 

CONTRIBUTE TO THE BURIAL?

 

 

 

 

 

 

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

YES

 

 

 

NO

(If "Yes," complete Item 21B)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION V - CLAIM FOR TRANSPORTATION REIMBURSEMENT

 

 

 

 

22. ARE YOU RESPONSIBLE FOR THE VETERAN'S TRANSPORTATION EXPENSES FROM THE PLACE OF DEATH TO THE FINAL RESTING PLACE?

 

 

 

 

 

(You must include an itemized receipt.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

YES

 

 

 

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION VI - CLAIM CERTIFICATION AND SIGNATURES (MUST COMPLETE)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CLAIMANT CERTIFICATION AND SIGNATURE

 

 

 

 

 

 

 

 

 

 

 

 

 

I WANT my claim processed under the FDC program. I CERTIFY and authorize the release of information. I CERTIFY that the statements in this

 

 

 

 

 

 

 

 

 

 

 

 

 

 

document are true and complete to the best of my knowledge. I AUTHORIZE any person or entity, including but not limited to any organization,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

service provider, employer, or government agency, to give the Department of Veterans Affairs any information about me and the veteran, and I

 

 

 

 

 

 

 

WAIVE any privilege which makes the information confidential. I CERTIFY I have received the notice attached to this application titled,

 

 

 

 

 

 

 

Application for Burial Benefits, and, I CERTIFY I have enclosed all the information or evidence that will support my claim, to include an

 

 

 

 

 

 

 

identification of relevant records available at a Federal facility such as a VA medical center; or, I have no additional information or evidence to give

 

 

 

 

 

 

 

VA to support my claim.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I do not want my claim processed under the FDC program. I am indicating I want my claim processed under the standard claim process because I

 

 

 

 

 

 

 

 

 

 

 

 

 

 

plan to submit further evidence in support of my claim.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

23A. SIGNATURE OF CLAIMANT (REQUIRED) (Physical Signature OR E-Signature)

 

 

23B. PRINTED NAME OF CLAIMANT

 

 

 

 

 

 

 

 

 

 

 

 

 

(If signed using an "X", complete Items 25A through 26B.) (If signing for a firm,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

corporation, or State agency, complete Items 24A through 24B.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

24A. FULL PRINTED NAME AND ADDRESS OF PERSON, FIRM, CORPORATION,

 

 

24B. OFFICIAL POSITION OF PERSON SIGNING ON BEHALF OF FIRM,

 

 

 

 

 

 

 

OR STATE AGENCY SIGNING AS CLAIMANT (If different from Item 7.)

 

 

 

 

 

 

 

 

 

 

CORPORATION OR STATE AGENCY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VA FORM 21P-530EZ, NOV 2021

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Page 7

VETERAN'S SSN (Pre-populated from Page 6)

SECTION VII - WITNESSES TO SIGNATURE

NOTE - If the claimant signed above using an "X", a signature must be witnessed by two persons to whom the person making the statement and the signatures and addresses of such witnesses must be shown below.

25A. SIGNATURE OF WITNESS (Physical Signature) (Only sign if the signature in Item 23A used an "X")

25B. PRINTED NAME AND ADDRESS OF WITNESS

26A. SIGNATURE OF WITNESS (Physical Signature) (Only sign if the signature in Item 23A used an "X")

26B. PRINTED NAME AND ADDRESS OF WITNESS

SECTION VIII - ALTERNATE SIGNER CERTIFICATION AND SIGNATURE (REQUIRED ONLY IF ITEM 23A IS BLANK)

I CERTIFY THAT by signing on behalf of the claimant, I am a court-appointed representative; OR, an attorney in fact or agent authorized to act on behalf of a claimant under a durable power of attorney; OR, a person who is responsible for the care of the claimant, to include but not limited to a spouse or other relative; OR, a manager or principal officer acting on behalf of an institution which is responsible for the care of an individual; AND, that the claimant is under the age of 18; OR, is mentally incompetent to provide substantially accurate information needed to complete the form, or to certify that the statements made on the form are true and complete; OR, is physically unable to sign this form.

I UNDERSTAND that I may be asked to confirm the truthfulness of the answers to the best of my knowledge under penalty of perjury. I also understand that VA may request further documentation or evidence to verify or confirm my authorization to sign or complete an application on behalf of the claimant if necessary. Examples of evidence which VA may request include: Social Security Number (SSN) or Taxpayer Identification Number (TIN); a certificate or order from a court with competent jurisdiction showing your authority to act for the claimant with a judge's signature and a date/time stamp; copy of documentation showing appointment of fiduciary; durable power of attorney showing the name and signature of the claimant and your authority as attorney in fact or agent; health care power of attorney, affidavit or notarized statement from an institution or person responsible for the care of the claimant indicating the capacity or responsibility of care provided; or any other documentation showing such authorization.

27A. ALTERNATE SIGNER SIGNATURE (REQUIRED) (Physical Signature)

27B. DATE SIGNED (MM/DD/YYYY)

PRIVACY ACT INFORMATION: The responses you submit are considered confidential (38 U.S.C. 5701). They may be disclosed outside the Department of Veterans Affairs (VA) only if the disclosure is authorized under the Privacy Act, including the routine uses identified in the VA system of records, 58VA21/22/28, Compensation, Pension, Education and Vocational Rehabilitation and Employment Records - VA, published in the Federal Register. The requested information is considered relevant and necessary to determine maximum benefits under the law and is required to obtain benefits. Information submitted is subject to verification through computer matching programs with other agencies.

RESPONDENT BURDEN: We need this information to determine your eligibility for burial benefits. Title 38, United States Code, allows us to ask for this information. We estimate that you will need an average of 30 minutes to review the instructions, find the information, and complete this form. VA cannot conduct or sponsor a collection of information unless a valid OMB control number is displayed. Valid OMB control numbers can be located on the OMB Internet Page at www.reginfo.gov/ public/do/PRAMain.

PENALTY - The law provides severe penalties which include fine or imprisonment, or both, for the willful submission of any statement or evidence of a material fact knowing it to be false.

DEPARTMENT OF VETERANS AFFAIRS HEADSTONES AND MARKERS

The Department of Veterans Affairs will furnish, upon request, a Government headstone or marker at the expense of the United States for the unmarked graves of certain individuals eligible for burial in a national cemetery, but not buried there. These individuals may include any veterans with an other than dishonorable discharge who dies after service or any servicemember who dies on active duty. Certain other individuals may also be eligible for the headstone or marker. Headstones or Markers for all individuals in a national or post cemetery are furnished automatically without a request from the family. For additional information on burial benefits go to the web site, www.cem.va.gov/bbene_burial.asp. To obtain VA Form 40-1330, Application for Standard Government Headstone or Marker go to www.va.gov/vaforms or contact your local VA regional office. The address of that office can be found at www.va.gov/directory.

VA FORM 21P-530EZ, NOV 2021

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