Section I: Veteran's identification
The deceased Veteran's name, Social Security number, service number if different, VA file number, date and place of birth, and date of death.
21P-530a
State Application for Interment Allowance (Under 38 U.S.C. Chapter 23)
- Agency
- VA
- Revision
- October 2024
- Fillable fields
- 53
- Pages
- 2
- Official source
- VA form page
- Checked
- October 20, 2026
VA Form 21P-530a: State Application for Interment Allowance (Under 38 U.S.C. Chapter 23)
VA Form 21P-530a is the U.S. Department of Veterans Affairs State Application for Interment Allowance (Under 38 U.S.C. Chapter 23). The PDF itself is titled State or Tribal Organization Application for Interment Allowance. VA's form page says to use it if you're a state or tribal organization and want to apply for a VA interment allowance for a Veteran buried in a State or Tribal Veterans' cemetery.
The form is two pages. Sections I and II identify the deceased Veteran and the Veteran's active duty service, Section III names the cemetery and the recipient organization, Section IV is the official's certification and signature, and Section V holds remarks. Page 2 also prints the mailing address and the Privacy Act and Respondent Burden notices.
VA's page says the completed form can be submitted on the form page or printed and mailed. You can fill out the PDF free in your browser on this page and download the result without an account.
What's on VA Form 21P-530a
Section II: active duty service
Branch of service, date and place the Veteran entered and left active service, grade, rank or rating when separated, and any other name the Veteran served under.
Section III: cemetery and recipient
The name of the State cemetery or tribal organization claiming the allowance, the cemetery's name and location, the date of burial and the recipient organization's details.
Section IV: certification and signature
A certification that the Veteran named in Item 1 was buried in a State-owned Veterans Cemetery or Tribal Cemetery (without charge), with the official's signature, title and date.
Section V: remarks
Item 18 is an open space for any remarks.
Notices
Page 2 prints the Privacy Act information and a respondent burden of 5 minutes per respondent, per year.
How to file VA Form 21P-530a
- 1
Read page 2 first
The instructions say to read the Privacy Act and Respondent Burden information on page 2 before completing the form.
- 2
Fill in the Veteran's details
Complete Sections I and II. The form says it can be completed online or by hand, printing in blue or black ink, neatly and legibly.
- 3
Add cemetery and payee details
Complete Section III with the cemetery, the date of burial and the recipient organization, and add any remarks in Section V.
- 4
Have the official sign
The delegated State or Tribal Official signs Item 17A in ink and enters a title and date.
- 5
Submit online or mail it
VA's page says to submit the completed form on the form page, or print it and mail it to the address on the form.
Why fill Form 21P-530a on indox
You get the real form, filled in a browser tab, with nothing standing between you and the finished PDF.
- Fill the form right in your browser, no software to install
- Free to fill and free to download, with no account
- The official blank straight from the VA, not a copy someone retyped
- Works on a phone, tablet or computer
Where to send it
By mail
Department of Veterans Affairs, Pension Intake Center, P.O. Box 5365, Janesville, Wisconsin 53547-5365.
Online
VA's page says you can download the PDF, fill it out and then submit the completed form on the form page.
Not by email
The burden notice names [email protected] for comments on the burden estimate and says not to send the completed VA Form 21P-530a to that address.
Edition
The OCT 2024 edition supersedes VA Form 21P-530a, AUG 2022, which will not be used. It carries OMB Control No. 2900-0565, which expires 10/31/2027.
Related forms
21P-530EZ
Application for Burial Benefits (Under 38 U.S.C. Chapter 23) (Fillable)
93 fields, 8 pages
VA40-0895-15
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4 fields, 1 page
VA40-0895-14
Checklist of Major Requirements for State or Tribal Government Cemetery Construction Grants
93 fields, 2 pages
VA40-1330
Claim for Standard Government Headstone or Marker
92 fields, 5 pages
Who uses VA Form 21P-530a?
VA's form page and the form itself describe an organization filing, not an individual.
Official sources and the blank
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Questions about Form 21P-530a
Who files VA Form 21P-530a?
VA's page says it is for a state or tribal organization that wants to apply for a VA interment allowance for a Veteran buried in a State or Tribal Veterans' cemetery. It is signed by the official delegated responsibility to apply for federal funds.
Can VA Form 21P-530a be submitted online?
Yes. VA's page says to download the PDF, fill it out and submit the completed form on the form page, or print it and mail it to the address on the form.
Where is VA Form 21P-530a mailed?
The form lists Department of Veterans Affairs, Pension Intake Center, P.O. Box 5365, Janesville, Wisconsin 53547-5365.
What does the official certify?
Section IV certifies that the Veteran named in Item 1 was buried in a State-owned Veterans Cemetery or Tribal Cemetery (without charge).
Does the form say how much the interment allowance is?
No. Neither the form nor VA's form page prints an allowance amount.
Can the AUG 2022 edition still be used?
The OCT 2024 edition says it supersedes VA Form 21P-530a, AUG 2022, which will not be used.