21P-530EZ
Application for Burial Benefits (Under 38 U.S.C. Chapter 23) (Fillable)
VA Form 21P-530EZ is the U.S. Department of Veterans Affairs Application for Burial Benefits (Under 38 U.S.C. Chapter 23). The form says to use it to submit a claim for a non-service-connected burial allowance, a service-connected burial allowance, a plot or interment allowance, transportation reimbursement, or burial benefits for the unclaimed remains of a Veteran.
The PDF is eight pages. Pages 1 to 5 are the Notice of Evidence Necessary to Substantiate a Claim for Burial Benefits, with who can file, time limits and evidence tables for each benefit. Pages 6 to 8 are the application itself, Sections I to IX, ending with the Privacy Act, Respondent Burden and penalty notices and a note about Government headstones and markers.
VA's form page says you can apply online instead of filling out and sending the paper form. You can fill out the PDF free in your browser on this page and download the result without an account.
The deceased Veteran's name, Social Security number, VA file number and dates of birth, death and burial, then the claimant's name, Social Security number, date of birth, address, phone, email and relationship to the Veteran.
Dates and places the Veteran entered and separated from active service, service number, grade, rank or rating, organization and branch, and any other name the Veteran served under.
The type of burial site, whether the Veteran was buried in a national or federal cemetery or in a State cemetery or Tribal Trust land, and any government or employer contribution to the burial with its amount.
The type of burial allowance claimed, where the Veteran's death occurred, whether a spouse previously received a VA burial allowance, and who is responsible for the burial expenses.
Whether you are responsible for the plot or interment expenses and for transportation from the place of death to the final resting place, which the form says includes an itemized receipt.
A choice between the FDC program and the standard claim process, the claimant's signature in ink, a signer for a firm, corporation or State agency, witnesses for an "X" signature, and the alternate signer.
Pages 1 to 5 explain the claimants, time limits and evidence tables for each burial benefit. Page 8 holds the Privacy Act and Respondent Burden text the form asks you to read first.
Check a box in Section VII. The form describes the Fully Developed Claim (FDC) program as optional, with a signed, fully complete application and the evidence sent together.
The form says it can be completed online or by hand. If by hand, print in ink, neatly and legibly.
The form asks for a copy of the public record of death unless the death was in a government institution or proof was already given, the cause of death for a service-connected claim, and an itemized statement for transportation.
Sign Item 25A in ink. An "X" signature needs two witnesses in Section VIII, and Section IX is for an alternate signer if Item 25A is blank.
Apply online on VA.gov, or mail the application and evidence to the Pension Claims Intake Center in Janesville, Wisconsin.
You get the real form, filled in a browser tab, with nothing standing between you and the finished PDF.
Department of Veterans Affairs, Pension Claims Intake Center, P.O. Box 5365, Janesville, WI 53547-5365.
VA's form page says you can apply online instead of filling out and sending the paper form. The notice also says you can upload supporting evidence online.
The form says a 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. It lists no time limit for the service-connected burial allowance, plot or interment allowance, a non-service-connected burial allowance based on a VA hospitalization death, or transportation reimbursement.
The form says you have up to one year from the date VA receives the claim to submit the information and evidence necessary to support it.
The notice mentions an accredited Veterans Service Officer (VSO), listed at https://www.va.gov/vso/, or your state office of Veterans Affairs.
The OCT 2024 edition supersedes VA Form 21P-530EZ, AUG 2022. It carries OMB Approved No. 2900-0003, which expires 10/31/2027, and an estimated burden of 30 minutes.
VA40-1330
92 fields, 5 pages
21P-534EZ
626 fields, 20 pages
20-0995
136 fields, 7 pages
21-4142
140 fields, 5 pages
21-4142a
96 fields, 2 pages
21P-530a
53 fields, 2 pages
The form's General Information page lists eligible claimants. It says VA may grant a claim that any eligible person files, and upon the Veteran's death pays the first living person to file a claim of those listed.
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The form lists the Veteran's surviving spouse or survivor of a legal union, children, parents, and the executor or administrator of the estate or a person acting for it. If the remains are unclaimed, the person or entity that provided burial services can file.
Yes. VA's form page says you can apply online instead of filling out and sending the paper form.
The form says a claim for non-service-connected burial allowance must be filed within 2 years after the Veteran's permanent burial or cremation. It lists no time limit for the service-connected burial allowance, plot or interment allowance, a non-service-connected burial allowance based on a VA hospitalization death, or transportation reimbursement.
The form calls the Fully Developed Claim program an optional expedited process. You send a signed, fully complete application with the required evidence and check FDC in Section VII. Adding evidence later moves the claim to the standard process.
The form says death in a government institution does not need to be proven. Otherwise it asks for a copy of the public record of death, unless it was already given to VA. A service-connected claim includes the cause of death.
No. The form and VA's form page do not print allowance amounts. Item 19B only asks for the amount of any government or employer contribution.
The notice says that for a burial decided within the past year with new and relevant evidence, or a supplemental claim, use VA Form 20-0995. It also mentions a higher-level review or an appeal to the Board of Veterans' Appeals.
