21P-534a

Application for Dependency and Indemnity Compensation by a Surviving Spouse or Child—In-Service Death Only

Agency
VA
Revision
August 2025
Fillable fields
64
Pages
2
Official source
VA form page
Checked
October 20, 2026
Fill 21P-534a online
Page 1 of form 21P-534a

VA Form 21P-534a: DIC Application by a Surviving Spouse or Child, In-Service Death Only

VA Form 21P-534a is the U.S. Department of Veterans Affairs Application for Dependency and Indemnity Compensation by a Surviving Spouse or Child, In-Service Death Only. VA's form page says that if you're the surviving spouse or child of a service member who died while on active duty, your military casualty assistance officer will help you complete it and mail it to the correct VA regional office.

The form notes that filing it tells VA you elect to receive Dependency and Indemnity Compensation (D.I.C.) and all other service-connected death benefits to which you and/or the deceased veteran's children may be entitled. Page 1 is the application, Items 1 to 20, and page 2 holds the instructions, the mailing address and the Privacy Act and Respondent Burden notices.

VA's page points survivors of a Veteran to VA Form 21P-534EZ and surviving parents to VA Form 21P-535. You can fill out the PDF free in your browser on this page and download the result without an account.

Top of page 1 of VA Form 21P-534a: DIC Application by a Surviving Spouse or Child, In-Service Death Only, as printed by VA

What's on VA Form 21P-534a

Items 1 to 4: names and SSNs

The Veteran's name and Social Security number, then the claimant's name and Social Security number, followed by the note on electing D.I.C. and other service-connected death benefits.

Items 5 to 7: surviving spouse

Whether the spouse lived continuously with the Veteran from the date of marriage to the date of death, the cause, date and duration of any separation, and the spouse's date of birth.

Item 8: children in custody

Children of the deceased Veteran (natural, step or adopted) in the claimant's custody, with full name, date of birth, Social Security number, place of birth and relationship to the claimant.

Items 9 to 13: contact details

The claimant's current mailing address, daytime and evening phone numbers, and whether the address will change, with the new address and the date it takes effect.

Items 14 and 15: direct deposit

Whether you want VA payments directly deposited, then checking or savings, the account number, the nine-digit routing or transit number and the name of the financial institution.

Items 16A to 20: signatures and CAO

The certification, the claimant's printed name, signature in ink and date, then the casualty assistance officer's name and rank, phone number and email, and the penalty notice.

How to file VA Form 21P-534a

  1. 1

    Work with your casualty assistance officer

    VA's page says the military casualty assistance officer will help you complete the application and mail it.

  2. 2

    Print every answer clearly

    The instructions say to answer fully and clearly or action on the claim may be delayed, and to write "unknown" when you do not know an answer.

  3. 3

    Attach what the form asks for

    Attach a copy of any court order of separation for Item 6, and a voided personal check or deposit slip to enroll in direct deposit.

  4. 4

    Sign and date it

    Sign Item 16B in ink and enter the date in Item 17. The CAO fills in Items 18 to 20.

  5. 5

    Copy it, then mail it with DD Form 1300

    Make a photocopy of the application and everything you submit, then mail the form with the service member's DD Form 1300, Report of Casualty, to the Pension Intake Center.

Why fill Form 21P-534a on indox

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Where to send it and getting help

By mail

Department of Veterans Affairs, Pension Intake Center, P.O. Box 5365, Janesville, WI 53547-5365. The form says to mail it along with the servicemember's DD Form 1300, Report of Casualty.

Other ways VA's page lists

Work with an accredited attorney, claims agent or Veterans Service Organization (VSO) representative, upload the form online with the QuickSubmit tool, or get help from a VA employee at a VA regional office.

Phone

For help completing the application or information about VA benefits, the form lists 1-800-827-1000 (Hearing Impaired TDD Relay Line 711).

Direct deposit

The form says the Department of the Treasury requires Federal benefit payments by electronic funds transfer. It lists https://www.benefits.va.gov/benefits/banking.asp for anyone without a bank account and 1-888-224-2950 for waiver requests.

Edition

The AUG 2025 edition supersedes VA Form 21P-534a, JUL 2022, which will not be used. It carries OMB Approved No. 2900-0004, which expires 08/31/2028, and an estimated burden of 15 minutes.

Related forms

Who uses VA Form 21P-534a?

  • Surviving spouses of service members

    VA's page says the form is for the surviving spouse of a service member who died while on active duty. Items 5 to 7 are for the surviving spouse only.

  • Children, or someone applying for them

    The page also names the surviving child. The instructions say Item 3 is the name of the surviving spouse or the person applying on behalf of minor children.

  • Military casualty assistance officers

    VA's page says the military casualty assistance officer (CAO) helps complete the form and mail it. Items 18 to 20 are completed by the CAO.

  • Guardians of minors and incompetent persons

    The instructions say the legal guardian completes and files the application for a minor or incompetent person, or, if none has been appointed, some person acting on their behalf.

  • Survivors of Veterans and parents use other forms

    VA's page points the surviving spouse or child of a Veteran to VA Form 21P-534EZ, and a surviving parent to VA Form 21P-535.

VA's form page and the instructions on page 2 describe who completes it.

Official sources and the blank

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Questions about Form 21P-534a

Who uses VA Form 21P-534a?

VA's page says it is for the surviving spouse or child of a service member who died while on active duty, and that the military casualty assistance officer will help complete and mail it.

What if the person who died was a Veteran, not on active duty?

VA's page says the surviving spouse or child of a Veteran fills out VA Form 21P-534EZ, Application for DIC, Survivors Pension, and/or Accrued Benefits.

Which form does a surviving parent use?

VA's page points surviving parents to VA Form 21P-535, Application for Dependency and Indemnity Compensation by Parent(s).

What is mailed with the form?

The instructions say the form is mailed along with the servicemember's DD Form 1300, Report of Casualty, to the Pension Intake Center in Janesville, WI.

What does filing this application elect?

The form says filing it tells VA you elect to receive Dependency and Indemnity Compensation (D.I.C.) and all other service-connected death benefits to which you and/or the deceased veteran's children may be entitled.

Can a guardian file for a minor child?

Yes. The instructions say the legal guardian completes and files it for a minor or incompetent person, or some person acting on their behalf if no guardian has been appointed.

Can I submit VA Form 21P-534a online?

VA's page lists the QuickSubmit tool to upload your form online, along with mail, an accredited representative and a VA regional office.