21P-534EZ
Application for D.I.C., Survivors Pension, and/or Accrued Benefits
VA Form 21P-534EZ is the U.S. Department of Veterans Affairs Application for D.I.C., Survivors Pension, and/or Accrued Benefits. The form says to use it to submit a claim for Dependency and Indemnity Compensation (D.I.C.), Survivors Pension and/or accrued benefits. Its relationship box lists a surviving spouse, a child 18 to 23 in school, a custodian filing for a child under 18 and a disabled adult child.
The PDF has 20 pages. Pages 1 to 9 are a notice that explains the evidence VA needs for each type of claim, followed by a checklist. The application itself has 14 sections on pages 10 to 18, and pages 19 and 20 are care worksheets for a facility or an in-home attendant. The form says to leave items in a section blank if they do not apply.
VA's 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 Veteran's name, Social Security number, birth date, date of death and whether the Veteran died on active duty. Then your details, what you are claiming, and the Veteran's service dates, branch, National Guard activation and any prisoner of war confinement.
Your marriage to the Veteran and how it ended, any remarriage, the Veteran's and your prior marriages, and each dependent child of the Veteran with birth date, status and custodian.
The type of D.I.C. claimed, including D.I.C. under 38 U.S.C. 1151 or a PACT Act re-evaluation, VA medical centers where the Veteran was treated, and questions on Special Monthly Pension or Special Monthly D.I.C. and nursing home care.
Whether you or your dependents have over $75,000.00 in assets, asset transfers in the three calendar years before this year, the primary residence lot size, the number of income sources, and up to four income entries in Items 9I to 9L.
In-home care or care facility costs with provider, type of care, dates and amounts, then other medical, last illness and burial expenses with who was paid, the purpose, date and frequency.
Direct deposit details, the claim certification and signature in Item 12A, two witnesses if the claimant signs with an X, and the alternate signer certification.
Pages 1 to 9 explain the evidence for each claim type. The checklist on page 9 marks verification of the Veteran's death, service verification such as a DD Form 214, and dependent children with an asterisk as required.
The form marks Sections I, II, XI and XII as must complete. In Item 2I, check D.I.C., Survivors Pension, accrued benefits or more than one.
Follow the skip notes. For example, the form says to skip Section III if the Veteran was receiving VA compensation or pension benefits at the time of death.
The form points to VA Form 21P-0969 when Section IX directs it, VA Form 21-2680 or 21-0779 for increased benefits or a nursing home, and VA Form 21P-8416 if more expense space is needed.
Sign Item 12A, marked required, and date Item 12B. If the claimant signs with an X, Section XIII asks for two witness signatures.
The form says to submit online or mail it to the Pension Intake Center, attach supporting materials and keep a photocopy of everything you send.
You get the real form, filled in a browser tab, with nothing standing between you and the finished PDF.
Department of Veterans Affairs, Pension Intake Center, P.O. Box 5365, Janesville, WI 53547-5365.
VA's page says you can apply online instead of filling out and sending the paper form. The form also lists QuickSubmit via access.va.gov.
The notice says that if you are not ready to submit a claim, VA Form 21-0966 protects your date of claim, and a 21P-534EZ completed within one year of it is considered filed as of the date VA received the 21-0966.
The form lists https://www.va.gov/contact-us and the toll-free number 1-800-827-1000 (TTY: 711).
The AUG 2025 edition supersedes the JUL 2022 edition. It carries OMB Control No. 2900-0004, which expires 08/31/2028, and a respondent burden of 40 minutes.
21P-0969
428 fields, 11 pages
21-2680
112 fields, 4 pages
21P-8416
517 fields, 10 pages
21P-535
222 fields, 10 pages
21P-601
107 fields, 5 pages
21-0966
49 fields, 2 pages
The form and VA's page describe who fills in which parts.
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Item 2B lists a surviving spouse, a child 18 to 23 in school, a custodian filing for a child under 18 and a disabled adult child. Parents claiming D.I.C. are pointed to VA Form 21P-535.
Yes. VA's page says you can apply online instead of filling out and sending the paper form.
The notice says to complete VA Form 21-0966, Intent to File, to protect your date of claim. A 21P-534EZ completed within one year of the 21-0966 is considered filed as of the date VA received the 21-0966.
The page 9 checklist marks verification of the Veteran's death, service verification such as a DD Form 214, and dependent children with an asterisk. The form says not to send original documents, since VA will not return them.
Section IX points to it if you or your dependents have over $75,000.00 in assets, transferred assets in the three calendar years before this year, own marketable land over 2 acres around the primary residence, have 5 or more income sources, or had income last year you no longer receive other than Social Security.
An administrator or licensed medical professional completes the facility worksheet, and the in-home care provider or an agency administrator completes the in-home attendant worksheet.
