21P-8049
Request for Details of Expenses
VA Form 21P-8049 is the U.S. Department of Veterans Affairs Request for Details of Expenses. Its instructions open with VA's reason for it: "We need additional information to determine whether you are entitled to benefits." The claimant gives the Veteran's and their own details, then reports dependents, monthly living expenses, hospital and medical costs, educational expenses, last illness, burial and just debts, and commercial life insurance payments.
The PDF is four pages in Sections I to IX. The form says to complete all items and that VA will interpret a blank space as "NONE" or "0". VA's form page offers the PDF to download and does not list an online version. You can fill out the PDF free in your browser on this page and download the result without an account.
The Veteran's name, one of a Social Security number, ICN or EDIPI, VA file number and birth date, then the claimant's name, Social Security number, birth date, relationship, mailing address, phone and optional email.
Items 12 to 16 give each dependent's name, age, relationship and whether they live with you, or the monthly amount you contribute to their support.
Monthly costs other than medical for you and those living with you: housing, food, taxes, interest, clothing, utilities, education of children and other.
Whether you have or expect large or unusual hospital or medical expenses, with an estimated cost per year and an explanation, and whether you expect to provide for your children's education, with the total paid.
The deceased person's name, relationship and date of death, then up to four payments, each with whose expenses, who was paid, the nature of the expense or debt, the date, the total and the amount you paid.
Commercial life insurance received or expected, its date and the deceased person it came from, then remarks in Item 23 and the certification, signature and date in Items 24A and 24B.
The form asks you to read the Privacy Act and Respondent Burden on page 4 before completing it. Page 4 also has the mailing address.
The form marks both sections must complete. For the Veteran, complete only one of Items 2A, 2B or 2C. If completing by hand, print in ink, neatly and legibly.
The instructions say to complete all items and that VA will interpret a blank space as "NONE" or "0".
Use Item 23, Remarks, or attach a separate sheet naming the item number. Item 19A also sends dated education payments and Item 22B installment schedules to Remarks.
Sign Item 24A in ink, not printed, date Item 24B, and mail the form to the Pension 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 Intake Center, P.O. Box 5365, Janesville, WI 53547-5365.
The form lists https://www.va.gov/contact-us and the toll-free number 1-800-827-1000 (TTY: 711).
Section VIII says that under Public Law 108-454, VA may not count as income the lump sum proceeds of a life insurance policy on a veteran who dies after December 9, 2004, and that proceeds from all other insurance payments may be countable.
The MAR 2026 edition supersedes VA Form 21-8049, JAN 2023. It carries OMB Control No. 2900-0138, which expires 03/31/2029, and a respondent burden of 15 minutes.
21P-534EZ
626 fields, 20 pages
21P-535
222 fields, 10 pages
21P-527EZ
477 fields, 17 pages
21P-0969
428 fields, 11 pages
21P-8416
517 fields, 10 pages
21P-601
107 fields, 5 pages
The form is completed by the claimant and describes whose expenses each part covers.
No tool matches that search.
Its instructions say VA needs additional information to determine whether you are entitled to benefits. The form collects details of dependents and of living, medical, educational, last illness and burial expenses.
The form defines it as the period from the onset of the acute attack causing death to the date of death, generally within one year of the date of death.
The form defines them as unsecured debts incurred solely by the veteran or jointly by the veteran and surviving spouse, for other than the purpose of real or personal property, and paid by a surviving spouse or child after the veteran's passing.
Section VIII says that under Public Law 108-454, VA may not count the lump sum proceeds of a life insurance policy on a veteran who dies after December 9, 2004, and that proceeds from all other insurance payments may be countable.
The instructions say to complete all items and that VA will interpret a blank space as "NONE" or "0".
Page 4 lists Department of Veterans Affairs, Pension Intake Center, P.O. Box 5365, Janesville, WI 53547-5365. VA's form page does not list an online version.
