VA Form 21P-530A State Application for Interment Allowance Under 38 U.s.c. Chapter 23

What Is VA Form 21P-530A?

VA Form 21P-530A, State Application for Interment Allowance under 38 U.S.C. Chapter 23 is a document required to determine the state's eligibility for the interment allowance. This form is used to gather information about the veterans buried in a State Veterans' cemetery to determine their eligibility. The Department of Veterans Affairs (VA) requires this information to properly determine eligibility and pay state benefits.

The latest version of the form was released by the VA in April 2018 with all previous editions obsolete. VA Form 21P-530A fillable version is available for download below or can be found through the VA website.

This document must be completed by a state official using the information provided by the veteran's surviving spouse, children, parents, executor or administrator of the estate, a survivor of a legal union with the veteran, or the recipient organization, or a claimant who completed the VA Form 21P-530.

The related VA Form 21P-530, Application for Burial Benefits (under 38 U.S.C. Chapter 23), used by the person who paid the burial expenses to apply for a burial and funeral allowance up to $2000 if a veteran's death is service-related. The VA burial allowances are flat-rate monetary benefits.

Earlier, VA Form 21-530, Application for Burial Benefits was used for the same purpose. Today this form is out of use.

Plot or Interment Allowance is a one-time benefit payment payable toward:

  • Expenses incurred for the plot or interment if the burial was not in a State Cemetery or other cemeteries under the jurisdiction of the United States;
  • Expenses payable to a State (or political subdivision of a State) if the veteran died from non-service-connected causes and was buried in a State Cemetery or section used solely for the remains of persons eligible for burial in a State Cemetery.
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OMB Control No. 2900-0565
Respondent Burden: 30 Minutes
Expiration Date: 04/30/2021
STATE APPLICATION FOR INTERMENT ALLOWANCE UNDER 38 U.S.C. CHAPTER 23
Privacy Act Notice: VA will not disclose information collected on this form to any source other than what has been authorized under the Privacy Act of 1974 or Title 38, Code of Federal
Regulations 1.576 for routine uses (i.e., civil or criminal law enforcement, congressional communications, epidemiological or research studies, the collection of money owed to the United States,
litigation in which the United States is a party or has an interest, the administration of VA programs and delivery of VA benefits, verification of identity and status, and personnel administration) as
identified in the VA system of records, 58VA21/22/28, Compensation, Pension, Education, and Vocational Rehabilitation and Employment Records - VA, published in the Federal Register. Your
obligation to respond is required to obtain or retain benefits. Giving us the veterans' SSN account information is mandatory. Applicants are required to provide veterans' SSN under Title 38 U.S.C.
5101 (c) (1). The VA will not deny an individual benefits for refusing to provide his or her SSN unless the disclosure of the SSN is required by Federal Statute of law in effect prior to January 1,
1975, and still in effect. The requested information is considered relevant and necessary to determine maximum benefits under the law. The responses you submit are considered confidential
(38 U.S.C. 5701). Information submitted is subject to verification through computer matching programs with other agencies.
Respondent Burden: We need this information to determine eligibility for an interment allowance (38 U.S.C. 2303 and 2304). Title 38, United States Code, allows us to ask for this information.
We estimate that you will need an average of 30 minutes to review the instructions, find the information, and complete this form. VA cannot conduct or sponsor a collection of information unless a
valid OMB control number is displayed. You are not required to respond to a collection of information if this number is not displayed. Valid OMB control numbers can be located on the OMB
Internet Page at http://www.reginfo.gov/public/do/PRAMain. If desired, you can call 1-800-827-1000 to get information on where to send comments or suggestions about this form.
1. NAME OF STATE
2. PLACE OF BURIAL (LOCATION OF CEMETERY)
3. RECIPIENT ORGANIZATION (Full name and address of payee)
4. CLAIM FOR MONTH ENDING
5. INTERRED VETERANS INFORMATION
SOCIAL
SERVICE
SERVICE
VA FILE NO.
SERVICE
BRANCH
BURIAL
DATE OF
DATE OF
NAME OF VETERAN
SECURITY
TO
FROM
(First, middle, last)
(C/CSS)
NUMBER
OFSERVICE
BIRTH
DEATH
DATE
NUMBER
DATE
DATE
I HEREBY CERTIFY THAT the above veterans were buried in a State-owned veterans cemetery (without charge) and are entitled to burial benefits under the provisions of Title 38, U.S.C.
7. DATE SIGNED
(Sign in ink.)
6. SIGNATURE OF STATE OFFICIAL DELEGATED RESPONSIBILITY TO APPLY FOR FEDERAL FUNDS
TITLE OF STATE OFFICIAL DELEGATED RESPONSIBILITY
VA FORM
21P-530a
EXISTING STOCKS OF VA FORM 21-530a, AUG 2015, WILL BE USED.
APR 2018
OMB Control No. 2900-0565
Respondent Burden: 30 Minutes
Expiration Date: 04/30/2021
STATE APPLICATION FOR INTERMENT ALLOWANCE UNDER 38 U.S.C. CHAPTER 23
Privacy Act Notice: VA will not disclose information collected on this form to any source other than what has been authorized under the Privacy Act of 1974 or Title 38, Code of Federal
Regulations 1.576 for routine uses (i.e., civil or criminal law enforcement, congressional communications, epidemiological or research studies, the collection of money owed to the United States,
litigation in which the United States is a party or has an interest, the administration of VA programs and delivery of VA benefits, verification of identity and status, and personnel administration) as
identified in the VA system of records, 58VA21/22/28, Compensation, Pension, Education, and Vocational Rehabilitation and Employment Records - VA, published in the Federal Register. Your
obligation to respond is required to obtain or retain benefits. Giving us the veterans' SSN account information is mandatory. Applicants are required to provide veterans' SSN under Title 38 U.S.C.
5101 (c) (1). The VA will not deny an individual benefits for refusing to provide his or her SSN unless the disclosure of the SSN is required by Federal Statute of law in effect prior to January 1,
1975, and still in effect. The requested information is considered relevant and necessary to determine maximum benefits under the law. The responses you submit are considered confidential
(38 U.S.C. 5701). Information submitted is subject to verification through computer matching programs with other agencies.
Respondent Burden: We need this information to determine eligibility for an interment allowance (38 U.S.C. 2303 and 2304). Title 38, United States Code, allows us to ask for this information.
We estimate that you will need an average of 30 minutes to review the instructions, find the information, and complete this form. VA cannot conduct or sponsor a collection of information unless a
valid OMB control number is displayed. You are not required to respond to a collection of information if this number is not displayed. Valid OMB control numbers can be located on the OMB
Internet Page at http://www.reginfo.gov/public/do/PRAMain. If desired, you can call 1-800-827-1000 to get information on where to send comments or suggestions about this form.
1. NAME OF STATE
2. PLACE OF BURIAL (LOCATION OF CEMETERY)
3. RECIPIENT ORGANIZATION (Full name and address of payee)
4. CLAIM FOR MONTH ENDING
5. INTERRED VETERANS INFORMATION
SOCIAL
SERVICE
SERVICE
VA FILE NO.
SERVICE
BRANCH
BURIAL
DATE OF
DATE OF
NAME OF VETERAN
SECURITY
TO
FROM
(First, middle, last)
(C/CSS)
NUMBER
OFSERVICE
BIRTH
DEATH
DATE
NUMBER
DATE
DATE
I HEREBY CERTIFY THAT the above veterans were buried in a State-owned veterans cemetery (without charge) and are entitled to burial benefits under the provisions of Title 38, U.S.C.
7. DATE SIGNED
(Sign in ink.)
6. SIGNATURE OF STATE OFFICIAL DELEGATED RESPONSIBILITY TO APPLY FOR FEDERAL FUNDS
TITLE OF STATE OFFICIAL DELEGATED RESPONSIBILITY
VA FORM
21P-530a
EXISTING STOCKS OF VA FORM 21-530a, AUG 2015, WILL BE USED.
APR 2018

Download VA Form 21P-530A State Application for Interment Allowance Under 38 U.s.c. Chapter 23

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VA Form 21P-530A Instructions

The form is distributed without filing guidelines. Step-by-step instructions for VA Form 21P-530A can be found below.

How to Fill out VA Form 21P-530A?

The state is responsible for submitting a monthly consolidated request for the plot or interment allowance for veterans buried in State Cemeteries on the VA 21P-530A. A manager of a VA center certifies the list for payment and gives a copy of the certified list to a Veterans Service representative. Center personnel must process a notice of death for each claim number on the certified list, and update the corporate record to show that the burial payment has been processed.

Filling out VA Form 21P-530A is relatively simple. It consists of a table and several boxes for certification.

  1. The top line of the form requires the name of the state, the location of the cemetery, the full name, and address of the recipient organization and the month, for which the claim is filed.
  2. The table should contain the name of each buried veteran, their VA file number, social security number, the branch of service, dates of service, dates of birth and death, and the date of burial.
  3. The state official responsible for applying for federal funds provides their title, signs, and dates the form on the bottom line of the form. The state official is required to certify that the listed veterans were buried in a State Veterans Cemetery free of charge and are entitled to burial benefits under the provisions of Title 38, U.S.C.