General Instructions
For Application for Dependency and Indemnity Compensation by Parent(s) (Including Accrued Benefits and
Death Compensation when Applicable)
VA Form 21P-535
Note: Read very carefully, detach, and keep these instructions for your reference.
A. How can I contact VA if I have questions?
Benefit rates and income limits are frequently changed, so
it is not possible to keep this information current in these
If you have any questions about this form, how to fill it
instructions. You can find out what the current income
out, or about VA benefits, contact your nearest VA
limitations and rates of benefits are by contacting your
regional office. You can locate the address of the nearest
nearest VA regional office. You can locate your local VA
regional office in your telephone book blue pages under
regional at the following web site www.va.gov/directory.
"United States Government, Veterans" or call 1-800-827-
1000 (Hearing Impaired TDD line 711). You may also
Note: Unless a claim for DIC is filed within one year from
contact VA by Internet at https://iris.custhelp.com/.
the date of the veteran's death, that benefit is not payable
from a date earlier than the date VA receives the claim.
B. What is the purpose of VA Form 21P-535?
Use VA Form 21P-535 to apply for:
E. How do I apply for the aid and attendance
allowance?
• VA benefits you may be entitled to receive as the
surviving parent(s) of a deceased veteran
VA may pay a higher rate of DIC to a surviving parent who
• Any money VA owes the veteran but did not pay
is blind, a patient in a nursing home, or otherwise needs
prior to his/her death (accrued benefits).
regular aid and attendance. If you wish to apply for this
benefit, check "Yes" for Item 19.
If you apply for one of these benefits, the law requires that
F. How do I complete my application?
we also consider your entitlement for the other.
Print or type all answers clearly. If an answer is "none" or
C. What is the purpose of the attached SSA-24 form?
"0," write that. Your answer to every question is important
You can apply for Social Security benefits by using the
to help us complete your claim. If you do not know the
SSA-24 form attached to this VA form. You don't have to
answer, write "unknown." For additional space, use Item
apply if you don't want to or have already done so. If you
34, "Remarks, " or attach a separate sheet, indicating the
do want to apply, fill it out and leave it attached. We will
item number to which the answers apply. Make sure you
send it to the Social Security Administration for you.
sign and date this application (Items 30a through 31b).
They will then contact you.
Note: If the claim is being made on behalf of an
D. What is dependency and indemnity compensation
incompetent person, the application form should be
(DIC), and how does VA decide what I will or will not
completed and filed by the legal guardian. If no legal
receive?
guardian has been appointed, it may be completed and
DIC may be payable to parent(s) when:
filed by some person acting on behalf of the incompetent
person.
• a veteran's death occurred in service, or
• a veteran dies of a service-connected disability,
AND
G. What do I do when I have completed my
• your income is limited.
application?
VA pays Parents' DIC based on the amount of the
When you have completed this application, mail or fax to
claimant's countable income and whether the claimant is
the appropriate Pension Center listed on page 8. Be sure to
the sole surviving parent of the veteran or one of two
attach any materials that support and explain your claim.
parents. This is based on law. If the claimant is married
Also, make a photocopy of your application and everything
and lives with his/her spouse, the claimant's and the
that you submit to VA before mailing or faxing it.
spouse's income are counted. VA must include as income
payments received from all sources that Federal law
specifies.
VA FORM
SUPERSEDES VA FORM 21-535, MAR 2015,
21P-535
Page 1
MAY 2018
WHICH WILL NOT BE USED.
General Instructions
For Application for Dependency and Indemnity Compensation by Parent(s) (Including Accrued Benefits and
Death Compensation when Applicable)
VA Form 21P-535
Note: Read very carefully, detach, and keep these instructions for your reference.
A. How can I contact VA if I have questions?
Benefit rates and income limits are frequently changed, so
it is not possible to keep this information current in these
If you have any questions about this form, how to fill it
instructions. You can find out what the current income
out, or about VA benefits, contact your nearest VA
limitations and rates of benefits are by contacting your
regional office. You can locate the address of the nearest
nearest VA regional office. You can locate your local VA
regional office in your telephone book blue pages under
regional at the following web site www.va.gov/directory.
"United States Government, Veterans" or call 1-800-827-
1000 (Hearing Impaired TDD line 711). You may also
Note: Unless a claim for DIC is filed within one year from
contact VA by Internet at https://iris.custhelp.com/.
the date of the veteran's death, that benefit is not payable
from a date earlier than the date VA receives the claim.
B. What is the purpose of VA Form 21P-535?
Use VA Form 21P-535 to apply for:
E. How do I apply for the aid and attendance
allowance?
• VA benefits you may be entitled to receive as the
surviving parent(s) of a deceased veteran
VA may pay a higher rate of DIC to a surviving parent who
• Any money VA owes the veteran but did not pay
is blind, a patient in a nursing home, or otherwise needs
prior to his/her death (accrued benefits).
regular aid and attendance. If you wish to apply for this
benefit, check "Yes" for Item 19.
If you apply for one of these benefits, the law requires that
F. How do I complete my application?
we also consider your entitlement for the other.
Print or type all answers clearly. If an answer is "none" or
C. What is the purpose of the attached SSA-24 form?
"0," write that. Your answer to every question is important
You can apply for Social Security benefits by using the
to help us complete your claim. If you do not know the
SSA-24 form attached to this VA form. You don't have to
answer, write "unknown." For additional space, use Item
apply if you don't want to or have already done so. If you
34, "Remarks, " or attach a separate sheet, indicating the
do want to apply, fill it out and leave it attached. We will
item number to which the answers apply. Make sure you
send it to the Social Security Administration for you.
sign and date this application (Items 30a through 31b).
They will then contact you.
Note: If the claim is being made on behalf of an
D. What is dependency and indemnity compensation
incompetent person, the application form should be
(DIC), and how does VA decide what I will or will not
completed and filed by the legal guardian. If no legal
receive?
guardian has been appointed, it may be completed and
DIC may be payable to parent(s) when:
filed by some person acting on behalf of the incompetent
person.
• a veteran's death occurred in service, or
• a veteran dies of a service-connected disability,
AND
G. What do I do when I have completed my
• your income is limited.
application?
VA pays Parents' DIC based on the amount of the
When you have completed this application, mail or fax to
claimant's countable income and whether the claimant is
the appropriate Pension Center listed on page 8. Be sure to
the sole surviving parent of the veteran or one of two
attach any materials that support and explain your claim.
parents. This is based on law. If the claimant is married
Also, make a photocopy of your application and everything
and lives with his/her spouse, the claimant's and the
that you submit to VA before mailing or faxing it.
spouse's income are counted. VA must include as income
payments received from all sources that Federal law
specifies.
VA FORM
SUPERSEDES VA FORM 21-535, MAR 2015,
21P-535
Page 1
MAY 2018
WHICH WILL NOT BE USED.
H. How can I assign someone to act as my
or VA Form 21-22a, Appointment of Individual as
representative?
Claimant's Representative.
You may also download these forms at
A representative can be an accredited member of an
www.va.gov/vaforms/. If you have already designated a
accredited organization or other service organization that
representative, no further action is required on your part.
the Secretary of Veterans Affairs recognizes, an agent
recognized by VA, or a licensed lawyer. If you appeal the
I. What if I believe that VA has made an error in
decision, agents and attorneys can charge you for services
processing or deciding my benefits?
that you receive from them only after the Board of
You can ask for a personal hearing at any time during the
Veterans' Appeals (BVA) gives you its final decision
processing of your claim. That means you can ask for the
about your application. That means you can use an
hearing while VA is processing your claim or after VA has
attorney during any stage of your application for benefits;
made a decision. You should contact the nearest VA
however, the agent or attorney cannot charge you for
regional office and tell them that you want a personal
services unless you are trying to resolve a dispute with
hearing on your case. Someone in the local VA regional
VA after BVA has made a decision about your claim.
office will arrange a time and a place for your hearing. At
If you want to use a representative to help you with your
this hearing, you may bring witnesses. VA will record
application, contact the nearest VA regional office.
whatever you and your witnesses say during the hearing
Depending on the type of representative you want to
and include it in the official record. VA will furnish the
designate, we will send you one of the following forms:
hearing room and officials, and prepare a transcript of the
VA Form 21-22, Appointment of Veterans Service
hearing. VA cannot pay your expenses or the expenses of
Organization as Claimant's Representative,
anyone you want to bring with you to the hearing.
IMPORTANT - If you are certifying that you are married for the purpose of VA benefits, your marriage must be recognized by the place
where you and/or your spouse resided at the time of marriage, or where you and/or your spouse resided when you filed your claim (or a
later date when you became eligible for benefits) (38 U.S.C. § 103(c)). Additional guidance on when VA recognizes marriages is
available at http://www.va.gov/opa/marriage/.
Privacy Act Notice: The 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 5, Code of Federal Regulations 1.526 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 your SSN account information is mandatory. Applicants are required to provide their
SSN under Title 38 USC 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. Information that you furnish may be
utilized in computer matching programs with other Federal or state agencies for the purpose of determining your eligibility to receive VA
benefits, as well as to collect any amount owed to the United States by virtue of your participation in any benefit program administered
by the Department of Veterans Affairs.
Respondent Burden: We need this information to determine eligibility for death benefits and accrued benefits under 38 U.S.C. 1121,
1310, 1315, and 5121. Title 38, United States Code, allows us to ask for this information. We estimate that you will need an average of
1 hour and 12 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
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.
Page 2
VA FORM 21P-535, MAY 2018
OMB Control No. 2900-0005
Respondent Burden: 1 hour and 12 minutes
Expiration Date: 05/31/2021
VA DATE STAMP
(DO NOT WRITE IN THIS SPACE)
APPLICATION FOR DEPENDENCY AND INDEMNITY COMPENSATION BY PARENT(S)
(Including Accrued Benefits and Death Compensation when Applicable)
INSTRUCTIONS: Please read the attached "General Instructions" and the Privacy Act and Respondent Burden
information before completing this form.
SECTION I: VETERAN'S IDENTIFICATION INFORMATION
NOTE: You can either complete the form online or by hand. Please print your information using blue or black ink, neatly and legibly to help process the form.
1. VETERAN'S NAME (First, Middle Initial, Last)
4. VETERAN'S DATE OF BIRTH
2. VETERAN'S SOCIAL SECURITY NUMBER
3. VA FILE NUMBER (If applicable)
Day
Month
Year
6. VETERAN'S SERVICE NUMBER (If applicable)
5. VETERAN'S DATE OF DEATH? (Month, Day, Year)
Day
Month
Year
7. NAME OF PERSON FILING CLAIM? (First, Middle Initial, Last)
9. HAVE YOU EVER FILED A CLAIM WITH VA?
10. WHAT IS YOUR VA FILE NUMBER?
8. WHAT IS YOUR RELATIONSHIP TO THE VETERAN?
No
Yes
(If "Yes," answer Item 10)
(If applicable)
(Include Area Code)
11. EMAIL ADDRESS
12. TELEPHONE NUMBER
13B. LIST THE OTHER NAME(S) THE VETERAN SERVED UNDER:
13A. DID THE VETERAN SERVE UNDER ANOTHER NAME?
Yes
No
(If "Yes," answer Item 13B)
NOTE: Attach a copy of the death certificate unless the veteran died while serving in the Army, Navy, Air Force, Marine Corps, or Coast Guard, or
as a commissioned officer in the National Oceanic and Atmospheric Administration, Coast and Geodetic Survey, Environmental Science Services
Administration, or Public Health Service, or in a hospital or institution under the control of the U.S. government.
SECTION II: VETERAN'S ACTIVE DUTY SERVICE
NOTE: SKIP TO SECTION III IF THE VETERAN WAS RECEIVING VA COMPENSATION OR PENSION AT THE TIME OF HIS/HER
DEATH. If the veteran never filed a claim with VA, attach the original DD214 or a certified copy for each period of service listed. We will return
original documents to you.
If more space is needed use Item 34, "Remarks,".
14A. VETERAN ENTERED ACTIVE SERVICE (Month, Day, Year)
14B. PLACE ENTERED ACTIVE SERVICE
14C. SERVICE NUMBER
14G. GRADE, RANK
14D. VETERAN LEFT ACTIVE SERVICE (Month, Day, Year)
14E. PLACE LEFT ACTIVE SERVICE
14F. BRANCH OF SERVICE
OR RATING
SECTION III: VETERAN'S PARENT(S) INFORMATION
NOTE: Parent means a biological or adoptive parent, or a foster parent. A foster parent is a person who stood in the relationship of a
parent to a veteran for at least one year before the veteran's last entry into active service. The foster relationship must have begun prior
to the veteran's 21st birthday. If you are claiming benefits as the foster parent of the veteran, you will also need to complete VA Form
21P-524, Statement Of Person Claiming To Have Stood In Relation of Parent. If you need a copy of this form, you may download the
form at www.va.gov/vaforms. Note: Only one parent can be recognized for benefit payment purposes.
• The age of majority is determined by State law and is age 18 in most States. Contact your State government for more information.
• Provide a copy of the veteran's public record of birth or a copy of the court record of adoption if the veteran was adopted.
• Parental control is considered to have been given up if the parent has ceased to provide for the child and the normal parent/child
relationship has been broken.
VA FORM
SUPERSEDES VA FORM 21-535, MAR 2015,
21P-535
Page 3
MAY 2018
WHICH WILL NOT BE USED.
Veteran's Social Security No.
SECTION III: VETERAN'S PARENT(S) INFORMATION (Continued)
15B. PARENT'S ADDRESS (Street address, rural route, or P.O. box, Apt. No.,
15A. PARENT'S NAME? (First, Middle, Last)
City, State, ZIP Code and Country)
15D. PARENT'S DATE OF DEATH (MM,DD,YYYY)
15C. PARENT'S DATE OF BIRTH (MM,DD,YYYY)
15E. PARENT'S SOCIAL SECURITY NUMBER
(If deceased, complete Item 15D)
15F. PARENT'S TELEPHONE NUMBER(S) (Include Area Code)
15G. PARENT'S EMAIL ADDRESS (If applicable)
Daytime:
Evening:
16B. PARENT'S ADDRESS (Street address, rural route, or P.O. box, Apt. No.,
16A. PARENT'S NAME? (First, Middle, Last)
City, State, ZIP Code and Country)
16C. PARENT'S DATE OF BIRTH (MM,DD,YYYY)
16D. PARENT'S DATE OF DEATH (MM,DD,YYYY)
16E. PARENT'S SOCIAL SECURITY NUMBER
(If deceased, complete Item 16D)
16F. PARENT'S TELEPHONE NUMBER(S) (Include Area Code)
16G. PARENT'S EMAIL ADDRESS (If applicable)
Daytime:
Evening:
17B. DATE(S) OF PARENTAL CONTROL (MM,DD,YYYY)
17A. WAS THE VETERAN A MEMBER OF YOUR HOUSEHOLD OR UNDER YOUR PARENTAL
CONTROL AT ALL TIMES BEFORE HE/SHE REACHED THE AGE OF MAJORITY?
From:
To:
YES
NO
(If "NO," answer Items 17B through 17D)
From:
To:
17C. WHY WASN'T THE VETERAN A MEMBER OF YOUR HOUSEHOLD OR UNDER YOUR PARENTAL CONTROL AT ALL TIMES BEFORE HE/SHE REACHED THE
AGE OF MAJORITY? (Explain fully)
17D. NAME AND ADDRESS OF EACH PERSON WHO ASSUMED PARENTAL CONTROL OVER THE VETERAN OUTSIDE THE DATE(S) SHOWN IN ITEM 17B.
SECTION IV: VETERAN'S PARENT(S) MARITAL HISTORY
18A. WHAT IS YOUR MARITAL STATUS? (Check one)
MARRIED AND LIVE WITH OTHER PARENT OF VETERAN
MARRIED AND LIVE WITH SPOUSE WHO IS NOT THE OTHER PARENT OF VETERAN
SEPARATED, MARRIED BUT NOT LIVING WITH SPOUSE, IF CHECKED PROVIDE DATE OF SEPARATION:
What was the cause of the separation? Give the reason, date(s), and duration of the separation. If the separation was by court order, attach a copy of the order.
DIVORCED, IF CHECKED PROVIDE DATE OF DIVORCE:
WIDOWED, IF CHECKED PROVIDE DATE OF DEATH OF YOUR SPOUSE:
NEVER MARRIED, IF CHECKED SKIP TO SECTION V
18D. SPOUSE'S SOCIAL SECURITY NUMBER
18B. WHAT IS YOUR SPOUSE'S NAME (First, Middle, Last)
18C. SPOUSE'S DATE OF BIRTH (MM,DD,YYYY)
18E. IS YOUR SPOUSE ALSO A VETERAN?
18F. WHAT IS YOUR SPOUSE'S VA FILE NUMBER (If any)
(If "Yes," answer Item 18F)
YES
NO
Page 4
VA FORM 21P-535, MAY 2018
Veteran's Social Security No.
SECTION V: INFORMATION REGARDING PARENT'S NEED FOR NURSING HOME CARE OR AID AND ATTENDANCE
19. ARE YOU CLAIMING THE AID AND ATTENDANCE ALLOWANCE BECAUSE YOU NEED THE REGULAR ASSISTANCE OF ANOTHER PERSON OR HAVE SEVERE
VISUAL PROBLEMS?
(If "No," skip to Section VI)
YES
NO
NOTE: If you answered "Yes," to Item 19 and are not in a nursing home, submit a statement from your doctor showing the extent of
your disabilities. If you are in a nursing home, attach a statement signed by an official of the nursing home showing the date you were
admitted to the nursing home, the level of care you receive, and the amount you pay-out-of-pocket for your care.
20A. ARE YOU NOW IN A NURSING HOME?
20B. PROVIDE THE NAME AND COMPLETE MAILING ADDRESS OF THE NURSING HOME
(If "Yes," answer Item 20B also)
YES
NO
SECTION VI: INFORMATION REGARDING PARENT'S INCOME
IMPORTANT - Payments from any source will be counted, unless the law indicates that they don't need to be counted. Report all income in the boxes
below, and VA will determine any amount that does not count.
21. HAVE YOU CLAIMED OR ARE YOU
22. HAVE YOU FILED A CLAIM FOR COMPENSATION FROM
23. HAS A COURT AWARDED DAMAGES BASED ON
RECEIVING BENEFITS FROM THE SOCIAL
THE OFFICE OF WORKER'S COMPENSATION
THE DEATH OF THE VETERAN OR IS A CLAIM
SECURITY ADMINISTRATION?
PROGRAMS BASED ON THE DEATH OF THE VETERAN?
OR LEGAL ACTION FOR DAMAGES PENDING?
YES
NO
YES
NO
YES
NO
Report the total amounts before you take out deductions for taxes, insurance, etc.
Do not report the same income in both tables.
If you expect to receive a payment, but you don't know how much it will be, write "Unknown" in the space.
If you do not receive any payments from one of the sources that we list, write "0" or "None" in the space.
VA will interpret a blank space to mean "0" or "None".
If you are receiving monthly benefits, give us a copy of your most recent award letter. This will help us determine the amount of benefits you should
be paid.
Monthly Income - Report The Income You And Your Spouse Receive Monthly
Note: If you are filing this application as the guardian or custodian of the veteran's parent, do not report your own income.
Spouse
Sources of recurring monthly income
Parent
(If living together)
24a. Social Security
$
$
24b. U.S. Civil Service
24c. U.S. Railroad Retirement
24d. Military Retirement
24e. Black Lung Benefits
24f. Other income received monthly (Please write source below)
24g. Other income received monthly (Please write source below)
Annual Income By Calendar Year - Tell Us About Annual Income For You And Your Spouse
NOTE: Report income received from January 1 to the date of the veteran's death. If the claim is filed more than one year after the veteran died, report
the income you received from January 1 to the date you sign this application.
Spouse
Sources of recurring monthly income
Parent
(If living together)
25a. Gross wages and salary
$
$
25b. Total dividends and interest
25c. Life insurance
25d. Other income expected (Please write source below)
Page 5
VA FORM 21P-535, MAY 2018
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