VA Form 21-530 Application for Burial Benefits

What Is VA Form 21-530?

VA Form 21-530, Application for Burial Benefits was a document previously used to apply for burial and funeral allowance if a veteran's death was service related. The person who paid the burial expenses could apply for reimbursement up to $2000.

The last VA Form 21-530 fillable version was released by the Department of Veterans Affairs (VA) in May 2012 and is available for download below. Alternatively, you can find it on the Office of Information and Regulatory Affairs website. However, this form is available as an archive version, since it is no longer in use with the VA Form 21P-530, Application for Burial Benefits under 38 U.S.C., Chapter 23 used instead.

Another form related to burial benefits is the VA Form 21P-530a, State Application for Interment Allowance under 38 U.S.C. Chapter 23, which is completed by a state official to provide information necessary to determine the state's eligibility for interment allowance.

ADVERTISEMENT
INSTRUCTIONS FOR COMPLETING APPLICATION FOR BURIAL BENEFITS
(UNDER 38 U.S.C., CHAPTER 23)
IMPORTANT - READ THESE INSTRUCTIONS CAREFULLY
PRIVACY ACT INFORMATION: The responses you submit are considered confidential (38 U.S.C. 5701). They may be disclosed
outside the Department of Veterans Affairs (VA) only if the disclosure is authorized under the Privacy Act, including the routine uses
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. The requested information is considered relevant and necessary to
determine maximum benefits under the law and is required to obtain benefits. Information submitted is subject to verification through
computer matching programs with other agencies.
RESPONDENT BURDEN: We need this information to determine your eligibility burial benefits. Title 38, United States Code, allows
us to ask for this information. We estimate that you will need an average of 22 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.
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.
1. GENERAL
a. BURIAL ALLOWANCE - An amount towards the expenses of the funeral and burial of the veteran's remains. Burial
includes all recognized methods of interment.
b. PLOT ALLOWANCE - Plot means the final resting place of the remains. The allowance is payable towards:
(1) Expenses incurred for the plot or interment if burial was not in a national cemetery or other cemetery under the
jurisdiction of the United States; OR
(2) Expenses payable to a State (or political subdivision) if the veteran died from non service-connected causes and was
buried in a State-owned cemetery or section used solely for the remains of persons eligible for burial in a national
cemetery.
c. BURIAL ALLOWANCE FOR SERVICE-CONNECTED DEATH - When the veteran's death occurred as the result of a
service-connected disability, a special "service-connected" rate is payable.
d. TRANSPORTATION EXPENSES - The cost of transporting the body to the place of burial may be paid in addition to
the burial allowance when:
(1) The veteran died of a service-connected disability or had a compensable service-connected disability and burial is in a
national cemetery; OR
(2) The veteran died while in a hospital, domiciliary or nursing home to which he/she had been properly admitted under
authority of VA; OR
(3) The veteran died en route while traveling under prior authorization of VA for the purpose of examination, treatment or care.
2. WHO SHOULD FILE A CLAIM
a. CREDITOR - If expenses have not been paid, the claim should be filed by the funeral director or crematory service by
completing Parts I, II, and IV. If the funeral director or crematory service has paid or advanced funds for or furnished the
plot or interment expenses, inclusion of these items on the statement of account will serve as claim for the plot allowance.
If cemetery owner or other creditor has not been paid for the plot and related interment expenses, he/she may file claim by
completing Parts I, III, and IV. If both the funeral director and cemetery owner are unpaid, each must submit a separate
VA Form 21-530 signed by the person who authorized services.
b. PERSON WHOSE FUNDS WERE USED - If all creditors have been paid, the claim should be filed by the person or
persons whose personal funds were used by completing Parts I, II, and IV.
21-530
VA FORM
Page 1
EXISTING STOCKS OF VA FORM 21-530,
MAY 2012
JAN 2010, WILL BE USED.
INSTRUCTIONS FOR COMPLETING APPLICATION FOR BURIAL BENEFITS
(UNDER 38 U.S.C., CHAPTER 23)
IMPORTANT - READ THESE INSTRUCTIONS CAREFULLY
PRIVACY ACT INFORMATION: The responses you submit are considered confidential (38 U.S.C. 5701). They may be disclosed
outside the Department of Veterans Affairs (VA) only if the disclosure is authorized under the Privacy Act, including the routine uses
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. The requested information is considered relevant and necessary to
determine maximum benefits under the law and is required to obtain benefits. Information submitted is subject to verification through
computer matching programs with other agencies.
RESPONDENT BURDEN: We need this information to determine your eligibility burial benefits. Title 38, United States Code, allows
us to ask for this information. We estimate that you will need an average of 22 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.
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.
1. GENERAL
a. BURIAL ALLOWANCE - An amount towards the expenses of the funeral and burial of the veteran's remains. Burial
includes all recognized methods of interment.
b. PLOT ALLOWANCE - Plot means the final resting place of the remains. The allowance is payable towards:
(1) Expenses incurred for the plot or interment if burial was not in a national cemetery or other cemetery under the
jurisdiction of the United States; OR
(2) Expenses payable to a State (or political subdivision) if the veteran died from non service-connected causes and was
buried in a State-owned cemetery or section used solely for the remains of persons eligible for burial in a national
cemetery.
c. BURIAL ALLOWANCE FOR SERVICE-CONNECTED DEATH - When the veteran's death occurred as the result of a
service-connected disability, a special "service-connected" rate is payable.
d. TRANSPORTATION EXPENSES - The cost of transporting the body to the place of burial may be paid in addition to
the burial allowance when:
(1) The veteran died of a service-connected disability or had a compensable service-connected disability and burial is in a
national cemetery; OR
(2) The veteran died while in a hospital, domiciliary or nursing home to which he/she had been properly admitted under
authority of VA; OR
(3) The veteran died en route while traveling under prior authorization of VA for the purpose of examination, treatment or care.
2. WHO SHOULD FILE A CLAIM
a. CREDITOR - If expenses have not been paid, the claim should be filed by the funeral director or crematory service by
completing Parts I, II, and IV. If the funeral director or crematory service has paid or advanced funds for or furnished the
plot or interment expenses, inclusion of these items on the statement of account will serve as claim for the plot allowance.
If cemetery owner or other creditor has not been paid for the plot and related interment expenses, he/she may file claim by
completing Parts I, III, and IV. If both the funeral director and cemetery owner are unpaid, each must submit a separate
VA Form 21-530 signed by the person who authorized services.
b. PERSON WHOSE FUNDS WERE USED - If all creditors have been paid, the claim should be filed by the person or
persons whose personal funds were used by completing Parts I, II, and IV.
21-530
VA FORM
Page 1
EXISTING STOCKS OF VA FORM 21-530,
MAY 2012
JAN 2010, WILL BE USED.
c. VETERAN'S ESTATE - If the expenses were paid from the veteran's estate, the claim should be filed by the executor/
administrator by completing Parts I, II, and IV. Submit a copy of the letters of administration or letters testamentary certified
over the signature and seal of the appointing court.
d. STATE - If a veteran whose death is non service-connected was buried without charge for plot or interment in a State-owned
cemetery or section used for persons eligible in a national cemetery, the claim may be filed by the State official completing
Parts I, III (Items 23 and 24), and IV.
3. TIME LIMIT FOR FILING A CLAIM - A claim for non service-connected burial expenses or plot allowance must be filed
with VA within 2 years from the date of the veteran's permanent burial or cremation. If a veteran's discharge was corrected after
death to "Under Conditions Other Than Dishonorable," the claim must be filed within 2 years from the date of correction. The
2-year limitation does not apply to service-connected burial benefits, transportation expenses or reimbursement of headstone expenses.
4. COMPLETING CLAIM BY A FIRM OR STATE AGENCY - The claim must be executed in the full name of the firm or
State agency, and show the official position or connection of the individual who signs on its behalf.
5. PROOF OF DEATH TO ACCOMPANY CLAIM - Death in a government institution does not need to be proven. In other
cases, the claimant must forward a copy of the public record of death. If proof has previously been furnished VA, it need not be
submitted again.
6. STATEMENT OF ACCOUNT MUST ACCOMPANY CLAIM
a. FUNERAL DIRECTOR - A statement of account on the funeral director's letterhead must show the name of the veteran;
the nature and cost of services, including any payments made to another funeral home (show name and address); all credits;
and the name of the person or persons by whom payment in whole or in part was made.
b. TRANSPORTATION - If transported by common carrier, a receipt must accompany the claim. All receipts for
transportation charges should show the name of the veteran, the name of the person who paid and the amount of the charges.
The itemized statement of account should show the charges made for transportation. Failure to itemize charges may result in
delay or payment of a lesser amount.
c. ACCOUNT PAID IN FULL - The statement of account should be receipted in the name of the firm or individual performing
the services. Bills or receipts filed in support of this claim become a part of the permanent record and will not be returned,
unless specifically requested.
d. PLOT ALLOWANCE ONLY - In a claim for the plot allowance only, the statement of account must show the cost of the
veteran's individual gravesite, the mausoleum vault, or the columbarium niche.
7. BURIAL ASSOCIATION OR BURIAL INSURANCE - If the veteran was a member of a burial association or if any insurance
company is obligated to pay all or part of the burial expenses, Item 22 should be answered "Yes." It will be necessary to support
the claim with a statement from the association or insurance company setting forth the terms of the contract and how and with
whom settlement was made.
8. SERVICE RECORD - The original or certified copy of the veteran's service separation document (DD214 or equivalent)
which contains information as to the length, time, and character of service will permit prompt processing.
9. TOLL-FREE TELEPHONE ASSISTANCE - You can call us toll-free within the U.S. by dialing 1-800-827-1000. If you
are located in the local dialing area of a VA regional office, you can also call us by checking your local telephone directory. For the
hearing impaired, our TDD number is 1-800-829-4833.
10. WHERE DO I MAIL MY COMPLETED APPLICATION? - You should mail your application to the VA regional office located
in your state. You can obtain the mailing address for VA regional offices by accessing the VA Internet website at www.va.gov/directory.
The address is also located in the government pages of your telephone book under "United States Government, Veterans."
Page 2
VA FORM 21-530, MAY 2012
OMB Approved No. 2900-0003
Respondent Burden: 22 minutes
(DO NOT WRITE IN THIS SPACE)
(VA DATE STAMP)
APPLICATION FOR BURIAL BENEFITS
(Under 38 U.S.C. Chapter 23)
IMPORTANT - Read instructions carefully before completing form. YOUR COMPLIANCE WITH ALL
INSTRUCTIONS WILL AVOID DELAY. Type or print all information.
1. FIRST, MIDDLE, LAST NAME OF DECEASED VETERAN
2. SOCIAL SECURITY NUMBER OF VETERAN
3. VA FILE NUMBER
4. FIRST, MIDDLE, LAST NAME OF CLAIMANT
(Include Area Code)
5C. E-MAIL ADDRESS
5. TELEPHONE NUMBER(S)
A. DAYTIME
B. EVENING
(Number and street or rural route, city or P.O., State and ZIP Code)
6A. MAILING ADDRESS OF CLAIMANT
6B. IF CLAIMANT IS A FUNERAL HOME PROVIDE THE EMPLOYER IDENTIFICATION NUMBER (EIN)
PART I - INFORMATION REGARDING VETERAN
7A. DATE OF BIRTH
7B. PLACE OF BIRTH
8A. DATE OF DEATH
8B. PLACE OF DEATH
8C. DATE OF BURIAL
(Check one)
8D. WHERE DID THE VETERAN'S DEATH OCCUR?
VA MEDICAL CENTER
NURSING HOME UNDER VA CONTRACT
(Specify)
STATE VETERANS HOME
OTHER
SERVICE INFORMATION (The following information should be furnished for the periods of the VETERAN'S ACTIVE SERVICE)
9C. SEPARATED FROM SERVICE
9A. ENTERED SERVICE
9B. SERVICE
9D. GRADE, RANK OR RATING,
NUMBER
ORGANIZATION AND BRANCH OF SERVICE
DATE
PLACE
DATE
PLACE
10. IF VETERAN SERVED UNDER NAME OTHER THAN THAT SHOWN IN ITEM 1, GIVE FULL NAME AND
11. ARE YOU CLAIMING THAT THE CAUSE OF
SERVICE RENDERED UNDER THAT NAME
DEATH WAS DUE TO SERVICE?
YES
NO
PART II - CLAIM FOR BURIAL BENEFITS AND/OR INTERMENT ALLOWANCE IF PAID BY CLAIMANT
NOTE - If claiming Plot Allowance Only, do not complete Part II, but complete Parts III and IV on page 4.
12. PLACE OF BURIAL OR LOCATION OF CREMAINS 13. WAS BURIAL (WITHOUT CHARGE FOR PLOT OR
14. WAS BURIAL IN A NATIONAL CEMETERY
INTERMENT) IN A STATE OWNED CEMETERY, OR
OR CEMETERY OWNED BY THE FEDERAL
SECTION THEREOF, USED SOLELY FOR PERSONS
GOVERNMENT?
ELIGIBLE FOR BURIAL IN A NATIONAL CEMETERY?
(IF "No," complete Items 15 and 16)
(If "No," complete Items 15 and 16)
YES
NO
YES
NO
15. BURIAL PLOT, MAUSOLEUM VAULT, COLUMBARIUM NICHE, ETC.
16. IF PLOT/INTERMENT EXPENSES ARE UNPAID, WHO WILL FILE CLAIM FOR
COST IS: (CHECK ONE)
EXPENSES? (Name and Address)
PAID BY ANOTHER PERSON(S)
PAID BY CLAIMANT FOR BURIAL
DUE FUNERAL DIRECTOR
NONE
DUE CEMETERY OWNER
17. TOTAL EXPENSE OF BURIAL, FUNERAL, TRANSPORTATION,
18. AMOUNT PAID
19. WHOSE FUNDS WERE USED?
AND IF CLAIMED, BURIAL PLOT
$
$
20A. HAS THE PERSON WHOSE FUNDS WERE USED BEEN
20B. AMOUNT OF REIMBURSEMENT
20C. SOURCE OF REIMBURSEMENT
REIMBURSED?
(If "Yes," complete Items 20B and 20C)
YES
NO
$
VA FORM
21-530
EXISTING STOCKS OF VA FORM 21-530,
Page 3
MAY 2012
JAN 2010, WILL BE USED
21A. HAS ANY AMOUNT BEEN, OR WILL ANY AMOUNT BE
21B. AMOUNT
21C. SOURCE(S)
ALLOWED ON EXPENSES BY LOCAL, STATE, OR FEDERAL
AGENCY?
$
YES
NO
(If "Yes," complete Items 21B and 21C)
22. WAS THE VETERAN A MEMBER OF A BURIAL ASSOCIATION OR COVERED BY BURIAL INSURANCE?
YES
NO
(Before answering, read and comply with Instruction 8)
PART III - CLAIM FOR PLOT COST ALLOWANCE
IMPORTANT - Complete only if burial was NOT in a national cemetery or cemetery owned by the Federal Government.
23. WAS BURIAL (WITHOUT CHARGE FOR PLOT OR INTERMENT) IN
24. PLACE OF BURIAL OR LOCATION OF CREMAINS
A STATE OWNED CEMETERY, OR SECTION THEREOF, USED SOLELY FOR
PERSONS ELIGIBLE FOR BURIAL IN A NATIONAL CEMETERY?
YES
NO
25A. COST OF BURIAL PLOT (Individual Grave Site, Mausoleum Vault, or
25B. DATE OF PURCHASE
25C. DATE OF PAYMENT
Columbarium Niche)
$
26A. HAVE BILLS BEEN PAID IN FULL?
26B. AMOUNT PAID
27. WHOSE FUNDS WERE USED?
YES
NO
(If "No,"complete Items 26B and 27)
$
28A. HAS PERSON WHOSE FUNDS WERE USED BEEN
28B. AMOUNT OF REIMBURSEMENT
28C. SOURCE OF REIMBURSEMENT
REIMBURSED?
$
YES
NO
(If "Yes,"complete Items 28B and 28C)
29A. HAS ANY AMOUNT BEEN, OR WILL ANY AMOUNT
29B. AMOUNT
29C. SOURCE
BE ALLOWED ON EXPENSES BY STATE OR FEDERAL
AGENCY?
$
YES
NO
(If "Yes,"complete Items 29B and 29C)
PART IV - CERTIFICATION AND SIGNATURE
I CERTIFY THAT the foregoing statements made in connection with this application on account of the named veteran are true and correct to
the best of my knowledge and belief.
30A. SIGNATURE OF CLAIMANT (If signed using an "X", complete Items 36A thru 37B)
30B. OFFICIAL POSITION OF PERSON SIGNING ON BEHALF OF FIRM,
(If signing for firm, corporation, or State agency, complete Items 30B thru 31)
CORPORATION OR STATE AGENCY
31. FULL NAME AND ADDRESS OF THE FIRM, CORPORATION, OR STATE AGENCY FILING AS CLAIMANT
NOTE - Where the claimant is a firm or other unpaid creditor, Items 32A thru 35 MUST be completed by the individual who authorized services.
I CERTIFY THAT the foregoing statements made by the claimant are correct to the best of my knowledge and belief.
32A. SIGNATURE OF PERSON WHO AUTHORIZED SERVICES (If signed using an "X",
32B. NAME OF PERSON AUTHORIZING SERVICES (Type or Print)
complete Items 36A thru 37B)
33. ADDRESS (Number and street or rural route, city or P.O., State and ZIP Code)
34. DATE
35. RELATIONSHIP TO VETERAN
WITNESS TO SIGNATURE IF MADE BY "X"
NOTE - If claimant signed above using an "X", signature must be witnessed by two persons to whom the person making the statement is personally known, and the
signatures and addresses of such witnesses must be shown below.
36A. SIGNATURE OF WITNESS
36B. ADDRESS OF WITNESS
37A. SIGNATURE OF WITNESS
37B. ADDRESS OF WITNESS
PENALTY - The law provides severe penalties which include fine or imprisonment, or both, for the willful submission of any statement or evidence of a material fact
knowing it to be false.
DEPARTMENT OF VETERANS AFFAIRS HEADSTONES AND MARKERS
The Department of Veterans Affairs will furnish, upon request, a Government headstone or marker at the expense of the United States for the unmarked graves
of certain individuals eligible for burial in a national cemetery, but not buried there. These individuals include any veteran with an other than dishonorable
discharge who dies after service or any serviceman or servicewoman who dies on active duty. Certain other individuals may also be eligible for the headstone or
marker. Headstones or markers for all individuals in a national or post cemetery are furnished automatically without request from the family.
For additional information on burial benefits go to the website, www.cem.va.gov/bbene_burial.asp. To obtain VA Form 40-1330, Application for Standard
Government Headstone or Marker go to www.va.gov/vaforms or contact your local VA regional office. The address of that office can be found at to www.va.
gov/directory.
Page 4
VA FORM 21-530, MAY 2012

Download VA Form 21-530 Application for Burial Benefits

1146 times
Rate
4.4(4.4 / 5) 57 votes
ADVERTISEMENT

VA Form 21-530 Instructions

  1. The claimant should provide the deceased veteran's full name, their social security number, VA file number, the full name of the claimant, their phone number, e-mail address, mailing address. If a claimant is a representative of a funeral home, they should provide the employer identification number;
  2. Part I requires information about the deceased veteran. This includes the date and place of birth, date, and place of death, date of burial, where the veteran's death occurred, date and place of entering and separating from service, service number, grade, rank or rating, organization and branch of service. The claimant must give the veteran's full name and service rendered under another name, if applicable and certify that the cause of death was due to service;
  3. Part II is for a claim for burial benefits or interment allowance. This part should contain a place of burial or location of cremains, the total expense of burial, funeral, transportation, and burial plot, the amount paid, and whose funds were used. The claimant has to answer several questions: was burial in a state-owned or national cemetery, or cemetery owned by the federal government, who will file claim for expenses, if the plot or interment expenses are unpaid, the amount and source of reimbursement, whether the person spent any amount allowed by local, state, or federal agency, exact amount and source, and whether the veteran was a member of a burial association or whether they were covered by burial insurance;
  4. Part III is for the claim for plot cost allowance. This part requires information, whether the burial was in a state-owned cemetery or not, place of burial or location of cremains, cost of the burial plot, date of purchase and payment, whether the bills have been paid in full and whether they have been reimbursed;
  5. Part IV is for certification. The claimant signs and dates the form, certifying that the provided information is true and correct. If they are signing the form in behalf of a firm, corporation or state agency, they should submit the organization's full name and address.

Where to Send VA Form 21-530?

VA 21-530 is no longer used. The VA Form 21P-530 should be filed instead. The form is available for online filing and submitting. Alternatively, the form can be filed manually and mailed or presented in person to a local VA benefits office.

Page of 4