VA Form 21P-534EZ Application for Dic, Survivors Pension, and/Or Accrued Benefits

What Is VA Form 21P-534EZ?

VA Form 21P-534EZ, Application for DIC, Death Pension, and/or Accrued Benefits is a document used to request Dependency and Indemnity Compensation (DIC), death pension, and accrued benefits under the Fully Developed Claim Program (FDC). The information provided to the Department of Veterans Affairs (VA) via this form is used for determination of allowance to the compensation or benefits.

The latest version of the form - formerly known as VA Form 21-534EZ - was released by the VA in October 2018. The most recent fillable VA Form 21P-534EZ is available for download below or can be found on the VA website.

The document has two related forms:

The first form is used by the surviving spouse or child to apply for dependency and indemnity compensations, death pension, and accrued benefits, including death compensation if applicable. The second form is filled out to request service-connected death benefits and compensations only.


Download VA Form 21P-534EZ Application for Dic, Survivors Pension, and/Or Accrued Benefits

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Help with VA Form 21P-534EZ

If you need help with completing the form or just want more information on the VA benefits, you can contact the VA representative online or call a toll-free number at 1-800-827-1000.

Besides, you can have an authorized representative to help you with completing the form, collecting all required evidence, and filing a claim. This representative can be an accredited attorney, a claim agent, or a Veterans Service Officer. To set up a person acting on your behalf, you need to inform the VA about that first using eBenefits or filling out and mailing one of the following documents:

  • To have a Veterans Service Officer as a representative, it is necessary to file and submit a copy of VA Form 21-22;
  • To set up a claims agent or attorney as an official representative, VA Form 21-22A should be submitted.

How to Fill out VA Form 21P-534EZ?

VA Form 21P-534EZ instructions are as follows:

  1. Section I must be completed by all the applicants and contain your and veteran's personal data.
  2. Items 1 through 9 require the complete information about the veteran, including full name, sex, Social Security number (SSN), dates of birth and death, service number, VA file number (if the veteran, surviving spouse, child, or parent has ever filed a claim with VA), and the information if the veteran died while on active duty.
  3. In Items 10 through 16B, you should indicate your personal information, including name, relationship to the veteran, SSN, date of birth, if you are a veteran too, mail & e-mail addresses, and phone numbers.
  4. You have to specify the claiming benefits in Item 17.
  5. You should complete Section II only if the veteran at the time of death was not receiving any compensation or pension benefits. This part requires full information about the veteran's service.
  6. If you are claiming benefits as the surviving spouse of the veteran, Section III should be completed. Otherwise, it is required to skip this part.
  7. When filling out Section III, you need to enlist all your marriages, and the marriages of the veteran and enter all the details demanded.
  8. Section IV must be filled out only if you request benefits for the veteran's children (including biological, adopted, and stepchildren).
  9. Section V is to be filled out if you apply for benefits as the parent of the veteran, and should contain the information about your marital status, the details on your spouse (if any), and if the veteran was a member of your household or under your parental control.
  10. If you claim DIC, you should complete Section VI. It requires specification of DIC you are claiming and a full list of the VA medical centers the veteran was treated in pertaining to this claim, as well as the dates of treatments.
  11. Section VII should be completed if you request special benefits due to health problems that require the regular assistance or due to your being in a nursing home.
  12. If you request survivors pension or parents DIC, you must complete Section VIII. Otherwise, it should be skipped.
  13. Section IX requires information about medical, burial, educational, or vocational expenses. If you claim the expenses for in-home care or assisted living, you need to complete the corresponding worksheet on pages 12-13.
  14. You must indicate direct deposit data in Section X.
  15. If you do not want your application to be considered under the FDC Program, it should be indicated in Item 49, Section XI.

To be valid, VA 21P-534EZ requires your signature and the date. If you have signed using an "X", the names and signatures of two witnesses should be provided in Section XII.

Where to Mail VA Form 21P-534EZ?

After completing, you should mail or take the form - as well as all the supporting evidence - to the nearest VA regional office. All the addresses of the VA offices can be found at the VA official website.

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