Va Form 21-530 - Application For Burial Benefits (Page 2 of 4) in pdf

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 nonservice-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.

4. TIME LIMIT FOR FILING A CLAIM - A claim for nonservice-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.

5. 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.

6. 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.

7. 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.

8. 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.

9. 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.

10. 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.

11. 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

The address is also located in the government pages of your telephone

book under "United States Government, Veterans."

VA FORM 21-530, JAN 2010

Va Form 21-530 - Application For Burial Benefits Page 2