Va Form 21p-509 - Statement Of Dependency Of Parent(S)
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4INSTRUCTIONS
FOR STATEMENT OF DEPENDENCY OF PARENT(S)
VA FORM 21P-509
Note: Read very carefully, detach, and keep these instructions for your reference. Print all answers clearly. If an
answer is "none" or "0," write that. Your answer to every question is important to help us complete your claim.
If you do not know the answer, write "unknown." If additional space is necessary, please attach a separate sheet
with your answer, and indicate the item to which the answer implies.
A. How can I contact VA if I have questions?
If you have questions about this form, how to fill it out, or about benefits, contact your nearest VA regional office. You can
locate the address of the nearest regional office in your telephone book blue pages under "United States Government,
Veterans" or call 1-800-827-1000 (Hearing Impaired TDD line 711). You may also contact VA by Internet at
vba.va.gov/benefits/address.htm.
B. What do I use VA Form 21P-509 for?
Use VA Form 21P-509 if:
1. You are a veteran whose parents are dependent on you for support, and you are:
•
Receiving compensation benefits based on a 30 percent or higher service-connected disability, or
•
Receiving VA educational benefits based on enrollment of 1/2 time or more.
OR
2. You are the parent of a deceased veteran who:
•
Died on active duty or as a result of service-connected injuries or disease prior to January 1, 1957, or
•
Died on or after May 1, 1957, and before January 1, 1972, while a waiver of premiums of his/her
U.S. Government Life Insurance was in effect.
C. What is meant by “Parent” on this form?
The term "Parent" includes a natural parent, a parent through adoption, and a foster parent (including stepparents who stood
in the relationship of parent to the veteran).
Specific Instructions
Net Worth of Parent(s) (Items 5A, 5B, and 5C)
Report the current value of all the interest and rights you (the parent(s)) have in any kind of property. This includes real
estate, stocks, bonds and the amount of bank deposits, savings and loan accounts, and cash on hand. However, net worth
does not include your (the parent(s)) single family dwelling unit, reasonable lot area, and personal things you use every day
furniture
like your vehicle, clothing, and
. If property is owned jointly by yourself and your spouse, report one-half of the
total value held jointly for each of you.
Income of Parent(s) (Items 6A, 6B, and 6C)
Report all income received for the 12 month period and for the calendar month immediately preceding the date of
completing this form, and the sources of income.
Page 1
21P-509
VA FORM
EXISTING STOCKS OF VA FORM 21-509, DEC 2010,
AUG 2014
WILL BE USED.
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