Va Form 21- 8834 - Application For Reimbursement Of Headstone Or Marker Expense Page 2
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2CAUTION --- This is a limited benefits and is not intended to reimburse the total cost of the selected headstone or marker.
The average government cost rate is the one in effect at the time the headstone or marker was purchased.
2. Eligibility. The deceased was buried on or after October 18, 1978 and;
a. A veteran who was discharged or released from service under conditions other than dishonorable; or
b. A service person who died while on active duty; or
c. A member of a Reserve component of the Armed Forces, Army National Guard or the Air National Guard who died while
hospitalized or was receiving treatment for a condition or disease contacted or incurred while performing reserve duties; or
d. A member of the Reserve Officer Training Corps whose death occurred under certain circumstances (additional information
regarding this may be obtained from your local VA Regional Office); and
e. Died on or before October 31, 1990; and
f. Was not buried or memorialized in a National Cemetery.
3. Who May File a Claim. Any person who paid for the veteran's or service person's headstone, marker, or additional engraving.
4. Time Limit For Filing Claim. There is no time limit for filing monetary allowance in lieu of a government furnished headstone or
marker.
5. Careful Execution of Claim Necessary. Provide full information, clearly and legibly handwritten or typed. If you are unable to
furnish the information requested or if you require assistance you should contact your nearest VA Regional Office for instructions.
6. Social Security Number. Enter the deceased veteran's social security number in Item 2.
7. Veteran's Estate. If the headstone, marker, or additional engraving was paid for with funds of the veteran's estate the claim may be
filed by the executor or administrator thereof by completing the application.
8. Proof of Veteran's Death to Accompany Claim. If proof of death has previously been furnished VA, it need not be submitted with
this application. Death of veterans in Federal government institutions are automatically reported to VA and need not be proven. In all
other cases the public record of death or a copy of a coroner's report of death, or the verdict of a coroner's jury, verified by the
custodial of such records must accompany this application.
9. Receipted Bill to Accompany Claim. This claim must be accompanied by a receipted bill (preferably on the printed billhead of the
monument company) showing the name of the deceased veteran, the name of the person by whom payment was made, a description
of the headstone, marker, or additional engraving, the nature and costs of the purchase, and statement as to the amount paid by the
purchaser, and all credits to the account if not paid in full.
10. Duplication of Benefits Prohibited. This application is for use only if a headstone or marker is purchased in lieu of one furnished
by VA. Claim one benefits only. There is no entitlement to both reimbursement and a government furnished headstone or marker.
11. Service Record. If the veteran previously filed a VA claim, include the VA claim number in Item 3. If the veteran never filed a
claim with VA, submit a photocopy of his/her discharge certificate to expedite processing.
12. NOTE. The payment of any fee in the preparation of this claim is prohibited.
13. Prohibition of Discriminatory Practices. Reimbursement of headstone, marker, or additional engraving expenses prohibited if the
retailer is found to discriminate based on race, color, or national origin (42 U.S.C. 2000(d)). Any person(s) who purchases a
headstone, marker, or additional engraving has the right to file a complaint with the nearest VA Regional Office if discrimination is
encountered.
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