Va Form 40-0241 - State Cemetery Data
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4FORM APPROVED OMB NO. 2900-0559
RESPONDENT BURDEN: 60 MINUTES
FISCAL YEAR ENDING (State) (Include
STATE CEMETERY DATA
month and year)
RESPONDENT BURDEN: Public reporting burden for this collection of information is estimated to average 60 minutes per response. Statutory
authority for the State Cemetery Grants Program is 38 U.S.C., subchapter 2408. This form is approved under OMB No. 2900-0559, and when form is
completed it provides VA with data regarding the number of interments conducted at states veterans cemeteries each year.
VA may not conduct or sponsor, and you are not required to respond to, this collection of information unless it displays a valid OMB Control Number.
Responding to this information collection is voluntary. Send comments regarding this burden estimate or any other aspects of this collection of
information, including suggestions for reducing this burden, to VA Clearance Officer (005R1B), 810 Vermont Avenue, NW, Washington, DC 20420.
Please do not send applications for benefits to this address.
1. NAME OF CEMETERY
2. MAILING ADDRESS
3. STATUS OF CEMETERY
OPEN
CLOSED
4. NAME OF DIRECTOR
5. PHONE NO. (Area Code)
6. FAX NO.
7. E-MAIL ADDRESS
8. WEBSITE ADDRESS
9. DATE OPENED
10. DATE DEDICATED
11. DATE OF FIRST BURIAL
12. DATE OF ESTIMATED CLOSURE
A. FULL CASKETED AREA
B. IN-GROUND CREMATED
C. COLUMBARIUM
(Month/Year)
(Month/Year)
(Month/Year)
13. NAME OF STATE AGENCY RESPONSIBLE FOR CEMETERY (For example: Department of Veterans Affairs. Include name, telephone no., and fax no.)
CEMETERY STATISTICS
ACREAGE
TOTAL
BURIALS
VETERAN
DEPENDENT
14. TOTAL ACREAGE OF CEMETERY SITE
29. NUMBER OF FIRST CASKETED BURIALS
COMPLETED THIS FISCAL YEAR
15. CURRENT DEVELOPED ACREAGE
30. NUMBER OF FIRST IN-GROUND
16. UNDEVELOPED ACREAGE PLANNED FOR FUTURE
CREMATED BURIALS THIS FISCAL YEAR
GRAVESITES
31. NUMBER OF FIRST COLUMBARIUM
INURNMENTS FILLED THIS FISCAL YEAR
CASKETED GRAVESITES
32. NUMBER OF SECOND CASKETED BURIALS
COMPLETED THIS FISCAL YEAR
17. NUMBER OF CURRENTLY DEVELOPED CASKETED
33. NUMBER OF SECOND IN-GROUND
GRAVESITES AVAILABLE
CREMATED BURIALS THIS FISCAL YEAR
34. NUMBER OF SECOND COLUMBARIUM
18. ESTIMATED NUMBER (PHASED) GRAVESITE YIELD IN
INURNMENTS FILLED THIS FISCAL YEAR
UNDEVELOPED ACREAGE
35. SUB TOTAL (Item numbers 29 through 34)
19. TOTAL NUMBER OF CASKETED GRAVESITES
MAINTAINED TO DATE
35A. SUB TOTAL (All previously reported burials)
CREMATION GRAVESITES
36. TOTAL BURIALS (Date of opening cemetery to
current year - both Veteran and Dependents)
20. NUMBER OF IN-GROUND CREMATION GRAVESITES
37. NUMBER OF PLOT ALLOWANCE PAYMENTS
CURRENTLY AVAILABLE
RECEIVED FOR VETERAN BURIALS
21. ESTIMATED NUMBER (PHASED) CREMATION GRAVESITES
38. AMOUNT CHARGED FOR BURIAL;
YIELD IN UNDEVELOPED ACREAGE
CASKETED OR CREMATED
(Do not include burial plot allowance)
22. TOTAL NUMBER OF IN-GROUND CREMATION
39. NUMBER OF STATE PERSONNEL IN THE OFFICE
GRAVESITES MAINTAINED TO DATE
COLUMBARIUM NICHES
40. NUMBER OF STATE PERSONNEL IN THE FIELD
23. NUMBER OF COLUMBARIUM NICHES CURRENTLY
41. TOTAL NUMBER OF PERSONNEL
AVAILABLE
OPERATING EXPENSE STATISTICS
TOTAL
24. ESTIMATED NUMBER (PHASED) UNDEVELOPED
COLUMBARIUM NICHES
42. STATE FUNDS OBLIGATED FOR HUMAN RESOURCES
(Do not include burial plot allowance)
25. TOTAL NUMBER OF COLUMBARIUM NICHES
MAINTAINED TO DATE
43. STATE FUNDS OBLIGATED FOR OTHER OPERATING
COSTS* (Do not include burial plot allowance)
TOTAL GRAVESITE USAGE
44. TOTAL OPERATING EXPENSE
26. NUMBER OF CURRENTLY DEVELOPED GRAVESITES OF
(Include burial plot allowance if applicable)
ALL TYPES (including columbarium niches) AVAILABLE
* In estimating operating costs, take into account equipment replacement
27. ESTIMATED NUMBER OF GRAVESITES OF ALL TYPES
cost, fuel expense, vehicle maintenance and repairs, ground maintenance
IN PHASED DEVELOPMENTS IN UNDEVELOPED ACREAGE
supplies (fertilizer, lime, turf replacement, etc.), office supplies,
28. TOTAL NUMBER OF GRAVESITES OF ALL TYPES
personnel travel expenses, building maintenance expenses.
(including columbarium niches) MAINTAINED TO DATE
40-0241
VA FORM
NATIONAL CEMETERY ADMINISTRATION (VACO)
APR 2008
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