Va Form 21-535 - Application For Dependency And Indemnity Compensation By Parent(S) Page 10
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10IMPORTANT: PLEASE READ THE FOLLOWING BEFORE YOU COMPLETE THE SSA-24.
INSTRUCTIONS FOR COMPLETING FORM SSA-24, APPLICATION FOR SURVIVORS BENEFITS
(Payable Under Title II of the Social Security Act)
This application form, SSA-24, is an Application for Survivors Benefits Payable under Title II of the Social
Security Act, as amended. Under authority of section 202(o) of the Social Security Act, the application requests
information in order to determine eligibility to social security benefits.
You do not have to complete this application; there are no penalties under the law if you do not complete part
or all of the SSA-24. However, it is usually to your advantage to provide the information because not providing it
could prevent an accurate and timely decision on your claim or could result in the loss of some benefits or
insurance coverage.
If you do wish to supply the information requested on the SSA-24, this information will be forwarded to the Social
Security Administration and used by them to determine whether social security benefits may be payable to
surviving dependent(s) of the veteran. Social Security will then contact you regarding any social security
benefits payable based on information given on this form.
Please understand that Social Security may, in certain instances, disclose the information on this form to another
Federal, State or local agency or individual without your written consent. This would be done in order to:
enable a third party or an agency to assist Social Security in establishing an individual's right to benefits or
coverage;
comply with Federal laws which require or authorize the release of information from social security records;
and
facilitate statistical research and audit activities necessary to assure the integrity and improvement of the
social security programs.
If you should have any question about entitlement to social security benefits or the information you have
provided on this form, please contact your local social security office.
Complete each item of the attached application, Form SSA-24, (except Items 20 through 23). When signed and
dated the form SHOULD BE LEFT ATTACHED to your completed
VA FORM 21-534, Application for Dependency and Indemnity Compensation, Death Pension and
Accrued Benefits by a Surviving Spouse or Child (Including Death Compensation if Applicable) or
VA FORM 21-535, Application for Dependency and Indemnity Compensation by Parent(s)
(Including Accrued Benefits and Death Compensation When Applicable).
PAPERWORK REDUCTION ACT: This information collection meets the clearance requirements of 44 U.S.C.
§3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You are not required to answer these
questions unless we display a valid Office of Management and Budget control number. We estimate that it will
take you about 15 minutes to read the instructions, gather the necessary facts, and answer the questions.
PAGE 8
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