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Va Form 21 534

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VA Form 21P-534 is a document that the Department of Veterans Affairs uses, and that is known an Application for Dependency and Indemnity Compensation, Death Pension, and Accrued Benefits by a Surviving Spouse or Child (Including Death Compensation if Available). Typically filled out by the next of kin of a deceased veteran, this form is used by a surviving spouse or child to receive benefits from the Department. Whether the next of kin wishes to receive compensation, death pension or accrued benefits, the individual will have to provide his or her personal information, information about the deceased veteran along with their military service history, and whether or not the veteran had ever filed a claim with the Department. The person filing the claim will also be asked to provide information to verify that they are, in fact, next of kin. For example, if a spouse is filing this form, he or she should provide a copy of their marriage certificate. Once all the necessary information is included, the VA can begin to process the claim.

Va Form 21 534

Related Documents

VA Form 29-4125 › VA Form 10-2850C › VA Form 10-2850A ›

What is a VA Form 21 534?

A VA Form 21P-534 is known as an Application for Dependency and Indemnity Compensation, Death Pension, and Accrued Benefits by a Surviving Spouse or Child (Including Death Compensation If Available). The form is used by the United States Department of Veterans Affairs. This form will be filled out by the next of kin for a deceased veteran. They will need to complete this form in order to receive VA benefits.
The filer will need to list information about the veteran, including whether or not the veteran ever filed a claim with the Department of Veterans Affairs. The beneficiary will need to include their personal information as well. In order to ensure there is a valid claim for benefits, information about the veteran’s military service will be necessary. If the veteran was the applicant’s spouse, they should include verifiable marriage information. Make sure all the information is accurate before signing it and submitting it to the VA.

Most Common Uses

This form is used to apply for benefits that you may be entitled to receive as a surviving spouse or child of a deceased veteran and any money that the VA owes the veteran but did not pay prior to the veteran's death.  The form includes a SSA-24 form, which is an application for Social Security benefits.  If you fill out the form, the VA will send it to the Social Security Administration for you.

Components of a VA Form 21 534

A VA Form 21P-234 contains the following sections:

  • Claim Information
  • Identifying Information
  • Veterans Active Duty Service
  • Marital Information
  • Dependant Children
  • Housebound, In a Nursing Home, or Require Aid and Attendance
  • Income and Assets
  • Direct Deposit Information
  • Medical, Last Illness, Burial, or Other Unreimbursed Expenses
  • Certification and Signature
  • Remarks
  • Worksheet for an Assisted Living, Adult Day Care, or a Similar Facility
  • Worksheet for In-home Attendant Expenses
  • Social Security Administration Application for Survivors Benefits

 
How do I apply for aid and attendance allowance and household benefits?

To apply for aid and attendance allowance and household benefits, you need to fill out VA Form 21P-534.

How to complete a VA Form 21 534 (Step by Step)

To complete a VA Form 21P-534, you will need to provide the following information:

  • Claim Information
    • Whether the veteran ever filed a claim with the VA
    • VA file number
    • Whether the surviving spouse of child ever filed a claim with the VA
    • VA file number
    • Name of person on whose service the claim was filed
    • Relationship to person
    • Whether you are claiming service connection for cause of death
  • Identifying Information
    • Veteran’s name
    • Veteran’s social security number
    • Whether veteran served under another name
    • Name(s) the veteran served under
    • Veteran’s date of birth
    • Veteran’s date of death
    • Whether veteran was a former prisoner of war
    • Claimant’s name
    • Relationship to veteran
    • Claimant’s address
    • Telephone numbers
    • Email address
    • Social security number
    • Date of birth
  • Veterans Active Duty Service - if veteran never filed a VA claim, attach the original DD214 for each period of service listed
    • Date first entered active service
    • Place entered active service
    • Service number
    • Date left active service
    • Place left active service
    • Branch of service
    • Grade, rank, or rating
    • Details of second active service
  • Veteran's Marriages
    • Number of times veteran was married
    • Date, to whom married, type of marriage, how marriage terminated, the date of termination
    • Number of times claimant was married
    • Whether claimant remarried after the death of veteran
    • Date, to whom married, type of marriage, how marriage terminated, the date of termination
    • Whether a child was born to claimant and veteran before or during marriage
    • Whether you are expecting the birth of veteran’s child
    • Whether you lived continuously with veteran during marriage or prior to date of death
    • Cause and dates of any separation
    • Whether there is any reason at the time of your marriage to veteran it may not have been valid
  • Dependant Children
    • List of all children who are unmarried and under 18, between 18 and 23 and a full time student, or any age if they are permanently unable to support themselves
    • Name of child, date of birth, social security number
    • Indicate if child is: biological, adopted, stepchild, 18-23 in school, seriously disabled, married, previously married
    • If a child does not live with you: name, address, who the child lives with, monthly amount you contribute to child’s support
  • Housebound, In a Nursing Home, or Require Aid and Attendance
    • Whether you are claiming special monthly pension because you need the regular assistance of another person, have severe visual problems, or are confined to your immediate premises.
    • Whether you are currently in a nursing home
    • Name and mailing address of facility
    • Whether Medicaid covers all or part of your nursing home costs
    • Whether you have applied for Medicaid
  • Income and Assets
    • Whether you are claiming or receiving benefits from the Social Security Administration on your own behalf or on behalf of a child or children in your custody
    • Whether Social Security is based on your own employment
    • Whether a surviving spouse or child filed a claim for compensation from the Office of Worker’s Compensation Programs based on the death of the veteran
    • Whether a court awarded damages based on the death of the veteran or whether a claim or legal action is pending
    • Whether you claimed or are receiving survivor benefit plan (SBP) annuity from a service department based on the death of the veteran
    • Whether you or your dependents receive social security benefits
    • Gross monthly income of each social security recipient
    • Whether you own your primary residence
    • Size of the lot where your primary residence sits
    • Whether part of your lot could be sold without selling your residence (attach VA Form 21P-0969)
    • Whether you or your dependents receive income other than social security
    • Whether you or your dependents received any income other than social security last year
    • Whether you or your dependents have more than $10,000 in assets
    • Whether you or your dependents have transferred any assets in the three calendar years before this year
  • Direct Deposit Information
    • Account number
    • Type of account or certification that you do not have an account with a financial institution or certified payment agent
    • Name of financial institution
    • Routing or transit number
  • Medical, Last Illness, Burial, or Other Unreimbursed Expenses
    • Whether you are claiming unreimbursed medical expenses
      • Whose medical, burial, or other expenses were paid
      • Paid to
      • Purpose of payment
      • Date paid
      • Hourly rate/hours
      • Amount you pay 
  • Certification and Signature - certification that statements are true and correct and authorization for any person or entity to give to the VA any information about you.
    • Signature
    • Today’s date
    • Signature of witness, printed name and address of witness
  • Remarks
  • Worksheet for an Assisted Living, Adult Day Care, or a Similar Facility
    • Whether the expenses you wish to claim are due to the disabled person’s treatment in a hospital, inpatient treatment center, nursing home, or VA approved medical foster home
    • Whether the facility is licensed, the facility’s staff provides the disabled person with health care or custodial care or both, and it is staffed 24 hours per day if residential
    • Whether the claimant is a disabled person, surviving spouse, or a Parents’ DIC claimant
    • Whether you claimed special monthly pension
    • If you receive health and/or custodial care, is that the primary reason you live in the facility
    • Whether the disabled person requires the health care services or custodial care because of a mental or physical disability
    • Whether the facility’s health care and/or custodial care is the primary reason that the disabled person lives in the facility
    • Certification that the information in the worksheet is accurate (attach current statement of fees)
  • Worksheet for In-home Attendant Expenses
    • Whether the claimant is a disabled person, surviving spouse, or a Parents’ DIC claimant
    • Whether you claimed a special monthly pension
    • Whether it is the primary responsibility of the in-home attendant to provide health or custodial care
    • Whether the disabled person requires the health care or custodial care because of a mental or physical disability
    • Whether it is the primary responsibility of the in-home attendant to provide health or custodial care
    • Indicate the activities that the attendant assists the disabled person with: eating, bathing/showering, dressing, transferring, using the toilet, shopping, food preparation, housekeeping, laundering, managing finances, handling medications, using the telephone, transportation
    • Certification that worksheet is accurate
  • Social Security Administration Application for Survivors Benefits
    • Name of veteran
    • Date of death
    • Social security number of veteran
    • Date of birth
    • Place of birth
    • Name of father
    • Maiden name of mother
    • Whether the veteran worked in the railroad industry at any time after 1936
    • Date entered active service, service number, date separated from active service
    • Grade, rank, or rating, organization and branch of service
    • Relationship of applicant to veteran
    • Date of birth of applicant
    • VA file number
    • Names of surviving children
    • Certification that application is accurate, date, signature, mailing address, telephone number
    • Signature of witnesses, address of witnesses

Other Considerations

How can I contact the VA with questions?

If you have questions for the VA, you can call 1-800-827-1000.  If you are hearing impaired, you can call TDD line 711.  You can also contact our nearest VA office that you can locate in your telephone book blue pages under “United States Government, Veterans” or online at https://iris.custhelp.va.gov/. 

How does the VA decide what I will receive?

The VA will pay pension based upon the amount of family income and assets and number of dependent children.  The amount is set by law.  If there is no surviving spouse, pension may be payable on behalf of a child or children.
Dependency and indemnity compensation may be payable when: a veteran's death occurred while on active service, or a veteran dies of a service-connected disability or disabilities that was/were either the principal or contributory cause of death, or a veteran died from a non-service connected injury or disease AND was receiving, or entitled to receive VA compensation for a service-connected disability rated totally disabling; for at least 10 years immediately before death; or for at least 5 years after the veteran's release from active duty preceding death; or for at least 1 year before death, if the veteran was a former prisoner of war who died after September 30, 1999.
Survivors Pension may be payable when: the death of a veteran with wartime service is not due to service, and income and assets are within applicable limits.

Assigning a Representative

You may appoint a VA accredited Veterans Service Organization, a VA accredited attorney, or claims agent to act as your representative.  To designate a representative, use VA Form 21-22, Appointment of a Veterans Service Organization as Claimant's Representative or VA Form 21-22A, Appointment of Individual as Claimant's Representative. 

Submitting the Form

When you are filling out the VA Form 21P-534, you should fill it out completely.  If a question does not apply to you, you should indicate “none” or “not applicable.”
 
Once the form is complete, you should mail it or fax it to a regional VA Pension Management Center.  You can also submit it in person.  Make sure to attach copies of all the required documents (marriage certificate, birth certificates, death certificate).

What if the VA makes a mistake?

You can request a personal hearing at any time during the processing of your claim.  If you would like a hearing, you should contact your nearest VA office.  You will be allowed to present evidence and bring witnesses.  The VA will record everything that is said at the hearing and will add the transcript to your record.

Download a PDF or Word Template

VA Form 21-534

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Create VA Form 21-534

VA Form 29-4125

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Create VA Form 29-4125

VA Form 10-2850C

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Create VA Form 10-2850C

VA Form 10-2850A

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Create VA Form 10-2850A

Sample Va Form 21 534

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Sample Va Form 21 534

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