Form VA Form 21P-535 VA Form 21P-535 Application for Dependency and Indemnity Compensation by

General Instructions
For Application for Dependency and Indemnity Compensation by Parent(s) (Including Accrued Benefits and
Death Compensation when Applicable)
VA Form 21-535
Note: Read very carefully, detach, and keep these instructions for your reference.
Benefit rates and income limits are frequently changed, so
A. How can I contact VA if I have questions?
it is not possible to keep this information current in these
If you have any questions about this form, how to fill it
instructions. You can find out what the current income
out, or about VA benefits, contact your nearest VA
limitations and rates of benefits are by contacting your
regional office. You can locate the address of the nearest
nearest VA regional office.
regional office in your telephone book blue pages under
"United States Government, Veterans" or call 1-800-8271000 (Hearing Impaired TDD line 711). You may also
contact VA by Internet at https://iris.va.gov.

Note: Unless a claim for DIC is filed within one year from
the date of the veteran's death, that benefit is not payable
from a date earlier than the date VA receives the claim.

B. What is the purpose of VA Form 21-535?

E. How do I apply for the aid and attendance
allowance?

Use VA Form 21-535 to apply for:
VA benefits you may be entitled to receive as the
surviving parent(s) of a deceased veteran
Any money VA owes the veteran but did not pay
prior to his/her death (accrued benefits).
If you apply for one of these benefits, the law requires that
we also consider your entitlement for the other.
C. What is the purpose of the attached SSA-24 form?
You can apply for Social Security benefits by using the
SSA-24 form attached to this VA form (see pages 7 and
8). You don't have to apply if you don't want to or have
already done so. If you do want to apply, fill it out and
leave it attached. We will send it to the Social Security
Administration for you. They will then contact you.
D. What is dependency and indemnity compensation
(DIC), and how does VA decide what I will or will not
receive?
DIC may be payable to parent(s) when:
a veteran's death occurred in service, or
a veteran dies of a service-connected disability,
your income is limited.
VA pays Parents' DIC based on the amount of the
claimant's countable income and whether the claimant is
the sole surviving parent of the veteran or one of two
parents. This is based on law. If the claimant is married
and lives with his/her spouse, the claimant's and the
spouse's income are counted. VA must include as income
payments received from all sources that Federal law
specifies.

21P-535

F. How do I complete my application?
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." For additional space, use Item
44, "Remarks, " or attach a separate sheet, indicating the
item number to which the answers apply. Make sure you
sign and date this application (Items 40a through 41b).
Note: If the claim is being made on behalf of an
incompetent person, the application form should be
completed and filed by the legal guardian. If no legal
guardian has been appointed, it may be completed and
filed by some person acting on behalf of the
incompetent person.
G. What do I do when I have completed my
application?

AND

VA FORM
XXX 2014

VA may pay a higher rate of DIC to a surviving parent
who is blind, a patient in a nursing home, or otherwise
needs regular aid and attendance. If you wish to apply for
this benefit, check "yes" for Item 29.

When you have completed this application, mail it or take
it to a VA regional office. Be sure to attach any materials
that support and explain your claim. Also, make a
photocopy of your application and everything that you
submit to VA before mailing it.

SUPERSEDES VA FORM 21-535, JUN 2014,
WHICH WILL NOT BE USED.

General Instructions

Page 1

H. How can I assign someone to act as my
representative?
A representative can be an accredited member of an
accredited organization or other service organization that
the Secretary of Veterans Affairs recognizes, an agent
recognized by VA, or a licensed lawyer. If you appeal the
decision, agents and attorneys can charge you for services
that you receive from them only after the Board of
Veterans' Appeals (BVA) gives you its final decision
about your application. That means you can use an
attorney during any stage of your application for benefits;
however, the agent or attorney cannot charge you for
services unless you are trying to resolve a dispute with VA
after BVA has made a decision about your claim.
If you want to use a representative to help you with your
application, contact the nearest VA regional office.
Depending on the type of representative you want to
designate, we will send you one of the following forms:
VA Form 21-22, Appointment of Veterans Service
Organization as Claimant's Representative,

or VA Form 22a, Appointment of Individual as Claimant's
Representative. You may also download these forms at
http://www.va.gov/vaforms/. If you have already
designated a representative, no further action is required
on your part.
I. What if I believe that VA has made an error in
processing or deciding my benefits?
You can ask for a personal hearing at any time during the
processing of your claim. That means you can ask for the
hearing while VA is processing your claim or after VA has
made a decision. You should contact the nearest VA
regional office and tell them that you want a personal
hearing on your case. Someone in the local VA regional
office will arrange a time and a place for your hearing. At
this hearing, you may bring witnesses. VA will record
whatever you and your witnesses say during the hearing
and include it in the official record. VA will furnish the
hearing room and officials, and prepare a transcript of the
hearing. VA cannot pay your expenses or the expenses of
anyone you want to bring with you to the hearing.

IMPORTANT - If you are certifying that you are married for the purpose of VA benefits, your marriage must be
recognized by the place where you and/or your spouse resided at the time of marriage, or where you and/or your spouse
resided when you filed your claim (or a later date when you became eligible for benefits) (38 U.S.C. § 103(c)). Additional
guidance on when VA recognizes marriages is available at http://www.va.gov/opa/marriage/.

Privacy Act Notice: The VA will not disclose information collected on this form to any source other than what has been authorized under the Privacy Act of 1974 or Title
5, Code of Federal Regulations 1.526 for routine uses (i.e., civil or criminal law enforcement, congressional communications, epidemiological or research studies, the
collection of money owed to the United States, litigation in which the United States is a party or has an interest, the administration of VA programs and delivery of VA
benefits, verification of identity and status, and personnel administration) as identified in the VA system of records, 58VA21/22/28, Compensation, Pension, Education, and
Vocational Rehabilitation and Employment Records - VA, and published in the Federal Register. Your obligation to respond is required to obtain or retain benefits. Giving
us your SSN account information is mandatory. Applicants are required to provide their SSN under Title 38 USC 5101 (c) (1). The VA will not deny an individual benefits
for refusing to provide his or her SSN unless the disclosure of the SSN is required by Federal Statute of law in effect prior to January 1, 1975, and still in effect. The
requested information is considered relevant and necessary to determine maximum benefits under the law. Information that you furnish may be utilized in computer
matching programs with other Federal or state agencies for the purpose of determining your eligibility to receive VA benefits, as well as to collect any amount owed to the
United States by virtue of your participation in any benefit program administered by the Department of Veterans Affairs.

Respondent Burden: We need this information to determine eligibility for death benefits and accrued benefits under 38 U.S.C. 1121, 1310, 1315, and 5121. Title 38,
United States Code, allows us to ask for this information. We estimate that you will need an average of 1 hour and 12 minutes to review the instructions, find the
information and complete this form. VA cannot conduct or sponsor a collection of information unless a valid OMB control number is displayed. You are not required to
respond to a collection of information if this number is not displayed. Valid OMB control numbers can be located on the OMB Internet Page at www.reginfo.gov/public/do/
PRAMain. If desired, you can call 1-800-827-1000 to get information on where to send comments or suggestions about this form.

VA FORM 21P-535, XXX 2014

General Instructions

Page 2

OMB Control No. 2900-0005
Respondent Burden: 1 hour and 12 minutes
Expiration Date: X/XX/XXXX
DO NOT WRITE IN
THIS SPACE
(VA DATE STAMP)

Application for Dependency and Indemnity Compensation by Parent(s) (Including Accrued
Benefits and Death Compensation when Applicable), VA Form 21P-535
Please read the attached "General Instructions" before you fill out this form.

SECTION
I

1. Did the veteran ever file a claim with VA?

Tell us what you
and the deceased
veteran have
applied for

3. Have you ever filed a claim with VA?

Yes

Yes

No

No

2. What is the VA file number?

(If "Yes," answer Item 2)

4. What is the VA file number?

(If "Yes," answer Items 4
through 6)

5. Based on whose service was the claim filed?
First
Middle
6. What is your relationship to that person?

SECTION
II
Tell us
about you
and the
deceased
veteran

Last

7. What is the veteran's name?
First

Last

Middle

Suffix (If applicable)
8. What is the veteran's Social Security number (SSN)? 9a. Did the veteran serve under another name?
Yes
9b. Please list the other name(s) the veteran
served under

No

10. What is the veteran's date of birth?

mo day
Attach a copy of the
death certificate unless
the veteran died while
serving in the Army,
Navy, Air Force,
Marine Corps, or Coast
Guard, or as a
commissioned officer in
the National Oceanic
and Atmospheric
Administration, Coast
and Geodetic Survey,
Environmental Science
Services
Administration, or
Public Health Service,
or in a hospital or
institution under the
control of the U.S.
government.

(If "Yes," answer Item 9b)

yr

11. What is the veteran's date of death?
mo day yr
12. What is your name?
Note: If both parents of the veteran are jointly claiming benefits, provide both full names.
Mother:
First

Middle

Last

Middle

Last

Father:
First
13. What is your address?

Street address, Rural Route, or P.O. Box
City
14. What are your telephone numbers?
(Include Area Code)

Apt. number
State

Country
ZIP Code
15. What is your e-mail address?

Daytime
Evening
16. What is your Social Security number?
Note: If both parents of the veteran are jointly
claiming benefits, provide both SSNs.
Mother:
Father:
VA FORM
XXX 2014

21P-535

SUPERSEDES VA FORM 21-535, JUN 2014,
WHICH WILL NOT BE USED.

17. What is your date of birth?
Note: If both parents of the veteran are jointly
claiming benefits, provide both dates of birth.
Mother
Father
mo day

yr

mo day
21P-535

yr
page 1

SECTION Tell us about
the veteran's
III
active duty
service

1. Enter complete information
for all periods of service. If
more space is needed use
Item 44 "Remarks."
2. If the veteran never filed a
claim with VA, attach the
original DD214 or a certified
copy for each period of
service listed. We will return
original documents to you.

Note: Skip to Section IV if the veteran was receiving VA compensation or pension at the
time of his/her death.
18a. Entered Active
Service (first period)
mo day

Provide a copy of the veteran's
public record of birth or a copy
of the court record of adoption
if the veteran was adopted.

18f. Branch of
Service

18i. Place
18h. Entered Active
Service (second period)
mo day

mo day

parents

18e. Place

18g. Grade, Rank or
Rating

yr
18j. Service Number

yr

18k. Left This Active
Service

SECTION Tell us about
the veteran's
IV

18c. Service Number

yr

18d. Left This Active
Service
mo day

18b. Place

18l. Place

18m. Branch of
Service

18n. Grade, Rank or
Rating

yr

Definitions:
Parent means a biological mother or father, adoptive mother or father, and a foster mother or father.
A foster parent is a person who stood in the relationship of a parent to a veteran for at least one year
before the veteran's last entry into active service. The foster relationship must have begun prior to
the veteran's 21st birthday. If you are claiming benefits as the foster parent of the veteran, you will
also need to complete VA Form 21-524, Statement of Person Claiming To Have Stood in Relation of
Parent. If you need a copy of this form, you may contact VA as shown on page 1, of the General
Instructions or download the form from our website at http://www.va.gov/vaforms/. Note: Only
one father and one mother can be recognized for benefit payment purposes.
The age of majority is determined by State law and is age 18 in most States. Contact your State
government for more information.
Parental control is considered to have been given up if the parent has ceased to provide for the child
and the normal parent/child relationship has been broken.
19. What is the name of the veteran's mother? If deceased, provide date of death.
First
mo day

Middle

Last

yr

20. What is the name of the veteran's father? If deceased, provide date of death.
First

Middle

Last

mo day yr
21. What is the name of the veteran's foster mother? (If none, write "none.") If deceased, provide
date of death.
First

Middle

Last

mo day yr
22. What is the name of the veteran's foster father? (If none, write "none.") If deceased, provide
date of death.
First
mo day
VA FORM 21P-535, XXX 2014

Middle

Last

yr
21P-535

page 2

SECTION IV (Continued) 23a. Was the veteran a member of your household 23b. Date of parental control.
Tell us about
the veteran's
parents

or under your parental control at all times
before he/she reached the age of majority?
Yes

No

to

mo day

yr

mo day

yr

mo day

yr

to

(If "NO," answer Items 23b through 23d.)

mo day

yr

23c. Why wasn't the veteran a member of your household or under your parental control at all times
before he/she reached the age of majority? (Explain fully)

23d. Name and address of each person who assumed parental control over the veteran outside the
date(s) shown in item 23b.

SECTION Tell us about
your marital
V
history

First

Middle

Last

First

Middle

Last

24. What is your marital status? (Check one)
Married and live with other parent of veteran
Married and live with spouse who is not the other parent of veteran
Separated, married but not living with spouse

What was the date of
separation?

Divorced

What was the date of
divorce?

mo day

yr

Widowed

What was the date of
your spouse's death?

mo day

yr

mo day yr
What was the cause of the separation? Give the reason, date(s), and duration of the separation. If
the separation was by court order, attach a copy of the order.

Never married

If never married, skip to Section VI.

25. What is your spouse's name?
First

Middle

26. What is your spouse's date of birth?
mo day

27. What is your spouse's Social Security number?

yr

28a. Is your spouse also a veteran?
Yes

Last

28b. What is your spouse's VA file number (if any)?

No

(If "Yes," answer Item 28b also)
VA FORM 21P-535, XXX 2014

21P-535

page 3

SECTION Tell us if you
are in a
VI

nursing home
or require aid
and
attendance

If you answered "yes" to item
29 and are not in a nursing
home, submit a statement from
your doctor showing the extent
of your disabilities. If you are
in a nursing home, attach a
statement signed by an official
of the nursing home showing
the date you were admitted to
the nursing home, the level of
care you receive, and the
amount you pay-out-of-pocket
for your care.

SECTION Tell us about
the income of
VII
you and your
spouse

Payments from any source will
be counted, unless the law
indicates that they don't need to
be counted. Report all income
in the tables below, and VA
will determine any amount that
does not count.

29. Are you claiming the aid and attendance
allowance because you need the regular
assistance of another person or have severe
visual problems?
Yes

30a. Are you now in a nursing home?

No

Yes

(If "No," skip to Section VII.)

No

(If "YES," answer Items 30b also.)

30b. What is the name and complete mailing address of the facility?

Report the total amounts before you take out deductions for taxes, insurance, etc.
Do not report the same income in both tables.
If you expect to receive a payment, but you don't know how much it will be, write "Unknown" in
the space.
If you do not receive any payments from one of the sources that we list, write "0" or "None" in the
space.
VA will interpret a blank space to mean "0" or "None".
If you are receiving monthly benefits, give us a copy of your most recent award letter. This will
help us determine the amount of benefits you should be paid.
31. Have you claimed or are you receiving
32. Have you filed a claim for compensation
benefits from the Social Security
from the Office of Worker's Compensation
Administration?
Programs based on the death of the veteran?
Yes

No

Yes

No

33. Has a court awarded damages based on the
death of the veteran or is a claim or legal
action for damages pending?
Yes

No

Monthly Income-Tell us the income you and your spouse receive every month

Note: If you are filing this application as the guardian or custodian of the veteran's parent, do not report your own income.

34a. Social Security

Spouse
(if living together)

Parent

Sources of recurring monthly income
$

$

34b. U.S. Civil Service
34c. U.S. Railroad Retirement
34d. Military Retirement
34e. Black Lung Benefits
34f. Other income received monthly (Please write source below)

34g. Other income received monthly (Please write source below)

VA FORM 21P-535, XXX 2014

21P-535

page 4

Annual Income by Calendar Year - Tell us about annual income for you and your spouse

Report income received from January 1 to the date of the veteran's death. If the claim is filed more than one year after the veteran died,
report the income you received from January 1 to the date you sign this application.

Sources of annual income
35a. Gross wages and salary

Spouse
(if living together)

Parent
$

$

35b. Total dividends and interest
35c. Life insurance
35d. Other income expected (Please write source below)

SECTION VIII
Tell us about
medical, last
illness and burial
or other
reimbursed
expenses
36a. Amount paid by
you

Family medical expenses and certain other expenses actually paid by you may be deductible from your
income. Show the amount of any continuing family medical expenses such as the monthly Medicare
deduction or nursing home fees you pay. Also, show unreimbursed last illness and burial expenses you paid.
Last illness and burial expenses are unreimbursed amounts paid by you for the last illness and burial of the
veteran or your spouse at any time prior to the end of the year following the year of death. Show medical,
legal or other expenses you paid because of a claim for compensation for injury or death for which civilian
disability or death benefits have been awarded. When determining your countable income, we may be able to
deduct these expenses from the disability benefits for the year in which the expenses are paid. Do not
include any expenses for which you were reimbursed. If you receive reimbursement after you have filed this
claim, promptly advise the VA office handling your claim. If more space is needed, attach a separate sheet.
36b. Date Paid

36c. Purpose
(Medicare deduction,
doctor's fees, burial
expenses, etc.)

36d. Paid to
36e. Relationship of person for
(Name of Doctor, hospital, whom expenses paid
pharmacy, etc.)

$
mo day

yr

mo day

yr

mo day

yr

mo day

yr

$
$
$

SECTION IX
Give us direct
deposit
information
If benefits are
awarded we will need
more information in
order to process any
payments to you. Please
read the paragraph
starting with, "The
Department of
Treasury..." and then
either:
1. Attach a voided
check, or
2. Answer questions
37-39 to the right.
VA FORM 21P-535, XXX 2014

The Department of Treasury requires all Federal payments be made by electronic funds transfer (EFT), also
called Direct Deposit. Please attach a voided personal check or deposit slip or provide the information
requested below in Items 37, 38, and 39 to enroll in Direct Deposit. If you do not have a bank account, you
must receive your payment through Direct Express Debit MasterCard. To request a Direct Express Debit
MasterCard you must apply at www.usdirectexpress.com or by telephone at 1-800-333-1795. If you elect not
to enroll, you must contact representatives handling waiver requests for the Department of Treasury at
1-888-224-2950. They will encourage your participation in EFT and address any questions or concerns you
may have.
37. Account number (Please check the appropriate box and provide that account number, if applicable)
Checking
I certify that I do not have an account with a financial
institution or certified payment agent
Savings
Account number
38. Name of financial institution
39. Routing or transit number

21P-535

page 5

SECTION Give us
X
your

signature

1. Read the box that starts,
"I certify and authorize
the release of
information:"
2. Sign the box that
says, "Your signature."
3. If you sign with an "X,"
then you must have two
people you know witness
you as you sign. They
must then sign the form
and print their names and
addresses also.

SECTION
XI

I certify and authorize the release of information:
I certify that the statements in this document are true and complete to the best of my knowledge. I
authorize any person or entity, including but not limited to any organization, service provider,
employer, or government agency, to give the Department of Veterans Affairs any information about
me except protected health information, and I waive any privilege which makes the information
confidential.
40a. Signature of mother, foster mother,
guardian or custodian

40b. Today's date
mo day yr

41a. Signature of father, foster father,
guardian or custodian

41b. Today's date
mo day yr

42a. Signature of witness (If claimant
signed above using an "X")

42b. Printed name and address of witness

43a. Signature of witness (If claimant
signed above using an "X")

43b. Printed name and address of witness

44. Remarks (If you need more space to answer a question or have a comment about a specific item
number on this form, please identify your answer or statement by the Section and item number)

Remarks - Use this
space for any
additional
statements
that you would like
to make concerning
your application.

IMPORTANT
Penalty: The law
provides severe penalties
which include fine or
imprisonment, or both,
for the willful
submission of any
statement or evidence of
a material fact, knowing
it to be false, or for the
fraudulent acceptance of
any payment which you
are not entitled to.

VA FORM 21P-535, XXX 2014

21P-535

page 6

Form Approved
OMB Control No. 0960-0062
SOCIAL SECURITY ADMINISTRATION

APPLICATION FOR SURVIVORS BENEFITS

(DO NOT WRITE IN THIS SPACE)

(PAYABLE UNDER TITLE II OF THE SOCIAL SECURITY ACT)
IMPORTANT-- Read instructions before completing form. Detach and retain ONLY the instruction sheet
1. FIRST NAME - MIDDLE NAME - LAST NAME OF VETERAN (Type or print)

VA DATE STAMP

2. DATE OF DEATH

NOTE: If the veteran's Social Security No. is unknown, complete Items 4, 5, 6 and 7 about veteran.
4. DATE OF BIRTH

3. SOCIAL SECURITY NO. OF VETERAN
6. NAME OF FATHER

5. PLACE OF BIRTH
8. DID THE VETERAN WORK IN THE RAILROAD
INDUSTRY AT ANY TIME AFTER 1936?

7. MAIDEN NAME OF MOTHER

YES

NO

NOTE: The following information should be furnished for each period of the veteran's active service (regular or reserves) after September 7, 1939, in the
military service of the United States or service as a commissioned officer in the Public Health Service or the National Oceanic and Atmospheric
Administration or during WWII, Philippine or Filipino or Allied country military service. If additional space is needed, attach a separate sheet.
9A. DATE ENTERED ACTIVE SERVICE

9B. SERVICE NO.

10. RELATIONSHIP OF APPLICANT TO VETERAN
SURVIVING SPOUSE

CHILD

9C. DATE SEPARATED FROM ACTIVE
SERVICE

11. DATE OF BIRTH OF APPLICANT

9D. GRADE, RANK, OR RATING, ORGANIZATION
AND BRANCH OF SERVICE

12. VA FILE NO.

PARENT

CHILDREN: Show names of surviving children (including natural children, adopted children and stepchildren) or dependent grandchildren (including
stepgrandchildren) who at any time since the veteran died, were unmarried and (a) under age 18; (b) age 18 to 19 and attending secondary school; (c)
disabled or handicapped (18 or over and disability began before age 22).
13A.

13B.

13C.

13D.

I know that anyone who makes or causes to be made a false statement or representation of a material fact in an application or for use in determining a
right to payment under the Social Security Act commits a crime punishable under Federal law by fine, imprisonment, or both. I affirm that all information I
have given in this document is true.
15. SIGNATURE OF APPLICANT (First name, middle initial, last name) (Sign in ink)
SIGN
HERE
16. MAILING ADDRESS OF APPLICANT (No. and street or rural route, city or P.O., State and ZIP Code)
17. TELEPHONE NO. (Include Area Code)
14. DATE (Month, day, year)

WITNESSES REQUIRED ONLY IF SIGNATURE OF APPLICANT IS MADE BY "X" MARK ABOVE

18A. SIGNATURE OF WITNESS

18B. ADDRESS OF WITNESS (No. and street, city, State and ZIP Code)

19A. SIGNATURE OF WITNESS

19B. ADDRESS OF WITNESS (No. and street, city, State and ZIP Code)

ITEMS BELOW TO BE COMPLETED BY THE DEPARTMENT OF VETERANS AFFAIRS Use reverse for "Remarks"
21. PROOFS REQUESTED FROM CLAIMANT OR OTHER (Specify)

20. PROOFS RECEIVED
DEATH
AGE
OTHER (Specify)

MARRIAGE

DEATH

(NAME)
(NAME)

AGE
OTHER (Specify)

(NAME)
22. DATE

MARRIAGE

(NAME)
(NAME)
(NAME)

23. NAME AND ADDRESS OF TRANSMITTING VA OFFICE

Form SSA-24 (2-2002) Destroy All Prior Editions

PAGE 7

IMPORTANT: 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 21P-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 21P-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.

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