40-0241 Grant Funded Cemetery Data

Form Approved, OMB NO. 2900-0559
Expiration Date: Nov. 30, 2023
Respondent Burden: 60 Minutes
YEAR

GRANT FUNDED CEMETERY DATA

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.
ANNUAL REPORT FOR INTERMENTS COMPLETED THROUGH JUNE
CHANGED

SUPPLEMENTAL

SPECIAL REPORTS

1. NAME OF CEMETERY

2. MAILING ADDRESS

3. STATUS OF CEMETERY
OPEN
CREMATION ONLY
CLOSED 1st INTERMENTS
OTHER

4. VETERANS CEMETERY DIRECTOR

5. TITLE

8. STATE OR LOCAL GOVERNMENT VETERANS SERVICES DIRECTOR
(Secretary of VA, Director of VA, etc.)

6. E-MAIL ADDRESS

7. PHONE NO. (Area Code)

9. E-MAIL ADDRESS

10. PHONE NO. (Area Code)

By signing this report, I certify that the information provided is true and accurate and that the Veterans Cemetery and facilities conform to the NCA Operational
Standards and Measures.
11. VETERANS CEMETERY DIRECTOR SIGNATURE

12. STATE OR LOCAL GOVERNMENT VETERANS SERVICES DIRECTOR SIGNATURE

13. E-MAIL ADDRESS FOR THE CEMETERY

14. PRIMARY WEB ADDRESS FOR THE CEMETERY

15. DATE CEMETERY OPENED 16. DOES THE CEMETERY PERFORM BURIAL SERVICES
FOR INTERMENT
FOR NON-VETERANS LISTED IN 38 U.S.C. 2408 (i)(2)?
YES

17. HAS A VOLUNTARY COMPLIANCE REVIEW SELF-ASSESSMENT
BEEN PERFORMED DURING THE REPORTING PERIOD?

NO

YES

NO

18. EXPECTED DATES OF BURIAL OPTION DEPLETION
A. PRE-PLACED CRYPT (PPC)
CASKETED AREA (Month/Year) (If used)

B. CASKETED AREA (NON PPC)
(Month/Year)

C. IN-GROUND CREMATIONS
(Month/Year)

D. COLUMBARIUM
(Month/Year)

E. MEMORIAL MARKERS SECTION/
MEMORIALWALL (Month/Year)

CEMETERY STATISTICS
SECTION A - GRAVESITE INFORMATION

TOTAL

19. TOTAL ACREAGE OF CEMETERY SITE
20. CURRENT DEVELOPED ACREAGE
21. UNDEVELOPED ACREAGE PLANNED FOR FUTURE GRAVESITES
CASKETED GRAVESITES CONTAINING PRE-PLACED CRYPTS (PPC)
22. NUMBER OF CURRENTLY DEVELOPED CASKETED GRAVESITES AVAILABLE WITH PPCs
23. TOTAL NUMBER OF CASKETED GRAVESITES WITH PPCs MAINTAINED TO DATE
24. TOTAL NUMBER OF CASKETED GRAVESITES WITH PPCs CURRENTLY APPROVED AND FUNDED OR UNDER CONSTRUCTION
25. TOTAL NUMBER OF CASKETED GRAVESITES AVAILABLE THAT WILL REQUIRE OBRs AT THE TIME OF NEED
26. TOTAL NUMBER OF CASKETED GRAVESITES WITH OBRs MAINTAINED TO DATE
IN-GROUND CREMATION GRAVESITES
27. NUMBER OF IN-GROUND CREMATION GRAVESITES CURRENTLY AVAILABLE
28. TOTAL NUMBER OF IN-GROUND CREMATION GRAVESITES MAINTAINED TO DATE
29. TOTAL NUMBER OF IN-GROUND CREMATION GRAVESITES CURRENTLY APPROVED AND FUNDED OR UNDER CONSTRUCTION
COLUMBARIUM NICHES
30. NUMBER OF COLUMBARIUM NICHES CURRENTLY AVAILABLE
31. TOTAL NUMBER OF COLUMBARIUM NICHES MAINTAINED TO DATE
32. TOTAL NUMBER OF COLUMBARIUM NICHES CURRENTLY APPROVED AND FUNDED OR UNDER CONSTRUCTION
VA FORM
JUN 2023

40-0241

NATIONAL CEMETERY ADMINISTRATION (VACO)

MEMORIAL MARKERS (No physical remains interred)
33. NUMBER OF MEMORIAL MARKERS AVAILABLE
34. TOTAL NUMBER OF MEMORIAL MARKERS MAINTAINED TO DATE
35. TOTAL NUMBER OF MEMORIAL MARKERS CURRENTLY APPROVED AND FUNDED OR UNDER CONSTRUCTION
TOTAL GRAVESITE USAGE
36. NUMBER OF CURRENTLY DEVELOPED GRAVESITES OF ALL TYPES (including memorial markers) AVAILABLE
37. TOTAL NUMBER OF IN-USE GRAVESITES OF ALL TYPES (including memorial markers) MAINTAINED TO DATE

SECTION B - BURIALS AND MEMORIALS
Workload Data during this reporting period

VETERAN

DEPENDENT

38 USC 2408 (I)(2) 38 USC 2408(i)(2)
A, B, C
D and E

38. NUMBER OF FIRST CASKETED INTERMENTS USING A PRE-PLACED OBR
39. NUMBER OF FIRST CASKETED BURIALS COMPLETED THIS YEAR USING AN OBR
40. NUMBER OF FIRST IN-GROUND CREMATED BURIALS THIS YEAR
41. NUMBER OF FIRST COLUMBARIUM INURNMENTS FILLED THIS YEAR
42. NUMBER OF FIRST CREMATION - SCATTERED REMAINS SERVICES CONDUCTED THIS
YEAR
43. NUMBER OF FIRST MEMORIAL MARKERS ESTABLISHED THIS YEAR
44. NUMBER OF SECOND CASKETED BURIALS COMPLETED THIS YEAR USING A PPC
45. NUMBER OF SECOND CASKETED BURIALS COMPLETED THIS YEAR USING AN OBR
46. NUMBER OF SECOND IN-GROUND CREMATED BURIALS THIS YEAR
47. NUMBER OF SECOND COLUMBARIUM INURNMENTS FILLED THIS FISCAL YEAR
48. NUMBER OF SECOND CREMATION - SCATTERED REMAINS SERVICES CONDUCTED
THIS YEAR
49. NUMBER OF SECOND MEMORIAL MARKERS ESTABLISHED THIS YEAR
50. SUB TOTAL (Item numbers 38 through 49)
51. SUB TOTAL (All previously reported burials and memorials)
52. TOTAL BURIALS AND MEMORIALS (Date of opening cemetery to current year)
53. AMOUNT CHARGED FOR BURIAL; CASKETED OR CREMATED (Do not include burial plot
allowance)
54. UNDER STATE AND TRIBAL LAWS, RULES AND REGULATIONS, WHO MAY BE BURIED AT THIS CEMETERY?

a. INDIVIDUALS ELIGIBLE TO BE BURIED IN A VA NATIONL CEMETERY

b. SOME OR ALL INDIVIDUALS DESCRIBED IN 38 USC 2408 (i)(2)

c. OTHERS NOT DESCRIBED BY A OR B. DESCRIBE IN DETAIL
55. NOTES

VA FORM 40-0241, JUN 2023, PAGE 2. OLD STOCK WILL NOT BE USED.

NATIONAL CEMETERY ADMINISTRATION (VACO)

Department of Veterans Affairs Sample Data Sheet
(Instructions)
Department of Veterans Affairs Sample Data Sheet
Number 1: Provide the full name of the Cemetery
Number 2: Provide the complete mailing address for the cemetery.
Number 3: Provide open or closed status of the cemetery Other: 2nd Interments Only; Cremation Inurnments Only.
Number 4: Provide the required information of the director of the cemetery and Veterans Service Director. Include signatures to certify.
Number 5: Provide a current and up to date phone number including area code for the Veterans Cemetery
Number 6: Provide the complete name of the state or local government veterans service director.
Number 7: Provide a current and up to date phone number including area code for the state or local government veterans service director.
Number 8: Include signature to certify veterans cemetery director.
Number 9: Include signature to certify state or local government veterans services director
Number 10: Provide current up to date e-mailing address for the Director of the cemetery.
Number 11: Provide the primary Web site address of the cemetery.
Number 12: Provide date cemetery opened.
Number 13: Indicate Yes or No for performing burial services for non-active duty service members defined in 38 U.S.C. 2408 (i)(2) and their
dependents.
Number 14: Indicate Yes or No for performing a Compliance Review Self-Assessment during the year. Has cemetery leadership conducted a
compliance review assessment using NCA's current Operational Standards and Measures during the reporting period. (Voluntary but
recommended.)
Number 15: If burial option is already depleted put month and year of depletion. If burial option was never available at the cemetery put "N/A
Number 16: Provide the name of State Agency responsible for the cemetery.
Acreage
Number 17: Provide the total number of acres for the cemetery (included both developed and undeveloped.)
Number 18: Provide the current number of acres that is developed for burial options.
Number 19: Provide the total number of undeveloped Acres.
Casketed Gravesites containing Pre-Placed Crypts (PPC)
Number 20: Provide the current number of developed casketed gravesites available with PPCs.
Number 21: Provide the total number of casketed gravesites with PPCs maintained to date.
Number 22: Provide the number of casketed gravesites with PPCs currently approved and funded or under construction.
Casketed Gravesites requiring Outer Burial Receptacle (OBR)
Number 23: Provide the current number of casketed gravesites available that will require an OBR at the time of need.
Number 24: Provide the total number of casketed gravesites with OBRs maintained to date.
In-Ground Cremation Gravesites
Number 25: Provide the current number of in-ground cremation gravesites currently available.
Number 26: Provide the total number of in-ground cremation burials maintained to date.
Number 27: Provide the number of in-ground cremation gravesites currently approved and funded or under construction.
Columbarium Niches
Number 28: Provide the current number of columbarium niches available.
Number 29: Provide the total number of columbarium niches maintained to date.
Number 30: Provide the number of columbarium niches currently approved and funded or under construction.
Memorial Markers (No physical remains interred)
Number 31: Provide the current number of memorial markers available.
Number 32: Provide the total number of memorial markers maintained to date.
Number 33: Provide the number of memorial markers currently approved and funded or under construction.
Total Gravesite Usage
Number 34: Provide the current number of casketed, cremation, columbarium and memorial markers (adding blocks # 17, # 20 and # 23).
Number 35: Provide total number of casketed, in-ground, columbarium and memorial markers maintained to date
(adding blocks # 19, # 22 and # 25).
Marked Burial or Memorial Plots
Number 36: Provide the number of first casketed burials using PPC for the year - all Veterans, Dependents, Non-Active Duty (EGR), and Dependents
of Non-Active Duty (EGR-D).

Number 37: Provide the number of first casketed burials using OBR for the year - all Veterans, Dependents, Non-Active Duty, and Dependents of
Non-Active Duty.
Number 38: Provide the number of first in-ground cremated burials for the year - all Veterans and Dependents, Non-Active Duty (EGR), and
Dependents of Non-Active Duty (EGR-D).
Number 39: Provide the numbers of first columbarium burials for the year - all Veterans and Dependents, Non-Active Duty (EGR), and Dependents
of Non-Active Duty (EGR-D)
Number 40: Provide the number of second casketed, burials using PPC for the year - all Veterans and Dependents, Non-Active Duty (EGR), and
Dependents of Non-Active Duty (EGR-D).
Number 41: Provide the number of second in-ground cremated burials for the year - all Veterans, Dependents, Non-Active Duty (EGR), and
Dependents of Non-Active Duty (EGR-D).
Number 42: Provide the number of second columbarium burials for the year - all Veterans and Dependents, Non-Active Duty (EGR), and
Dependents of Non-Active Duty (EGR-D).
Number 43: Provide the number of second cremation scattered remains conducted for the year - all Veterans and Dependents, Non-Active Duty
(EGR), and Dependents of Non-Active Duty (EGR-D).
Number 44: Provide the number of second memorial markers established (no physical remains interred) for the year - all Veterans and Dependents,
Non-Active Duty (EGR), and Dependents of Non-Active Duty (EGR-D).
Number 45: Provide sub total (adding blocks # 33 through # 44) - both Veterans and Dependents, Non-Active Duty (EGR), and Dependents of NonActive Duty (EGR-D).
Number 46: Provide sub total (All previously reported burials).
Number 47: Provide the total number of burials from date of opening the cemetery to the current date ) (adding blocks # 35 and # 36).
Number 48: Provide the number of first cremation scattered remains conducted for the year - all Veterans and Dependents, Non-Active Duty (EGR),
and Dependents of Non-Active Duty (EGR-D).
Number 49: Provide the number of first memorial markers established (no physical remains interred) for the year - all Veterans and Dependents, NonActive Duty (EGR), and Dependents of Non-Active Duty (EGR-D).
Number 50: Provide the number of first casketed burials using OBR for the year - all Veterans, Dependents, Non-Active Duty (EGR), and Dependents
of Non-Active Duty (EGR-D).
Number 51: Provide the amount the Cemetery charges for any burials or memorial services
Number 52: What are your eligibility requirements, including residency requirements.
Number 53 List the names of all Medal of Honor recipients and other notable Veterans buried in your cemetery.
Number 54: Describe the staffing of the Veterans Cemetery used to meet national cemetery standards of operations and compliance: Contractors,
State or Tribal employees, Volunteers, etc.
How to Estimate Date of Closure For PPC Casketed Burial Area
Example: Block # 29 - (Veterans) 4 and (Dependents) 18 = 22
Block # 17 is 400
Divide 22 into 400 = 18 years
Add 18 years to the reporting month and year (April 2008) = April 2026
How to Estimate Date of Closure For OBR Casketed Burial Area
Add block # 29 for both Veterans and Dependents and use that total to divide into block #17. That total should be added to the current reporting year
to obtain the estimated closure date.
Example: Block # 29 - (Veterans) 4 and (Dependents) 18 = 22
Block # 17 is 400
Divide 22 into 400 = 18 years
Add 18 years to the reporting month and year (April 2008) = April 2026"
How to Estimate Date of In-Ground Burial Area
Example: Block # 30 - (Veterans) 12 and (Dependents) 6 = 18
Block # 20 is 276
Divide 18 into 276 = 15 years
Add the 15 years to the reporting month and year (April 2008) = April 2023
How to Estimate Date of Closure for Columbarium Area
Example: Block #31 - (Veterans) 22 and (Dependents) 7 = 29
Block #23 is 640
Divide 29 into 640 = 22 years
Add the 22 years to the reporting month and year (April 2008) = April 2030
How to Estimate Date of Closure for Memorial Markers
Example: Block #31 - (Veterans) 22 and (Dependents) 7 = 29
Block #23 is 640
Divide 29 into 640 = 22 years
Add the 22 years to the reporting month and year (April 2008) = April 2030