In Section I, you’ll be asked questions regarding the reason for your application. Are you applying for accrued disability benefits or DIC benefits? You’ll need to have information regarding any previous claims that the veteran or you filed, along with your VA file numbers. You’ll need to give your relationship to the deceased veteran.
In Section II, you’ll give personal information regarding the deceased veteran. This includes their full name, date of birth and death, Social Security number, and whether they were ever held as a prisoner of war. You should also be ready to provide your own name, address, and contact information.
Section III is where you’ll give details regarding the military service of the veteran. Included is the date they entered the service, their branch number, their service number, and the date they stopped being on active duty. If they ever re-entered the service, the same information will need to be provided regarding their second period of duty.
Section IV is only for people claiming benefits as a surviving spouse. You’ll need to give information regarding your marriages, along with the marriages of the deceased veteran. Section V is only for people claiming benefits for a veteran’s qualifying children. If this is the case, you’ll have to list each child’s name, their place and date of birth, their relationship to the deceased, and their Social Security number.
Section VI is the section you’ll use to ask for any additional benefits you need. This would be used if you live in a nursing home, are housebound, or need help with the completion of daily tasks.
Section VII is where you’ll give information about your net worth, along with the net worth of your dependents. A family member can only collect the death pension if they’re experiencing financial need. Section VIII is where you’ll denote your gross income, along with whatever income you expect to receive in the following year.
Section IX is used to list any expenses that you haven’t yet received a reimbursement for. This might include education costs, burial expenses, and family medical expenses. Section X is where you’ll give your direct deposit information. In Section XI, you’ll sign and date the application.
If you need to make any additional comments, Section XII is dedicated to any remarks you haven’t gotten to put down on the application yet.[pdf-embedder url=”https://cdn-prod-pdfsimpli-wpcontent.azureedge.net/pdfseoforms/pdf-20180219t134432z-001/pdf/va-form-21-22a.pdf”]