VA Form 21P-534EZ: Application for D.I.C., Survivors Pension, and/or Accrued Benefits

What VA Form 21P-534EZ is for

An eligible surviving spouse or child uses this form to apply for Dependency and Indemnity Compensation (DIC), Survivors Pension and accrued benefits. Those are different benefits on one application, and you pick the ones you want in Item 2I.

Are you the veteran's parent? Parents apply for Parents' DIC on VA Form 21P-535 instead. VA's page for Form 21P-535.

Parts someone else completes

If you ask for extra benefits because you need regular help from another person (Item 8A), a physician, physician assistant, certified nurse practitioner or clinical nurse specialist completes VA Form 21-2680. The care worksheets on pages 19 and 20 are completed and signed by each care provider. Two witnesses complete Section XIII only if you sign with an X, and Section XIV is only for an alternate signer.

What you fill in by hand

The filler never asks for your Social Security number, VA file number, date of birth or signature. You write those in by hand. Leave these boxes for yourself:

• Items 1B and 2C, and the top of every page: Social Security numbers
• Items 1C and 2D: dates of birth
• Items 1E and 1G: VA file number and service number
• Items 6C, 6D, 6H, 6I, 6M and 6N: each child's birth date and Social Security number
• Items 9I to 9L: income schedule
• Section X: medical, care, last illness and burial expenses
• Section XI: direct deposit
• Items 12A and 12B: your signature and date
• Section XIII witnesses and Section XIV alternate signer
• Page 9 checklist and the care worksheets on pages 19 and 20

Where to send it

• Send a copy of the veteran's death certificate with the form, unless the veteran died on active duty.
• Online: use the application linked from VA's Form 21P-534EZ page, or upload the completed form through AccessVA QuickSubmit.
• By mail: Department of Veterans Affairs, Pension Intake Center, P.O. Box 5365, Janesville, WI 53547-5365.
• By fax: the form does not print a fax number. VA's intake directory lists 844-655-1604 for pension and survivors. If your VA letters give other instructions, check with VA at 800-827-1000.
• Send copies of your documents, not originals. The instructions warn that originals will not be returned.
• Keep your submission confirmation.

Claim Raven does not submit forms to VA. You review the filled PDF, sign and date it, and send it to VA yourself. Claim Raven is independent and is not affiliated with VA.

Official form and guide

• VA's page for Form 21P-534EZ on VA.gov
• VA Form 21P-534EZ example and how to fill it out

This filler uses the August 2025 edition of the form.