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VA Form 21P-509 serves as a crucial document for veterans seeking to establish the dependency of their parents for benefits. It is designed for veterans who have a service-connected disability rated at 30 percent or higher, or who are enrolled in VA educational programs. This form also applies to parents of deceased veterans who meet specific conditions related to their service. In completing the form, individuals must provide detailed information about both net worth and income. Essential categories include property ownership, monthly income from various sources, and an outline of regular expenses. The instructions emphasize the importance of clarity and accuracy, encouraging respondents to provide "none" or "unknown" where applicable. Both the veteran and their parents must sign the form, signifying the truthfulness of the provided information. The VA maintains strict confidentiality regarding personal data collected through this process, adhering to privacy regulations. Understanding how to properly fill out this form can significantly impact eligibility for support, making it vital for those needing assistance to approach this task thoroughly and carefully.

Va 21 509 Example

INSTRUCTIONS

FOR STATEMENT OF DEPENDENCY OF PARENT(S)

VA FORM 21P-509

Note: Read very carefully, detach, and keep these instructions for your reference. 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." If additional space is necessary, please attach a separate sheet with your answer, and indicate the item to which the answer implies.

A. How can I contact VA if I have questions?

If you have questions about this form, how to fill it out, or about benefits, contact your nearest VA regional office. You can locate the address of the nearest regional office in your telephone book blue pages under "United States Government, Veterans" or call 1-800-827-1000 (Hearing Impaired TDD line 711). You may also contact VA by Internet at http://www.vba.va.gov/benefits/address.htm.

B.What do I use VA Form 21P-509 for? Use VA Form 21P-509 if:

1.You are a veteran whose parents are dependent on you for support, and you are:

•Receiving compensation benefits based on a 30 percent or higher service-connected disability, or

•Receiving VA educational benefits based on enrollment of 1/2 time or more.

OR

2.You are the parent of a deceased veteran who:

•Died on active duty or as a result of service-connected injuries or disease prior to January 1, 1957, or

•Died on or after May 1, 1957, and before January 1, 1972, while a waiver of premiums of his/her U.S. Government Life Insurance was in effect.

C.What is meant by “Parent” on this form?

The term "Parent" includes a natural parent, a parent through adoption, and a foster parent (including stepparents who stood in the relationship of parent to the veteran).

Specific Instructions

Net Worth of Parent(s) (Items 5A, 5B, and 5C)

Report the current value of all the interest and rights you (the parent(s)) have in any kind of property. This includes real estate, stocks, bonds and the amount of bank deposits, savings and loan accounts, and cash on hand. However, net worth

does not include your (the parent(s)) single family dwelling unit, reasonable lot area, and personal things you use every day like your vehicle, clothing, and furniture. If property is owned jointly by yourself and your spouse, report one-half of

the total value held jointly for each of you.

Income of Parent(s) (Items 6A, 6B, and 6C)

Report all income received for the 12 month period and for the calendar month immediately preceding the date of completing this form, and the sources of income.

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The term "income" means payments and benefits received from sources such as:

•Wages or salary (before any deductions) earned by all members of the parent(s)' household, including minors

•Actual contributions to the family by adult members outside of the household

•Social Security benefits, retirement pay, allotments, and family allowances

•Pension, compensation or insurance benefits (other than those received from the Department of Veterans Affairs)

•Interest and dividends

•Rents, property, business, and farm operations

When reporting net income for a business, farm, etc. attach a separate sheet showing gross income and itemized expenses. Net income is gross income less the expenses of operating a rental property or a business or farm. Gross income includes both receipts in cash and the market value of goods or services received in lieu of cash. Expenses include cost of goods sold (for businesses), normal repairs, taxes, salary or wages of employees, insurance, interest on business debts (but not payment of principal), supplies purchased, and other similar expenses.

Expenses of Parent(s) (Items 7A, 7B, 7C, and 8)

Report the expenses for the 12 month period and for the calendar month immediately preceding the date of completing this form. Include expenses for rent (or housing), home repairs, maintenance, clothing, medical care, utilities, groceries, taxes, etc.

Dependents (Items 9A, 9B, 10A, 10B, 10C, and 10D)

Item 9A is to be completed by the parent(s) of a deceased veteran. Item 9B is to be completed by the veteran. Items 10A, 10B, 10C, and 10D are to be completed whenever the parent(s) have dependents residing with the parent(s).

Note: Parent(s) must sign and date the form (Items 11A, 11B, 12A, and 12B). A veteran claiming his/her parent(s) as dependent(s) must also date and sign the form (Items 13A and 13B).

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: 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 38, Code of Federal Regulations 1.576 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 response 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). 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. The responses you submit are considered confidential (38 U.S.C. 5701). 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. Applicants are required to provide their SSN under Title 38 USC 5101 (c)

(1). 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. The responses you submit are considered confidential (38 U.S.C. 5701). 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 to benefits for dependent parents. Title 38, United States Code, allows us to ask for this information. We estimate that you will need an average of 30 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.

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OMB Approved No. 2900-0089

 

 

 

 

 

Respondent Burden: 30 minutes

 

 

 

 

 

Expiration Date: 04/30/2024

 

STATEMENT OF DEPENDENCY OF PARENT(S)

 

 

 

 

 

Important - Please read the attached instructions before completing this form.

 

 

 

 

1. FIRST NAME - MIDDLE NAME - LAST NAME OF VETERAN

 

2. VA FILE NUMBER

 

 

 

 

 

 

 

3A. FULL NAME OF VETERAN'S PARENT

3B. DATE OF BIRTH

4A. FULL NAME OF VETERAN'S PARENT

4B. DATE OF BIRTH

 

(Mo, day, yr.)

 

 

 

(Mo, day, yr.)

 

 

 

 

 

 

 

3C. SOCIAL SECURITY

 

 

 

4C. SOCIAL SECURITY

 

NUMBER

 

 

 

NUMBER

5. NET WORTH

OWNER

A.

DESCRIPTION OF PROPERTY (Include location of real property)

B.

PRESENT

MARKET VALUE

(Dollar amount)

C.

ENCUMBRANCE ON PROPERTY

(Dollar amount)

PARENT

PARENT

PRESENT SPOUSE

OF PARENT

6. INCOME

MEMBER

 

B.

C.

A.

INCOME FOR LATEST

OF

CALENDAR MONTH

TOTAL FOR

SOURCE FROM WHICH INCOME IS RECEIVED

12 MONTHS

FAMILY

FROM EACH SOURCE

 

(Dollar amount)

 

(Dollar amount)

 

 

 

 

 

 

 

VETERAN'S

 

 

 

 

 

 

PARENT

 

 

 

VETERAN'S

PARENT

PRESENT SPOUSE

OF PARENT

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11D. DAYTIME PHONE NUMBER

EXPENSES OF PARENT(S) (Including spouse if remarried)

INSTRUCTIONS - Enter below the expenses for you (the parent(s), including if remarried) for the 12 month period and for the calendar month immediately preceding the date of completing this form, and the purposes for which paid out. Include expenses for rent (or housing), home repairs, maintenance, clothing, medical care, utilities, groceries, taxes, etc.

7A. TYPE OF EXPENSE (List separately)

7B. EXPENSES FOR

LAST CALENDAR

MONTH

(Dollar amount)

7C. TOTAL FOR

12 MONTHS

(Dollar amount)

8. IF EXPENSES EXCEED INCOME, STATE FROM WHAT SOURCE SUCH EXPENSES ARE MET

9A. PARENTS ONLY - ARE THERE ANY PERSONS LIVING IN YOUR HOUSEHOLD DEPENDENT SOLELY UPON YOU FOR SUPPORT?

YES

NO

(If "YES," complete Items 10A, 10B, 10C and 10D)

 

9B. VETERANS ONLY - ARE THERE ANY PERSONS LIVING IN YOUR PARENT(S)' HOUSEHOLD DEPENDENT SOLELY UPON YOU FOR SUPPORT?

YES

NO

(If "YES," complete Items 10A, 10B, 10C and 10D)

INFORMATION RELATING TO PERSONS SOLELY DEPENDENT UPON PARENT(S) (If additional space is needed use separate sheet)

 

10B.

10C.

 

10A. NAME OF DEPENDENT PERSONS

RELATIONSHIP

10D. REASON FOR DEPENDENCY

DATE OF BIRTH

 

TO PARENT(S)

 

 

 

 

I CERTIFY THAT the preceding statements are true and correct to the best of my knowledge and belief.

11A. DATE11B. SIGNATURE OF PARENT (Sign in ink) 11C. ADDRESS OF MOTHER 11E. EVENING PHONE NUMBER

12A. DATE

12B. SIGNATURE OF PARENT (Sign in ink)

12C. ADDRESS OF FATHER

 

 

 

12D. DAYTIME PHONE NUMBER

12E. EVENING PHONE NUMBER

 

 

 

 

13A. DATE

13B. SIGNATURE OF VETERAN (Sign in ink)

13C. ADDRESS OF VETERAN

 

 

 

13D. DAYTIME PHONE NUMBER

13E. EVENING PHONE NUMBER

 

WITNESSES - If you sign by (X), your mark must be witnessed by two persons who know you personally and the signature and address of the witnesses must be shown.

14A. SIGNATURE OF WITNESS (Sign in ink)

14B. ADDRESS OF WITNESS

15A. SIGNATURE OF WITNESS (Sign in ink)

15B. ADDRESS OF WITNESS

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 to which you are not entitled.

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Form Characteristics

Fact Name Details
Purpose of the Form VA Form 21P-509 is used by veterans to claim their parents as dependents, provided they meet certain eligibility requirements.
Eligibility for Veterans Veterans can use this form if they are receiving compensation benefits for a service-connected disability rated at 30% or higher or VA educational benefits based on at least half-time enrollment.
Eligibility for Deceased Veterans The form is also applicable for parents of veterans who died in service on active duty or as a result of service-related injuries, meeting specific time frames.
Definition of Parent The term "Parent" encompasses natural parents, adoptive parents, and foster parents, including stepparents who have taken on parental roles.
Privacy Protection The form adheres to the Privacy Act of 1974, ensuring confidentiality of information provided by applicants.
Respondent Burden Applicants can expect to spend about 30 minutes completing this form, as it involves gathering and reporting specific financial information.
Contact Information For questions, individuals should contact their nearest VA regional office or call 1-800-827-1000. Resources are also available online.
Income Reporting Parents must report various income sources, including wages, Social Security benefits, and pension payments, for a specific time period.
Expense Reporting Expenses such as rent, medical care, and utilities need to be reported for both the last calendar month and the total for the past year.

Guidelines on Utilizing Va 21 509

After gathering necessary documentation, follow these steps to complete the VA Form 21P-509 accurately. Providing complete and clear information is essential for the processing of the claim.

  1. Enter the first name, middle name, and last name of the veteran in the designated fields.
  2. Fill in the VA file number for the veteran.
  3. Complete Section 3 with the full name and date of birth for the first parent of the veteran, along with their Social Security number.
  4. In Section 4, provide the full name and date of birth for the second parent, along with their Social Security number.
  5. In Section 5, report the net worth of the parent(s). List properties they own, their market value, and any encumbrances.
  6. In Section 6, document the income for the latest calendar month and for the past 12 months. Include all sources of income.
  7. In Section 7, report expenses for the most recent calendar month and over the past 12 months. Include a variety of expense categories, such as housing and medical care.
  8. Indicate in Section 8 if expenses exceed income. Provide information on how these excess expenses are managed.
  9. For Section 9, answer if there are any dependents living with the parent(s) who rely on them for support.
  10. In Section 10, list dependent persons, their relationship to the parent(s), and their respective dates of birth.
  11. Sections 11 and 12 require the signature and date from the parent(s). Ensure that both parents sign if applicable.
  12. Section 13 requires the veteran's signature and date.
  13. Complete Sections 14 and 15 with signatures of two witnesses if the parent signed by mark (X).

Once completed, review the form for accuracy. It may be beneficial to keep a copy for personal records. Then, submit the form to the appropriate VA regional office for processing.

What You Should Know About This Form

What is VA Form 21P-509 used for?

VA Form 21P-509, also known as the Statement of Dependency of Parent(s), is used by veterans to declare that their parents are dependent on them for support. This form is applicable if the veteran is receiving compensation benefits based on a service-connected disability of 30 percent or higher or VA educational benefits. Additionally, it can be used by parents of deceased veterans under specific circumstances related to the veteran's death.

Who qualifies as a "Parent" on this form?

The term "Parent" covers various relationships. It includes natural parents, adoptive parents, and foster parents, such as stepparents who fulfill the role of a parent to the veteran. All parental figures who provided support or cared for the veteran may be included in this definition.

What kind of information is required regarding the parents' net worth?

When reporting net worth, it's essential to disclose the current value of all properties owned by the parent(s). This includes real estate, stocks, bonds, and any bank deposits. However, the value of the primary residence, reasonable lot area, and personal items like furniture and vehicles are not included. If a property is jointly owned with a spouse, only half of the total value should be reported for each individual.

What should be included in the income section for parents?

In the income section, you must report all types of income received by the parent(s) over the last 12 months. This includes wages, Social Security benefits, retirement pay, pension, insurance benefits, and any other sources of income. It's important to include both gross income and any applicable deductions when specifying net income from business or rental properties.

How do I report the expenses of the parent(s)?

To report expenses, you should include all necessary expenditures for the last 12 months and the calendar month before filling out the form. Typical expenses could include rent, home repairs, utility bills, medical costs, groceries, and taxes. The form requires detail about each type of expense and total amounts for both time frames.

What if the expenses exceed the income reported?

If the reported expenses surpass the income, it is important to specify how those expenses have been covered. This could involve outlining alternative sources of financial support, such as savings or assistance from other family members.

Are there any requirements around signatures on the form?

The form requires signatures from both parent(s) and, if applicable, the veteran claiming the dependency status. Each individual must sign and date their part of the form to ensure it is valid. If a parent cannot sign in a conventional way, their mark must be witnessed by two individuals who know them personally.

How can I contact the VA for assistance regarding this form?

If you need help with VA Form 21P-509 or have questions about your benefits, you can reach out to your nearest VA regional office for assistance. You can locate this information in a telephone directory or by calling 1-800-827-1000. For online inquiries, the VA's website provides relevant contact information and resources.

What are the privacy considerations associated with this form?

Information provided in VA Form 21P-509 is protected under the Privacy Act. The VA will not disclose the information collected on this form without proper authorization. Your responses are confidential and are used to determine eligibility for benefits and for other administrative purposes, ensuring that your data remains secure with the VA.

Common mistakes

When filling out the VA Form 21P-509, one common mistake is leaving answers blank. Completing every section is crucial. If a question does not apply or if the answer is "none," you should write that clearly. Any omission can delay processing or even result in a denial of the claim.

Another frequent error involves misreporting income or financial figures. It's important to accurately report all income received during the specified periods. This includes wages, Social Security benefits, and any contributions from family members. Failing to include all sources of income can lead to discrepancies and complications down the line.

Some individuals overlook the requirement to provide a complete account of expenses. This section is vital for assessing financial need. Parents should detail their ongoing monthly expenses, such as rent, utilities, and medical costs. Inaccuracies or incomplete information in this area can affect eligibility for benefits.

Lastly, not signing and dating the form correctly is a critical mistake. Both the parent(s) and the veteran must sign the document, ensuring they acknowledge the information provided. Incomplete signatures can cause the application to be rejected, so double-checking this section is essential. By being attentive to these details, you can help ensure a smoother application process.

Documents used along the form

The VA Form 21-509 is used to substantiate claims regarding the dependency of parents on veterans for support. While submitting this form, other related documents may be needed to support the claims made. Below is a list of additional forms and documents that are often required in conjunction with the VA Form 21-509.

  • VA Form 21-526EZ: This form is utilized for filing a claim for disability compensation. Veterans must fill it out to provide evidence of their service-related disabilities in order to receive benefits. It includes questions about the veteran's military service and the nature of their conditions.
  • VA Form 21-4142: Known as the Authorization to Release Information, this form allows the VA to obtain medical records or other pertinent information from the sources indicated. This may be necessary to verify claims regarding dependency and medical status.
  • VA Form 21-534EZ: This form is a simplified application for Dependency and Indemnity Compensation (DIC). It is specifically for the surviving spouse and dependents of a veteran who has died as a result of service-related injuries or diseases.
  • Proof of Relationship Documents: To establish dependency, documentation showing the relationship between the veteran and their parents may be required. This could include birth certificates, marriage licenses, or adoption papers.

Gathering these documents ahead of time can streamline the application process and help ensure that all necessary information is available for review. It aids in the efficient processing of claims for the benefits needed.

Similar forms

  • VA Form 21-534: This form is used to apply for Dependency and Indemnity Compensation (DIC) benefits. Similar to VA Form 21P-509, it requires information about the veteran's dependence on a qualifying relationship, specifically focusing on surviving spouses or children of a deceased veteran. Both forms aim to determine eligibility for benefits based on familial relationships.

  • VA Form 21-530: This form is utilized by parents of deceased veterans to apply for burial benefits. Like Form 21P-509, it also pertains to parental dependency, although its focus is on burial expenses rather than ongoing financial support. Both documents gather comprehensive information regarding the veteran’s family background.

  • VA Form 21P-8416: The purpose of this form is to apply for assistance in obtaining a changed dependency status for a parent. This is similar to VA Form 21P-509 in that both require an assessment of the parent’s financial situation and dependency on the veteran for support. They both help the VA understand the financial needs stemming from the veteran's familial obligations.

  • VA Form 21-526EZ: This is a simplified application for veterans’ benefits, specifically for service-connected compensation. While it mainly addresses a veteran's own status, it aligns with VA Form 21P-509 in the way both forms assess economic need and dependencies related to the veteran’s service. They share the goal of establishing eligibility for benefits based on financial circumstances and family relationships.

Dos and Don'ts

When filling out the VA Form 21P-509, it's important to ensure that the process goes smoothly. Here are nine recommendations on what to do and what to avoid:

  • DO: Read the instructions thoroughly before starting.
  • DO: Print your answers clearly to avoid any confusion.
  • DO: Write "none" or "0" if an answer is not applicable.
  • DO: Use "unknown" if you're unsure about any information.
  • DO: Provide detailed information about all sources of income.
  • DON'T: Leave any questions blank; every answer matters.
  • DON'T: Forget to sign and date the form in the required sections.
  • DON'T: Include personal belongings such as your vehicle or furniture in the net worth calculation.
  • DON'T: Underestimate the importance of providing accurate financial information.

Following these guidelines can lead to a more efficient application process and may contribute positively to your claim. It's all about clarity and completeness!

Misconceptions

  • Myth 1: This form is only for veterans.

    • This form is also applicable to parents of deceased veterans, particularly those who died while on active duty or due to service-connected injuries.

  • Myth 2: I don’t need to report my spouse’s income.

    • The form requires you to report all household income, including that of your spouse, which is crucial for an accurate assessment of dependency.

  • Myth 3: It's okay to leave questions blank if I don't know the answer.

    • If you don’t know the answer to a question, you should write "unknown" instead of leaving it blank. Each response is vital for processing your claim.

  • Myth 4: The net worth excludes my family home.

    • While the value of your primary residence is excluded, you still need to report all other assets, such as investments and savings, that contribute to your net worth.

  • Myth 5: I can use any format to provide additional information.

    • If additional space is needed, you must attach a separate sheet and indicate which item your response refers to. Clarity is essential.

  • Myth 6: I can sign this form anytime after I complete it.

    • Signature dates matter. The form must be dated and signed at the time it is submitted to ensure timeliness in the claims process.

  • Myth 7: My marriage does not have to be recognized by any authority.

    • The VA requires that marriages be recognized by the jurisdiction where the marriage occurred, which can impact eligibility for benefits.

  • Myth 8: Only financial information is needed.

    • The form also requires information about your dependents, ensuring that the VA understands your support obligations.

  • Myth 9: I'm not required to provide my Social Security Number.

    • Providing your Social Security Number is mandatory. The VA uses it to determine benefits eligibility, and refusal can delay or deny your claim.

  • Myth 10: Once submitted, the form will not change.

    • The VA regularly updates forms and requirements. It is crucial to verify that you are using the most current version of the form to avoid processing issues.

Key takeaways

  • VA Form 21P-509 is used to establish that a veteran's parents are financially dependent upon them for support.
  • Complete the form with clear and accurate answers. If an answer is zero or none, indicate that explicitly.
  • If unsure about any response, simply write "unknown" to maintain the integrity of your submission.
  • For assistance, contact the nearest VA regional office or call 1-800-827-1000.
  • The term "Parent" includes biological parents, adoptive parents, and foster parents.
  • Report current values for all property owned by the parent(s), excluding personal items like clothing and vehicles.
  • Include all sources of income from the past 12 months, detailing specific amounts and sources.
  • Document all expenses for the preceding month and the past year, encompassing necessities like housing, utilities, and healthcare.
  • Dependents living in the parent's household need to be listed in detail, including their relationships and reasons for dependency.
  • Signatures from both the parent(s) and the veteran are required to validate the form before submission.

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