ELIGIBILITY FOR BURIAL IN A VA NATIONAL CEMETERY

APPLICATION FOR PRE-NEED DETERMINATION OF ELIGIBILITY FOR BURIAL IN A VA NATIONAL CEMETERY

*REQUIRED ITEMS: YOU MUST COMPLETE THOSE ITEMS IDENTIFIED WITH AN ASTERISK (*)

SECTION I - VETERAN/SERVICEMEMBER

SECTION II - CLAIMANT INFORMATION

SECTION III - CERTIFICATION AND SIGNATURE

40-10007

INSTRUCTIONS FOR COMPLETING VA FORM 40-10007 APPLICATION FOR PRE-NEED DETERMINATION OF ELIGIBILITY FOR BURIAL IN A VA NATIONAL CEMETERY

SECTION I: VETERAN/SERVICEMEMBER

Item 13

Item 17

Item 22

SECTION II: CLAIMANT INFORMATION

Item 23

SECTION III: CERTIFICATION AND SIGNATURE

Item 33

REQUIRED ITEMS: YOU MUST COMPLETE THOSE ITEMS IDENTIFIED WITH AN ASTERISK ()

EXPIRATION DATE: November 30, 2018 RESPONDENT BURDEN: 20 minutes
APPLICATION FOR PRE-NEED DETERMINATION OF ELIGIBILITY FOR BURIAL IN A VA NATIONAL CEMETERY
NOTE: Please read information on reverse before completing this form. If additional space is required, attach a separate sheet of paper.

Mail: to National Cemetery Scheduling Office, P.O. Box 510543, St. Louis, MO 63151; or Fax: to the National Cemetery Scheduling Office at (855) 840-8299

Submit Application and Supporting Documentation to VA by:

IMPORTANT: Pre-Need means before death. Only complete this form if you are applying for a Pre-Need determination of eligibility for burial in a VA national cemetery. Time of Need means time of death. DO NOT complete this form if the individual is already deceased; instead, contact a local funeral home or the National Cemetery Scheduling Office at 1-800-535-1117 to expedite processing.
*REQUIRED ITEMS: YOU MUST COMPLETE THOSE ITEMS IDENTIFIED WITH AN ASTERISK (*)
(Claims for eligibility for burial are based upon the Veterans/Servicemember's military service)
SECTION I - VETERAN/SERVICEMEMBER
*1. VETERAN/SERVICEMEMBER NAME
(Include Suffix) (Last, First, Middle Name or Initial)*
2. NAME USED DURING MILITARY SERVICE (Include Suffix) (If different than Item 1) (Last, First, Middle Name)*
3. MAILING ADDRESS Street, City, State, and Zip Code, P.O. Box, Rural Route, etc*
4. SOCIAL SECURITY NUMBER5. MILITARY SERVICE NUMBER (If different from SSN)*
6. VA CLAIM NUMBER (If known)
MALEFEMALE
8. DATE OF BIRTH (MM/DD/YYYY)

MonthDayYear
Date
8. DATE OF BIRTH (MM/DD/YYYY)*

MonthDayYear
Date
9. PLACE OF BIRTH (City, State or Territory)
YESNODON'T KNOW
(If applicable) (MM/DD/YYYY)
SEPARATEDMARRIED*12. MARITAL STATUS SINGLEA. VETERANB. RETIRED ACTIVE DUTYC. DIED ON ACTIVE DUTYD. RETIRED RESERVEDIVORCEDWIDOWEDE. RETIRED NATIONAL GUARDF. DEATH RELATED TO INACTIVE DUTY TRAINING. OTHER (See instructions)
OF SERVICE (See instructions)

19. STATE (Abbrev.) 18. HIGHEST RANK ATTAINED (National Guard (No pay grades) Service Only)

YES (Complete Item 21)NO (Skip Item 21)DON'T KNOW (Skip Item 21)
21. NAME OF DECEDENT(S) AND VA NATIONAL CEMETERY WHERE BURIED
YESNO
(Information about the individual for whom determination for eligibility for burial in a VA National Cemetery is requested)
SECTION II - CLAIMANT INFORMATION
*23. CLAIMANT (See instructions) (***Each Claimant requires a separate VA Form 40-10007)
24. CLAIMANT'S MAILING ADDRESS Street, City, State, and Zip Code, P.O. Box, Rural Route, etc If different from item 3*
(Name) Last First Middle*
25. CLAIMANT'S TELEPHONE NUMBER (Include Area Code)
A. THE VETERAN/SERVICEMEMBER NAMED IN ITEM 1B. THE SPOUSE/SURVIVING SPOUSE OF THE VETERAN/SERVICEMEMBER IN ITEM 1
C. AN UNMARRIED ADULT CHILD OF THE VETERAN/SERVICEMEMBER IN ITEM 1D. OTHER (Please specify)
WHO IS (check one)*
26. CLAIMANT'S SOCIAL SECURITY NUMBER (If different from item 4)*
Format: (000) 000-0000.
26. CLAIMANT'S SOCIAL SECURITY NUMBER (If different from item 4)*
27. CLAIMANT'S DATE OF BIRTH (MM/DD/YYYY ) (If different from item 8)*

MonthDayYear
Date
28. CLAIMANT'S MAIDEN NAME (If applicable)*
29. DESIRED VA NATIONAL CEMETERY (Optional - See instructions)
30. EMAIL ADDRESS (Optional - See instructions)
example@example.com
SECTION III - CERTIFICATION AND SIGNATURE
CERTIFICATION: By signing below, I certify that I am the Claimant identified in item 23, or an individual signing for the Claimant identified in Item 34. All of the information entered on this form about the Claimant is true and correct to the best of my knowledge. A fraudulent statement that leads to burial in a national cemetery or receiving other benefits from the VA could result in disinterment from that national cemetery and other penalties in accordance with the law. I acknowledge that otherwise eligible individuals may be barred from burial for committing certain serious crimes, as provided under 38 U.S.C. § 2411. VA will therefore validate a previous determination of eligibility at the time of need to check for those bars in addition to law changes or Claimant status changes that may affect eligibility of the Claimant.
Signature*

Clear
32. DATE*

MonthDayYear
Date
*33. YOUR RELATIONSHIP TO THE CLAIMANT IN ITEM 23 (Check one; See instructions
A. SELF (Stop here. Leave Items 34-37 blank)B. INDIVIDUAL SIGNING FOR THE CLAIMANT who is under 18 years of age, is mentally incompetent, or is physically unable to sign the pre-need application
*34. NAME OF INDIVIDUAL FROM ITEM 33B COMPLETING FOR THE CLAIMANT
(Last, First, Middle Name)*
THE CLAIMANT Street, City, State, and Zip Code, P.O. Box, Rural Route, etc*
*35. MAILING ADDRESS OF INDIVIDUAL COMPLETING THIS FORM FOR
36. TELEPHONE NUMBER (Include Area Code)*
Format: (000) 000-0000.
37. EMAIL ADDRESS (Optional)
example@example.com
40-10007
INSTRUCTIONS FOR COMPLETING VA FORM 40-10007 APPLICATION FOR PRE-NEED DETERMINATION OF ELIGIBILITY FOR BURIAL IN A VA NATIONAL CEMETERY
For more complete information on eligibility requirements for burial in a VA national cemetery, visit the National Cemetery Administration online at http://www.cem.va.gov/cem/burial_benefits/eligible.asp or call the National Cemetery Scheduling Office at 1-800-535-1117. For the purposes of this form, the term burial includes inurnment (above ground remains placement in a columbarium) and scattering of ashes, (if the cemetery chosen offers those options cemetery. Burial in a specific VA national cemetery will be scheduled at the Time of Need. In order to assist in completing this form, specific instructions and explanations for certain items are given below.

A Pre-Need determination of eligibility does not guarantee burial in a specific VA national

Eligibility for burial in a VA national cemetery is based on the qualifying service of a Veteran/Servicemember. This section of the form is used to determine if qualifying service exists. Not all items are mandatory, however, answers to questions will aid VA in searching for records in archives to support the claim.
SECTION I: VETERAN/SERVICEMEMBER
Item 13
Military status used to apply for eligibility determination: For VA benefit purposes, a Veteran is a person who served in the active military, naval, or air service, and who was discharged under conditions other than dishonorable. VA will determine on a case-by-case basis whether certain Reserve duty qualifies. If eligibility derives from a status not listed, or if the individual is not certain of the status, check “Other” and submit evidence of service and VA will provide appropriate assistance. Servicemembers who die on active duty are eligible for burial. If you are arranging burial for an active duty Servicemember or his or her dependents, you should contact a local funeral home or the National Cemetery Scheduling Office at 1-800-535-1117 to expedite processing.
Item 17
Discharge - Character of Service: Please indicate one type of “Discharge - Character of Service”: Honorable; General; Entry Level Separation/Uncharacterized; Other Than Honorable; Bad Conduct; or Dishonorable. If uncertain of the type of discharge or character of service, indicate “Other” and include available supporting documents.
Item 22
Supporting military service documents: VA recommends that you attach photocopies of readily available supporting documents so that we can make the determination quickly. Documents may include the most recent discharge document (DD Form 214) showing the highest rank and valor awards and decorations, active duty service records other than for training purposes, or active duty for a minimum of 24 continuous months for enlisted Servicemembers after September 7, 1980; for officers, after October 16, 1981, or the full period for which the person was called to active duty. If you are unable to locate copies of military records, apply anyway, as VA will attempt to obtain records necessary to make a determination.
SECTION II: CLAIMANT INFORMATION
Item 23
Each Claimant requires a separate VA Form 40-10007.

23b. Spouse means a person who is or was legally married to a Veteran. Surviving Spouse mean a person who was legally married to a Veteran at the time of the Veteran's death and includes a surviving spouse who had a subsequent remarriage. A non-Veteran spouse of a Veteran whose marriage to the Veteran was dissolved by divorce or annulment issued by an authoritative court is not eligible for burial in a VA national cemetery.

23c. An unmarried adult child of the Veteran is an individual who became permanently physically or mentally disabled and incapable of self-support before reaching 21 years of age, or before reaching 23 years of age if pursuing a full-time course of instruction at an approved educational institution. If you are making a claim for an unmarried adult child, please provide supporting documentation such as recent medical documentation pertaining to the disability, date of onset of the disability, and the age of the child when diagnosed with this disability. VA recommends that you provide photocopies. Note: Minor children of eligible Veterans are eligible for burial in a VA national cemetery. The minor child of an eligible Veteran is a child who is unmarried and who is under 21 years of age; or who is under 23 years of age and is pursuing a full-time course of instruction at an approved educational institution.

23d. Please explain your Claimant status or relationship to the Veteran/Servicemember.

Items determination of eligibility does not guarantee burial in a specific national cemetery. Burial in a specific VA national 29 and 30

A list of VA national cemeteries is available online at http://www.cem.va.gov/cem/cems/allnational.asp A favorable Pre-Need

cemetery will be scheduled at the time of need. If you provide an email address, VA may use your email address to communicate with you about your claim and burial benefits.
SECTION III: CERTIFICATION AND SIGNATURE
Items 31 The pre-need application must be signed (Item 31) and dated (Item 32) for VA to process. and 32
Item 33
You must indicate your relationship to the claimant in Item 33.

33a. Check (A) if you are the claimant

33b. Check (B) and complete Items 34-37 if your are signing for a claimant who has not attained the age of 18 years, is mentally incompetent, or is physically unable to sign the pre-need application. You may be a court-appointed representative, a person who is responsible for the care of the individual (including a spouse or other relative), or an attorney in fact or agent authorized to act on behalf of the claimant under a durable power or attorney. If the claimant is in the care of an institution, a manager or principal officer of the institution may sign the form. Please attach supporting documents or an affidavit establishing your position relative to the claimant.

Privacy Act Information: VA considers the responses you submit confidential (38 U.S.C. 5701 VA may only disclose this information outside the VA if the disclosure is authorized under the Privacy Act, including the routine uses identified in the VA system of records, 175VA41A, published in the Federal Register. VA considers the requested information relevant and necessary to determine maximum benefits under the law. Respondent Burden: Public reporting burden for this collection of information is estimated to average 20 minutes per response, including the time to review instructions, search existing data sources, gather the necessary data, and complete and review the collection of information. The obligation to respond is voluntary and not required to obtain or retain benefits.

REVERSE OF VA FORM 40-10007, MAY 2017
This form will be received by VMCO at which time we can further assist you with your concerns. It will not be received by the VA until we have reviewed it.
Should be Empty:

*14. BRANCH OF SERVICE

15. DATE OF ENTRY

MILITARY SERVICE DATA