The VA Form 21-509, also known as the Statement of Dependency of Parent(s), is a crucial document for veterans who are claiming their parents as dependents in order to receive benefits. This form is designed to provide the Veterans Affairs with detailed information about the parent’s financial status, including net worth, income, and expenses, to assess their dependence on the veteran. For any veterans seeking to ensure their parents are recognized and supported under VA benefits, filling out this form accurately is a vital step.
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Navigating the intricacies of veterans' benefits and ensuring that dependent parents are provided for can be a challenging journey. The VA Form 21P-509, known as the Statement of Dependency of Parent(s), emerges as a pivotal document in this process. Specifically designed for veterans who have parents dependent on them for support and for parents of deceased veterans, this form facilitates claims for benefits by reporting income, net worth, and expenses accurately. With sections dedicated to capturing a wide array of financial information, including assets, income sources, and monthly expenditures, it underscores the importance of meticulously detailing the economic reality of the veteran's or the deceased veteran's parents. Points of contact and instructions are thoughtfully provided to guide applicants through each step, emphasizing the necessity of clarity and precision in responses to ensure a smooth assessment process for dependency claims. Moreover, the Privacy Act Notice and the solemn declaration section remind applicants of the legal significance of the information provided, reinforcing the form's role in the broader context of veterans' affairs and benefits administration.
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.
VA FORM
21P-509
SUPERSEDES VA FORM 21P-509, JAN 2018,
Page 1
APR 2021
WHICH WILL NOT BE USED.
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.
VA FORM 21P-509, APR 2021
Page 2
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.)
3C. SOCIAL SECURITY
4C. SOCIAL SECURITY
NUMBER
5. NET WORTH
OWNER
A.
DESCRIPTION OF PROPERTY (Include location of real property)
B.
PRESENT
MARKET VALUE
(Dollar amount)
C.
ENCUMBRANCE ON PROPERTY
PARENT
PRESENT SPOUSE
OF PARENT
6. INCOME
MEMBER
INCOME FOR LATEST
OF
CALENDAR MONTH
TOTAL FOR
SOURCE FROM WHICH INCOME IS RECEIVED
12 MONTHS
FAMILY
FROM EACH SOURCE
VETERAN'S
Page 3
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
7C. TOTAL FOR
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?
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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After gathering the necessary information, individuals are ready to start the process of completing the VA Form 21P-509, a vital step towards ensuring their dependent parents receive the support they're entitled to. This process demands attention to detail and accuracy to comply with the requirements. By following the outlined steps, individuals can navigate through the form confidently, knowing they are providing the essential information needed for the claim.
After thoroughly completing each section and ensuring all necessary attachments are included, the form is ready for submission. Submitting this form initiates the process of evaluating the dependency claim. It paves the way for the necessary support to be administered, highlighting the critical role of accuracy and completeness in filling out the form.
What is the purpose of VA Form 21P-509?
VA Form 21P-509 is designed for two main purposes: First, it is used by veterans who have parents dependent on them for support, particularly if the veteran is receiving compensation benefits for a service-connected disability rated 30 percent or higher, or is receiving VA educational benefits for 1/2 time or more. Second, it serves the parents of a deceased veteran who passed away on active duty or from service-connected injuries or diseases, under specific time conditions and insurance circumstances.
Who is considered a "Parent" according to VA Form 21P-509?
On VA Form 21P-509, a "Parent" encompasses a biological parent, an adoptive parent, and a foster parent. This definition also includes stepparents who have acted in the capacity of a parent to the veteran, indicating a broad interpretation to cover various parental relationships.
How can I get assistance if I have questions about filling out VA Form 21P-509?
If you need help or have questions about completing VA Form 21P-509, you can reach out to your nearest VA regional office. The contact information for the regional offices can be found in the blue pages of the telephone book under "United States Government, Veterans," or by calling 1-800-827-1000. Assistance is also available online through the VA's official website.
What types of income need to be reported on this form?
When completing VA Form 21P-509, you must report all sources of income received by the parent(s) during the 12 months prior to and including the calendar month immediately preceding the date the form is filled out. This includes wages or salary before deductions, contributions from adult family members, Social Security benefits, retirement pay, allotments, family allowances, as well as other sources like pension, compensation or insurance benefits not received from the Department of Veterans Affairs, interest, dividends, and income from rents, property, business or farm operations.
What does "Net Worth" exclude when reporting on VA Form 21P-509?
In the context of VA Form 21P-509, "Net Worth" does not account for the parent(s)' primary residence, reasonable surrounding land, and personal belongings used on a daily basis such as vehicles, clothing, and furniture. Essentially, it spans the current value of interests and rights in real estate, stocks, bonds, bank deposits, savings, and loan accounts, excluding everyday personal use items.
Are there specific details required for reporting income from a business or farm?
Yes, when reporting net income from a business, farm, or similar operations, the form mandates attaching a separate sheet that details the gross income and lists all associated operating expenses. This additional documentation should include costs like goods sold, repairs, taxes, employee salaries, insurance, interest on business debts, and other related expenses to accurately represent the net income.
What do I do if my expenses exceed my income?
If your reported expenses on the form exceed income, you must specify the source from which these additional expenses are being met. This information helps the VA understand your financial situation better, especially in assessing dependency claims.
What will happen if I do not provide all the information required on VA Form 21P-509?
Failing to provide the complete and accurate information required on VA Form 21P-509 may affect the determination of benefit eligibility for dependent parents. The VA uses this information to assess your claim and determine the maximum benefits allowable by law. Providing incomplete or inaccurate information could delay processing times or result in the denial of the claim. Additionally, there are legal penalties for knowingly submitting false statements or evidence.
Filling out the VA 21-509 form, known officially as the Statement of Dependency of Parent(s), is critical for veterans and their parents to ensure they receive the benefits they're entitled to. However, errors can occur, leading to delays or outright denial of benefits. Here are four common mistakes people make when completing this form.
Firstly, a prevalent mistake is not being thorough with net worth and income details. Items 5A, 5B, 5C, 6A, 6B, and 6C require you to report the value of all your assets and income. It's essential to include accurate details about any kind of property, stocks, bonds, and sources of income. Often, individuals either underestimate their assets or forget to include all sources of income, impacting the assessment of their eligibility for benefits. Remember, the form explicitly states not to include your primary residence, reasonable lot area, and personal effects in your net worth, which is a detail some overlook.
Another common error is not fully detailing expenses and dependencies in Items 7A, 7B, 7C, 9A, 9B, 10A, 10B, 10C, and 10D. Applicants must report all living expenses and individuals dependent on them for support. Failing to list all expenses, or not adequately explaining the reason for dependency of household members, can result in the VA not fully understanding your financial situation, potentially leading to less assistance than is needed.
Additionally, incorrect or incomplete contact information (Item 11D, 11E, 12D, 12E, 13D, and 13E) can considerably slow down the processing of the form. This could halt any progress if the VA needs clarification on submitted information but cannot reach you. Ensuring that all contact information is current and accurately entered is crucial for a smooth process.
Lastly, many individuals forget or neglect to sign and date the form (Items 11A, 11B, 12A, 12B, 13A, and 13B). This may seem like a minor oversight, but it is a critical requirement. An unsigned or undated form is considered incomplete and cannot be processed, leading to unnecessary delays in receiving benefits.
By paying close attention to the specific requirements of the VA 21-509 form and avoiding these common mistakes, veterans and their families can ensure a smoother process in securing the benefits they deserve. Always remember to review each section carefully and provide comprehensive, accurate information.
When preparing to support a claim involving the VA Form 21P-509, which helps document the dependency of a parent on a veteran, several additional forms and documents are frequently necessary to provide comprehensive support for your case. These materials are crucial in ensuring the Veterans Affairs can accurately determine the dependence status and provide the appropriate benefits.
Compiling these forms and documents with diligent attention to their details is key to navigating the complexities of the claims process effectively. They work together to paint a full picture of the veteran and their dependent parent's situation, ensuring the Veterans Affairs has all necessary information to make accurate determinations regarding benefits. By understanding the purpose and requirements of each, you are better equipped to support and expedite your claims process.
The VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits, shares similarities with VA Form 21P-509 through its function as a tool for veterans to claim benefits due to circumstances directly associated with their service. Both forms require detailed personal information, including financial status and dependency details, to evaluate the claimant's eligibility for benefits. Where the 21P-509 form focuses on establishing a parent's dependency on a veteran, the 21-526EZ form is broader, encompassing various compensation claims for disabilities or conditions connected to military service.
Similarly, the VA Form 21-686c, Declaration of Status of Dependents, parallels the 21P-509 form by its emphasis on the claimant's family situation. It is used primarily by veterans or service members to update their dependents' status, which can affect their compensation levels. Both forms require the claimant to provide detailed information about their dependents, albeit with the 21P-509 form focusing on parents as dependents, highlighting the specifics of their financial dependency, just as 21-686c might for spouses, children, or other dependent family members.
The VA Form 10-10EZ, Application for Health Benefits, also bears resemblance to VA Form 21P-509, but it is tailored toward enrolling veterans in the VA health care system. Despite the difference in focus—health benefits versus dependency claims—both forms collect comprehensive personal and financial information to determine eligibility for benefits. The 21P-509 form assesses a parent's financial dependency for potential benefits, while the 10-10EZ evaluates a veteran's eligibility for health services based on similar personal and financial criteria.
Another related document is the SSA-8000-BK, Application for Supplemental Security Income (SSI), administered by the Social Security Administration. This form is akin to the VA Form 21P-509 in that it gathers detailed financial information to assess an individual's eligibility for benefits. The SSA-8000-BK focuses on income, resources, and living arrangements to determine qualification for SSI payments, paralleling the financial assessment aspect of the VA 21P-509 form, which determines a parent's dependency on a veteran for support.
The IRS Form 1040, U.S. Individual Income Tax Return, although primarily a tax document, shares the feature of requiring detailed financial information from the individual, similar to what is requested in VA Form 21P-509. Both forms collect data on income and financial status, but for different purposes: the 21P-509 for assessing dependency of parents for veterans' benefits and the 1040 for determining tax liabilities. The detailed financial disclosures in both documents serve as a comprehensive overview of the individual's financial situation.
VA Form 22-5490, Dependents' Application for VA Education Benefits, is similar to the 21P-509 form as it involves making claims for benefits based on a familial relationship to a veteran. While the 5490 form focuses on education benefits for a veteran's dependents, including children and spouses, the 21P-509 targets the specific scenario of a parent dependent on their veteran child. Both require detailed personal information to establish the eligibility of the claimant for benefits derived from a veteran's service.
Lastly, the VA Form 21P-527EZ, Application for Pension, provides a useful comparison. This form is aimed at veterans and surviving spouses seeking pension benefits, often based on need or disability. Like the 21P-509, it requires extensive information about the claimant's financial situation, including income and net worth, to determine eligibility for benefits. Both forms assess financial need, but the 21P-509 specifically focuses on establishing a parent's dependency on their veteran child for support.
Filling out the VA Form 21-509, titled Statement of Dependency of Parent(s), is a crucial process that requires attention to detail and honesty. This form helps veterans apply for additional benefits for their dependent parents or, in certain cases, allows a parent to claim benefits due to the service-related injury or death of their veteran child. Here are important dos and don’ts to remember when completing this form:
Remember, honesty and completeness in filling out VA Form 21-509 translate into a smoother process for evaluating the claim, potentially benefiting the parent(s) in need of support due to their dependency on the veteran. Avoiding common pitfalls by following these dos and don’ts can expedite the benefits application and approval process.
There are several misunderstandings about the VA Form 21-509, Statement of Dependency of Parent(s), which can lead to confusion for veterans and their families. This form is crucial for veterans seeking to claim their parents as dependents for VA benefits purposes. Addressing these misconceptions helps ensure accurate and timely processing of benefits. Here are ten common misconceptions and the realities behind them:
Understanding the VA Form 21-509 thoroughly is crucial for veterans and their families to navigate the benefits process effectively. Misconceptions can lead to delays or denials of benefits, making it essential to grasp what the form requires and how it functions within the broader context of VA benefits.
Here are key takeaways about filling out and using the VA Form 21P-509, Statement of Dependency of Parent(s):
When completing and submitting VA Form 21P-509, these points ensure that veterans and their parents provide all the necessary information for VA to determine eligibility and benefits correctly.
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