GENERAL INFORMATION SHEET
CLAIM FOR STANDARD GOVERNMENT HEADSTONE OR MARKER
RESPONDENT BURDEN - Public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time for
reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. VA
cannot conduct or sponsor a collection of information unless it has a valid OMB number. Your obligation to respond is voluntary, however, your response is required
to obtain benefits. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden
to the VA Clearance Officer (005R1B), 810 Vermont Avenue, NW, Washington, DC 20420. Please DO NOT send claims for benefits to this address.
PRIVACY ACT - 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, 48VA40B, published in the Federal Register. VA considers the
requested information relevant and necessary to determine maximum benefits under the law.
a. BURIAL HEADSTONE OR MARKER
Only for Veterans who died on or after November 1, 1990 - Furnished for the grave of any eligible deceased Veteran and provided for placement in
private and local government cemeteries regardless of whether or not the grave is marked with a privately-purchased headstone or marker.
Only for Veterans who died before November 1, 1990 - Furnished for the UNMARKED GRAVE of any eligible deceased Veteran. The applicant must
certify that a privately-purchased headstone or marker or Government-furnished headstone or marker is not present on the grave.
b. MEMORIAL HEADSTONE OR MARKER - Furnished to commemorate an eligible deceased Veteran whose remains have not been recovered or
identified, were buried at sea, donated to science, or cremated and the remains scattered. VA will only furnish a memorial headstone or marker after the
disposition of the Veteran's remains. A memorial headstone or marker must be placed in an established cemetery, and will not be used as a memento. For
a memorial headstone or marker please check box in block 34 and explain the disposition of the remains in block 33.
c. MEDALLION - Eligible deceased Veterans may receive a Government-furnished headstone or marker, or a medallion, but not both. If requesting a
medallion, please use VA Form 40-1330M, Claim for Government Medallion for Placement in a Private Cemetery.
d. PRESIDENTIAL MEMORIAL CERTIFICATE - A Presidential Memorial Certificate (PMC) is an engraved paper certificate, signed by the current
president, to honor the memory of Veterans discharged under other than dishonorable conditions. If the Veteran is eligible for a headstone, marker, or
medallion, one PMC will automatically be provided unless otherwise specified. Additional PMCs may be requested by indicating how many in block 22 of
WHO IS ELIGIBLE - Any deceased Veteran who was discharged under conditions other than dishonorable or any Servicemember of the Armed Forces of the United
States who dies on active duty may be eligible. Please attach a copy of the deceased Veteran's discharge certificate (DD Form 214 or equivalent) or a copy of other
official document(s) establishing qualifying military service. If you are unable to locate copies of military records, apply anyway, as VA will attempt to obtain records
necessary to make an eligibility determination. Do not send original documents; they will not be returned. Service after September 7, 1980, must be for a
minimum of 24 months continuous active duty or be completed under special circumstances, e.g., death on active duty. Persons who have only limited active
duty service for training while in the National Guard or Reserves are not eligible unless there are special circumstances, e.g., death while on active duty, or as a result
of training. Reservists and National Guard members who, at time of death, were entitled to retired pay, or would have been entitled, but for being under the age of 60,
are eligible; please submit a copy of the Reserve Retirement Eligibility Benefits Letter with the claim. Reservists called to active duty other than training and National
Guard members who are Federalized and who serve for the period called are eligible. Service prior to World War I requires detailed documentation, e.g., muster rolls,
extracts from State files, military or State organization where served, pension or land warrant, etc.
WHO CAN APPLY - Federal regulation defines “applicant” for a Burial Headstone or Marker that will mark the gravesite or burial site of an eligible deceased
A decedent's family member, which includes the decedent's spouse or individual who was in a legal union as defined in 38 CFR 3.1702(b)(1)(ii) with the
decedent; a child, parent, or sibling of the decedent, whether biological, adopted, or step relation; and any lineal or collateral descendant of the decedent;
(ii) A personal representative, defined as a family member or other individual who has identified himself or herself as the person responsible for making
decisions concerning the interment of the remains of or memorialization of a deceased individual;
(iii) A representative of a Congressionally-chartered Veterans Service Organization;
(iv) An individual employed by the relevant state, tribal organization, or local government whose official responsibilities include serving veterans
and families of veterans, such as a state or county veterans service officer;
(v) Any individual who is responsible, under the laws of the relevant state or locality, for the disposition of the unclaimed
remains of the decedent or for other matters relating to the interment or memorialization of the decedent; or
(vi) Any individual, if the dates of service of the veteran to be memorialized, or on whose service the eligibility of another individual for
memorialization is based, ended prior to April 6, 1917.
Federal regulation defines “applicant” for a Memorial Headstone or Marker to commemorate an eligible individual as a member of the decedent's family,
which includes the decedent's spouse or individual who was in a legal union as defined in 38 CFR 3.1702(b)(1)(ii) with the decedent; a child, parent, or
sibling of the decedent, whether biological, adopted, or step relation; and any lineal or collateral descendant of the decedent.
HOW TO SUBMIT A CLAIM
FAX VA Form 40-1330 claims and supporting documents to 1-800-455-7143.
IMPORTANT: If faxing more than one claim - fax each
claim package (claim plus supporting documents) individually, i.e.,
disconnect the call and redial for each submission.
MAIL claims to: Memorial Products Service (41B)
Department of Veterans Affairs
5109 Russell Road
Quantico, VA 22134-3903
SIGNATURES REQUIRED - The applicant signs in block 23; the person agreeing to accept delivery (consignee) in block 28, and the cemetery or other responsible
official in block 30. If there is no official on duty at the cemetery, the signature of the person responsible for the property listed in block 27 is required. Entries of
"None," "Not Applicable," or "NA" will not be accepted. State Veterans' Cemeteries are not required to complete blocks 25, 26, 27, 28 or 29.
ASSISTANCE NEEDED - Should you have questions when filling out this form, you may contact our Applicant Assistance Unit toll free at: 1-800-697-6947, or via e-
mail at email@example.com. If additional assistance is needed to complete this claim, contact the nearest VA Regional Office, national cemetery, or a local veterans'
organization. No fee should be paid in connection with the preparation of this claim. Use block 33 for any clarification or other information you wish to provide.
TRANSPORTATION AND DELIVERY OF MARKER - The headstone or marker is shipped without charge to the consignee designated in block 25 of the claim.
The truck driver is required to bring the pallet or monument to the end of the trailer. The consignee must utilize their equipment to unload the pallet or monument from
the truck. Deliveries will not be made to a Post Office box. You must provide the full delivery address and telephone number of the consignee. Please explain in
block 33 if the consignee is not a business. For delivery to a Rural Route address, you must include a daytime telephone number including area code in block 26. If
you fail to include the required address and telephone number, we will not deliver the marker. The Government is not responsible for costs to install or remove the
headstone or marker in private cemeteries.
CAUTION - To avoid delays in the production and delivery of the headstone or marker, please check carefully to be sure you have accurately furnished all required
information before faxing or mailing the claim. If inaccurate information is furnished, it may result in an incorrectly inscribed headstone or marker. Headstones and
markers furnished remain the property of the United States Government and may not be used for any purpose other than to be placed at an eligible individual's grave
or in a memorial section within a cemetery.
DETACH AND RETAIN THIS GENERAL INFORMATION SHEET FOR YOUR RECORDS.
ALL PREVIOUS VERSIONS OF THIS FORM ARE OBSOLETE.