Form 40-10007 Preneed Burial Planning

OMB NUMBER:
RESPONDENT BURDEN: 15 minutes

PRENEED BURIAL PLANNING
All eligibility determinations are made at the time of need. If you have immediate need for burial arrangements, please contact a funeral home or the
National Cemetery Scheduling Office at (800) 535-1117. The PreNeed Burial Planning tool is provided for assistance in planning for future burial in a
Department of Veterans Affairs (VA) national cemetery. VA will review the completed form and all supporting documents submitted, and provide a
response to you indicating whether the documentation is complete. VA's response will not be an eligibility determination before the actual time of need
and will not guarantee eligibility at the time of need.
For more information about Veteran burial eligibility, visit VA online at: http://www.cem.va.gov. Burial in a national cemetery is on a first-come,
first-served basis and no gravesite reservations are accepted. Copies of military discharge documents or other service records should be submitted
with this PreNeed Burial Planning tool. Your information will be stored in an electronic database and you should retain your copies in a safe place.
Note: Instructions on reverse.

*REQUIRED FIELDS

SECTION I - REQUESTER INFORMATION
*3. MAILING ADDRESS (No., Street, City, State, and Zip Code)

*1. NAME (Last, First, Middle Name or Initial)

4. TELEPHONE NUMBER (Include Area Code)
*5. YOUR RELATIONSHIP TO
VETERAN/SERVICE MEMBER

2. E-MAIL ADDRESS

*6. WHO IS THIS PRENEED BURIAL PLAN FOR?
VETERAN/SERVICE MEMBER (Skip Section III)

HUSBAND

NO

DEPENDENT

8. NAME OF DECEDENT BURIED IN A VA NATIONAL CEMETERY

7. HAS ANYONE BEEN BURIED IN A VA NATIONAL CEMETERY
USING THIS VETERAN'S/SERVICE MEMBER'S ELIGIBILITY?
YES

WIFE

DON'T KNOW

9. DECEDENT'S RELATIONSHIP TO VETERAN/SERVICE MEMBER

10. IN WHICH VA NATIONAL CEMETERY IS THE DECEDENT BURIED?
(See listing at http://www.cem.va.gov)

SECTION II - VETERAN/SERVICE MEMBER IDENTIFYING INFORMATION
*11. NAME (Last, First, Middle Name or Initial)

SUFFIX

12. NAME USED DURING SERVICE (If different)
(Last, First, Middle Name or Initial)

SUFFIX

13. GENDER
MALE

*14. SOCIAL SECURITY NUMBER

15. MILITARY SERVICE NUMBER *16. DATE OF BIRTH (MM/DD/YYYY) 17. PLACE OF BIRTH

18. DATE OF DEATH (If applicable)
(MM/DD/YYYY)

19. VA CLAIM NUMBER

20. MARITAL STATUS

*21. MILITARY STATUS
ACTIVE DUTY
VETERAN
RESERVE/NATIONAL GUARD

FEMALE

RETIRED
OTHER/UNKNOWN

MILITARY DATA (If retired Veteran, provide earliest entry date and latest release date)
*22. BRANCH OF SERVICE

23. STATE
(Abbrev.) (For
National Guard)

24. DATE OF ENTRY

25. DATE OF
DISCHARGE

26. DISCHARGE - CHARACTER
OF SERVICE (See reverse)

27. HIGHEST RANK ATTAINED
(No pay grades)

SECTION III - SPOUSE/DEPENDENT IDENTIFYING INFORMATION
*28. SPOUSE'S/DEPENDENT'S NAME
(Last, First, Middle Name or Initial)

29. SPOUSE'S MAIDEN NAME
(If applicable)

*30. SPOUSE'S/DEPENDENT'S
*31. SPOUSE'S/DEPENDENT'S
DATE OF BIRTH (MM/DD/YYYY)
SOCIAL SECURITY NUMBER

32. DEPENDENT'S RELATIONSHIP TO VETERAN/SERVICE MEMBER
SECTION IV - DOCUMENTS AND SIGNATURE
SUPPORTING DOCUMENTS (See reverse - all supporting documents should be submitted with this form.)
33. IS VETERAN'S/SERVICE MEMBER'S MOST RECENT
DISCHARGE DOCUMENT ATTACHED?
YES
NO

34. OTHER DOCUMENTS ATTACHED

CERTIFICATION: I certify that I am the Veteran/service member or family member and that all information provided is true and correct to the best
of my knowledge. I understand that an eligibility determination can only be made at the time of need.
*35. SIGNATURE

VA FORM
JUN 2012

40-10007

*36. DATE

Instructions for Completing VA Form 40-10007 PreNeed Burial Planning
The PreNeed Burial Planning tool is not a benefit claim. It is intended to assist Veterans, service members, and their families when considering
options for future burial arrangements at their time of need. For complete information on eligibility for burial in a VA national cemetery, visit the
National Cemetery Administration on-line at http://www.cem.va.gov. The following is section-by-section guidance on completing the PreNeed
Burial Planning form. If you do not have and cannot obtain the information requested in each field, please enter "NA," meaning the information is not
available.
Section I: Requester Information: The contact information will be used by VA to provide a response to you. Information about other people
already buried using the Veteran's/service member's eligibility will be helpful in providing a response to you.
Field 9: If an individual has been buried based on the Veteran's/service member's eligibility for burial in a VA national cemetery, please explain the
relationship to Veteran/service member.
Field 10: Please select from a list of VA national cemeteries that can be accessed on-line at http://www.cem.va.gov.
Section II: Veteran/Service Member Identifying Information: This information will be used to identify the Veteran/service member and provide
details about their military service.
Field 26: Discharge - Character of Service: Honorable, General, Entry Level Separation/Uncharacterized, Other Than Honorable, Bad Conduct
Discharge, Dishonorable, Other.
Section III: Spouse/Dependent Identifying Information: This information will be used to identify the spouse or dependent who would be using
the Veteran's/service member's eligibility for burial in a VA National Cemetery.
Field 28: Provide the name of the individual who would be using the Veteran's/service member's eligibility for burial in a VA national cemetery.
Section IV: Supporting Documents: You may provide any information you believe will help establish the Veteran's/service member's eligibility.
Supporting documents may include, but are not limited to, the most recent discharge document (DoD Form DD-214) and other military records that
demonstrate active duty service other than for training purposes or active duty of more than 24 months (for enlisted service members, after September
7, 1980; for officers, after October 16, 1981). If you are unable to locate copies of military records, please contact the National Personnel Records
Center (NPRC) at (314) 801-0800 or online at http://www.archives.gov/veterans/military-service-records/index.html.
Form and supporting documentation may be submitted to VA by:
1. Entering online at http://www.ebenefits.va.gov;
2. Mailing copies to: National Cemetery Scheduling & Eligibility Office, 4850 Lemay Ferry Rd., St. Louis, MO 63129; or
3. Faxing to the National Cemetery Scheduling & Eligibility Office at (855) 840-8299.
Privacy Act Information: The responses you submit are considered confidential (38 U.S.C. 5701). They may be disclosed outside the VA only if the
disclosure is authorized under the Privacy Act, including the routine uses identified in the VA system of records, 42VA41, published in the Federal
Register. The requested information is considered relevant and necessary to determine maximum benefits under the law. Information submitted is
subject to verification through computer matching programs with other agencies.
Respondent Burden: Public reporting burden for this collection of information is estimated to average 15 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, JUN 2012