Application for Standard government Headstone or Marker for Installation in Private or State Veterans Cemetery

2900-0222 supplementary.docx

Application for Standard Government Headstone or Marker for Installation in Private or State Veterans Cemetery

Application for Standard government Headstone or Marker for Installation in Private or State Veterans Cemetery

OMB: 2900-0222

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On the 40-1330M:


  • On the General Information Sheet, Respondent Burden, one-fourth hour per response, was changed to 15 minutes per response

  • On the General Information Sheet, Benefit Provided – Medallion, added parenthesis next to medallion to read, Only for Veterans who died on or after November 1, 1990

On the General Information Sheet, the paragraph Benefit Provided- Medallion, was edited to read, Furnished upon receipt of claim for affixing to an existing privately-purchased headstone or marker placed at the gravesite of an eligible deceased Veteran who is buried in a private cemetery. The medallion is made of bronze and available in three approximate sizes: 5 inches, 3 inches, and 1-1/2 inches. Each medallion is inscribed with the word VETERAN across the top and the Branch of Service at the bottom (see Note in Block 6 of the claim for further information). Eligible Veterans may receive a Government furnished headstone or marker, or a medallion, but not both. If requesting a headstone or marker, please use the VA Form 40-1330.

  • On the General Information Sheet, under the two medallion pictures, the word Bronze was removed

  • On the General Information Sheet, Delivery and Installation was moved to between Assistance Needed and Caution. No edits were made to the paragraph itself

  • On the General Information Sheet, the paragraph Who Can Apply was added and it reads Federal Regulation defines “applicant” as the decedent’s Next of Kin (NOK); a person authorized in writing by the NOK; or a personal representative authorized in writing by the decedent. Written authorization must be included with claim. A notarized statement is not required.

  • On the General Information Sheet, How to Submit A Claim, OR was deleted within the fax and mail paragraphs

  • On the General Information Sheet, Signatures Required, was edited to read, The applicant must sign in Block 12A. The applicant must be the Next of Kin or an authorized representative of the decedent or the Next of Kin


  • On the actual form, Block 1, Type of Request was deleted

  • On the actual form, Block 8, now reads, Name and Mailing address of Applicant, before it read, Name and mailing address of person to contact for additional information

  • On the actual form, Block 9, now reads, Are You, Next of Kin, Authorized Representative on behalf of decedent, Authorized Representative on behalf of next of kin

  • On the actual form, Block 10, now reads, Daytime phone no. of applicant

  • On the actual form, Block 17, PMC request, was deleted


On the 40-1330:


  • On the General Information Sheet, Respondent Burden, one-fourth hour per response, was changed to 15 minutes per response

  • On the General Information Sheet, Benefit Provided, a. Headstone or marker was edited and c. Medallion was added

  • On the General Information Sheet, the paragraph Who Can Apply was added and it reads Federal Regulation defines “applicant” as the decedent’s Next of Kin (NOK); a person authorized in writing by the NOK; or a personal representative authorized in writing by the decedent. Written authorization must be included with claim. A notarized statement is not required.


  • On the Illustrations page, the wording under Bronze niche marker was edited

  • On the Illustrations page, Note, this sentence was added at the end of the paragraph, Inscriptions on these headstone types are intentionally limited to assure historic accuracy. For example, only rank above Private was historically authorized; emblems of belief and the words Civil War are not provided.

  • On the Illustrations page, Inscription Information, the order of the five items was switched around


  • On the actual form, Block 1, its contents were deleted and it now reads, For VA Use Only

  • On the actual form, Block 13A now reads, Name and Mailing address of Applicant, before it read, Name and mailing address of person to contact for additional information

  • On the actual form, Block 16, now reads, Are You, Next of Kin, Authorized Representative on behalf of decedent, Authorized Representative on behalf of next of kin

  • On the actual form, Block 13B now reads, Daytime phone no. of applicant

  • On the actual form, at the bottom, the words State Veterans Cemetery and Grave Location were deleted and block 29 was deleted


  • On the Authorized Emblems page, under Emblem of belief Available, we added nine new emblem names that were authorized. Also, the last paragraph on the same page was edited



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File Created2021-01-31

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