Document Page: First | Prev | Next | All | Image | This Release | Search

                         SJRVIVOR BENEFITS CHECK-OFF LIST


This check-off list is provided for use by the next of kin of active duty
deceased Marines, Casualty Assistance Officers, and contact representatives of
government agencies counseling and/or assisting survivors in the preparation and
submission of claim. for survivors benef its.

VA Form 2i-~34, Application for Dependency and Indemnity Compensation from the
Veterans' Administra~ion.   (Widow and Children)
Date Received:
Date Submitted: ______________________________
Submitted to:  (VA Office Address) _______________________________________________
Name and address of person assisting: __________________________________________


VA Form 21-S35, Application for Dependency and Indemnity Compensation from the
Veterans ` Administration (Parents)
Date Received: _______________________________
Date Submitted: ______________________________
Submitted to:   (VA Office Address) ________________________________________________
Name and address of person assisting: __________________________________________


SS Form OA-C24, Application for Survivor Benefits from Social Security
Administration.   (Widow, Children and Parents)
Date Received: ________________________________
Date Submitted: ______________________________
Submitted to:  (Social Security Office Address) _________________________________
Name and Address of Person Assisting: __________________________________________


VA Form 29-8283, Claim for Death Benefits (Servicemen5s Group Life Insurance)
(Persons eligible and/or designated as beneficiary(ies))
Date Received: _________________________
Date Submitted: ________________________ To: Office of Servicemen's Group Life
                                               Insurance
                                               213 Wash~ngton Street
                                               Newar~, NJ  07102

Name and Address of Person Assisting: __________________________________________


VA Form 40-1330, Application for Headstone or Marker (Primary next of Kin or
person controlling remains)
Date Received: ______________________
Date Submitted: _____________________ To: Director, Monument Services (42),
                                            Department of Memorial Affairs
                                            Veterans Administration
                                            810 Vermont Avenue, N.W.
                                            Washin~on, DC   2O~2O


Name and Address of Person Assisting: ___________________________________________


DD Form 1375,  Request for Payment of Funeral and/or Burial Expenses
(Reimbursement in the amount applicable by the Department of the Navy)
Date Received: _______________________
Date Submitted: __________________________
Submitted t0:  (Office of Medical Affairs having responsibility) _________________

Name and address of Person Assisting: ____________________________________________


                                            12

Document Page: First | Prev | Next | All | Image | This Release | Search