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VAU.S. Department of Veterans Affairs
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VA Form 21P-534EZ ยท v2.4

Survivor benefits application

Survivors upload the documents they already have. The reader suggests answers and the survivor confirms each one.

Published
warning

1 field has no downstream target

Those answers are captured on the intake record but are not sent anywhere yet. A person has to choose the mapping before they can flow downstream.

8 fields in v2.4

Each field records where it came from on the paper form, so a reviewer can always trace a digital answer back to the box it replaced.

Field schema for VA Form 21P-534EZ

  • Field
    claimant_full_nameYour full name
    Type
    Text
    Required
    Yes
    On the paper form
    Marriage certificate, spouse name
    Maps to
    claimant.fullName
  • Field
    claimant_dobYour date of birth
    Type
    Date
    Required
    Yes
    On the paper form
    Marriage certificate, spouse date of birth
    Maps to
    claimant.dateOfBirth
  • Field
    veteran_full_nameVeteran's full name
    Type
    Text
    Required
    Yes
    On the paper form
    Death certificate, decedent name
    Maps to
    veteran.fullName
  • Field
    date_of_deathDate of death
    Type
    Date
    Required
    Yes
    On the paper form
    Death certificate, date of death
    Maps to
    veteran.dateOfDeath
  • Field
    cause_of_deathCause of death
    Type
    Text
    Required
    No
    On the paper form
    Death certificate, part I, handwritten
    Maps to
    veteran.causeOfDeath
  • Field
    marriage_dateDate of marriage
    Type
    Date
    Required
    Yes
    On the paper form
    Marriage certificate, date solemnized
    Maps to
    relationship.marriedOn
  • Field
    monthly_incomeMonthly household income
    Type
    Currency
    Required
    Yes
    On the paper form
    Not on the uploaded documents
    Maps to
    income.monthlyTotal
  • Field
    burial_expenses_paidBurial expenses you paid
    Type
    Currency
    Required
    No
    On the paper form
    Not on the uploaded documents
    Maps to
    Unmapped