Claim for Government Medallion for Private Markers
This document provides essential information and instructions for claiming a government-issued medallion to be affixed to a private headstone or marker for eligible deceased veterans. It outlines eligibility criteria, required documentation, and submission methods. Use this file to ensure proper memorialization of veterans in private cemeteries.
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How do I fill this out?
Filling out this form requires attention to detail and accurate information. Begin by gathering necessary documents such as the veteran's discharge certificate. Follow the instructions carefully to ensure the claim is processed without delay.

How to fill out the Claim for Government Medallion for Private Markers?
1
Gather the required documents including the veteran's discharge certificate.
2
Complete all sections of the form clearly with necessary information.
3
Check that the grave is marked with a privately purchased marker.
4
Sign the form and ensure the cemetery official also signs in the designated area.
5
Submit the form through the preferred method: electronically, by fax, or by mail.
Who needs the Claim for Government Medallion for Private Markers?
1
Family members of deceased veterans who wish to commemorate their loved ones with a medallion.
2
Veterans service officers assisting families in the claim process.
3
Funeral home directors aiding in memorial service arrangements.
4
Cemetery officials verifying compliance with regulations regarding headstone markings.
5
Organizations dedicated to supporting veterans and their families in obtaining benefits.
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What are the instructions for submitting this form?
To submit this form, you can use one of the following methods: electronically send your claim and supporting documents through Quick Submit at access.va.gov. Alternatively, you may fax the completed form and relevant documents to 1-800-455-7143, ensuring each claim package is sent individually. For those preferring traditional methods, mail your application to the NCA FP Evidence Intake Center, PO Box 5237, Janesville, WI 53547. Always keep copies of your submission for your records, and ensure all fields are completed to minimize processing delays.
What are the important dates for this form in 2024 and 2025?
Important dates for this form include submission deadlines for eligibility verification before certain memorial dates in 2024 and 2025. Ensure that all applications are submitted timely to avoid processing delays. Check official VA announcements for any updated deadlines during these years.

What is the purpose of this form?
The purpose of this form is to facilitate the process for eligible family members or representatives to claim a government-issued medallion. The medallion serves as a significant tribute to honor veterans buried in private cemeteries. By completing this form accurately, applicants can ensure that their loved ones receive the appropriate recognition.

Tell me about this form and its components and fields line-by-line.

- 1. Veteran's Name: Full name of the deceased veteran.
- 2. Social Security Number: Veteran's social security number for identification purposes.
- 3. Date of Birth: Veteran's date of birth.
- 4. Branch of Service: Indication of which branch of the armed forces the veteran served in.
- 5. Medallion Size: Options to select the desired size of the medallion.
- 6. Applicant Information: Details about the individual submitting the claim.
What happens if I fail to submit this form?
Failure to submit this form correctly may lead to delays in processing the claim. If the form is incomplete or incorrect, the applicant may be contacted for additional information, prolonging the time needed to obtain the government medallion. In some cases, claims may be denied if essential information is missing.
- Incomplete Information: Missing fields or unclear responses can delay or deny your claim.
- Incorrect Documentation: Submitting wrong or insufficient documentation may require resubmission.
- Signature Issues: Failure to provide required signatures can invalidate the claim.
How do I know when to use this form?

- 1. To Honor Veterans: Use this form to ensure that the service of a respected veteran is memorialized.
- 2. For Family Members: Family members may apply on behalf of their deceased veteran relative.
- 3. For Funeral Service Providers: Funeral service representatives may use the form to assist families in obtaining the medallion.
Frequently Asked Questions
How do I submit my claim?
You can submit your claim electronically, by fax, or by mail depending on your preference.
What documents do I need to include?
You need to include a copy of the veteran's discharge certificate and any other supporting documents.
Can I edit the form after downloading?
Yes, you can edit the form using our PrintFriendly PDF editor before submitting.
How long does processing take?
Processing times may vary, but ensure your form is complete to avoid delays.
Is there a fee for this process?
There is no fee associated with the application for the medallion.
Who is eligible for a medallion?
Deceased veterans who served honorably in the armed forces on or after April 6, 1917 may be eligible.
Can I submit this form online?
Yes, you can electronically submit the completed form using our platform.
How will I receive the medallion?
The medallion will be shipped free of charge to the address provided in the application.
What if I make a mistake on the form?
Errors can be corrected during the editing process using our PDF editor.
Who can I contact for assistance?
For assistance, you can reach out to our Applicant Assistance Unit at 1-800-697-6947.