Description of Changes to VA Form 40-0247 (OMB # 2900-0567) 8-31-2022

ISSUE: The following form has minimal non-substantive changes to the Section IV and Section V. blocks. This change request is non-substantive and has no impact on the burden. The number of respondents, annual burden hours, estimated completion time, and annualized costs to the respondents and Federal government did not change.

Description of Changes to VA Form 40-0247, Presidential Memorial Certificate Request Form (OMB # 2900-0567)

The Department of Veterans Affairs (VA) National Cemetery Administration (NCA) is proposing changes to VA Form 40-0247, Presidential Memorial Certificate Request Form.

See VA Form 40-0247 PDF 1 attachment on page 1.

NCA is making the following non-substantive text edits to the form:

• Block Section IV: change from HE OR SHE to THE DECEDENT

• Block Section V: change title from MAILING ADDRESS AND FAX NUMBER to SUBMITTING FORM AND DOCUMENTS

• Block Section V: delete PLEASE SEND ANY MILITARY DOCUMENTS AND SIGNED FORM TO:

• Block Section V: change address from PRESIDENTIAL MEMORIAL CERTIFICATES (41B3) NATIONAL CEMETERY ADMINISTRATION 5109 RUSSELL ROAD QUANTICO, VA 22134-3903 to MAIL YOUR CLAIM AND SUPPORTING DOCUMENTS TO: NCA FP EVIDENCE INTAKE CENTER PO BOX 5237 JANESVILLE, WI 53547

• Block Section V: add ELECTRONICALLY SUBMIT YOUR CLAIM AND SUPPORTING DOCUMENTS BY USING QUICK SUBMIT AT ACCESS.VA.GOV. YOU WILL BE INSTRUCTED TO REGISTER DURING YOUR FIRST SIGN-ON ATTEMPT.

• Block Section V: change FAX TO to FAX CLAIM AND SUPPORTING DOCUMENTS TO:

VA will update the date of the form once OMB approval of the proposed changes is received.

APPENDIX C: VA FORM 0247

VA FORM 40-0247 PDF (Click square above) 1