Fillable Form VA 21-22 (2019)

What is Form VA 21-22?

The Appointment of Veterans Service Organization (VSO) as Claimant’s Representative, or Form VA 21-22, is a document used and developed by the Department of Veterans Affairs for veterans to claim their VA benefits or claims through the help of their chosen VSO.

What is the purpose of Form VA 21-22?

The purpose of Form VA 21-22 is for veterans to claim their VA benefits and claims with the help of a VSO.

Who should file Form VA 21-22?

Veterans who wish to have a VSO help them with their VA benefits and claims should file Form VA 21-22.

Membership in an organization is not a prerequisite to the appointment of the organization as the claimant's representative.

The following is a listing of national, regional, or local organizations recognized by the Secretary of Veterans Affairs in the preparation, presentation, and prosecution of claims under laws administered by the Department of Veterans Affairs.

• Recognized Service Organizations:

African American PTSD Association

American Legion

American Red Cross

AMVETS

American Ex-Prisoners of War, Inc.

American GI Forum, National Veterans Outreach Program

Armed Forces Services Corporation

Army and Navy Union, USA

Associates of Vietnam Veterans of America

Blinded Veterans Association

Catholic War Veterans of the U.S.A.

Disabled American Veterans

Fleet Reserve Association

Gold Star Wives of America, Inc.

Italian American War Veterans of the United States, Inc.

Jewish War Veterans of the United States

Legion of Valor of the United States of America, Inc.

Marine Corps League

Military Officers Association of America (MOAA)

Military Order of the Purple Heart

National Amputation Foundation, Inc.

National Association of County Veterans Service Officers, Inc,

National Association for Black Veterans, Inc.

National Veterans Legal Services Program

National Veterans Organization of America

Navy Mutual Aid Association

Paralyzed Veterans of America, Inc.

Polish Legion of American Veterans, U.S.A.

Swords to Plowshares, Veterans Rights Organization, Inc.

The Retired Enlisted Association

The Veterans Assistance Foundation, Inc.

The Veterans of the Vietnam War, Inc. & The Veterans

Coalition

United Spanish War Veterans of the United States

United Spinal Association, Inc.

Veterans of Foreign Wars of the United States

Veterans of World War I of the U.S.A., Inc.

Vietnam Era Veterans Association

Vietnam Veterans of America

West Virginia Department of Veterans Assistance

Wounded Warrior Project

Although agency titles vary, the following States and possessions maintain veterans service agencies which are recognized to present claims:

Alabama

American Samoa

Arizona

Arkansas

California

Colorado

Connecticut

Delaware

Florida

Georgia

Guam

Hawaii

Idaho

Illinois

Iowa

Kansas

Kentucky

Louisiana

Maine

Maryland

Massachusetts

Michigan

Minnesota

Mississippi

Missouri

Montana

Nebraska

Nevada

New Hampshire

New Jersey

New Mexico

New York

North Carolina

North Dakota

Northern Mariana Islands

Ohio

Oklahoma

Oregon

Pennsylvania

Puerto Rico

Rhode Island

South Carolina

South Dakota

Tennessee

Texas

Utah

Vermont

Virginia

Virgin Islands

Washington

West Virginia

Wisconsin

Wyoming

Where should you file and submit Form VA 21-22?

The address to mail Form VA 21-22 differs depending on what the veteran is claiming. To know which address to mail your Form VA 21-22, first identity the benefit type being claimed, then use the corresponding mail addresses below.

• For compensation claims:

Department of Veterans Affairs

Compensation Intake Center

P.O. Box 4444

Janesville, WI 53547-4444

• For Pension and Survivors Benefit Claims:

Department of Veterans Affairs

Pension Intake Center

P.O. Box 5365

Janesville, WI 53547-5365

• For Fiduciary:

Department of Veterans Affairs

Fiduciary Intake

P.O. Box 95211

Lakeland, FL 33804-5211

• For the Board of Veterans’ Appeals:

Department of Veterans Affairs

Board of Veterans' Appeals

P.O. Box 27063

Washington, DC 20038

The addresses mentioned above serve all United States and foreign locations.

When should you file and submit Form VA 21-22?

Veterans should file for Form VA 21-22 when they want to claim their VA benefits and claims.

The time it takes for their response to reach the VA affects how long it takes to process their claim. The Department of Veterans Affairs recommends that veterans applying for Form VA 21-22 respond electronically whenever possible. Only claimants or representatives can upload responses electronically currently.

How do you fill out Form VA 21-22?

First and foremost, please read the Privacy Act and Respondent Burden Information on Page 3 of Form VA 21-22 before completing the form.

Form VA 21-22 is composed of four (4) pages and five (5) sections. Of the four (4) pages, two (2) are to be filled out and the other two are for information regarding mailing locations and recognized service organizations. To complete Form VA 21-22, provide accurate and honest information being asked legibly on the boxes, lines, and spaces provided.

The five (5) sections of Form VA 21-22 are:

1. Veteran’s Information
2. Claimant’s Information (If other than veteran)
3. Service Organization Information
4. Authorization Information
5. Signatures

To start filling out Form VA 21-22, begin by completing the “Veteran’s Information” section. Again, it should be noted that you can either complete the form online or by hand. If completed by hand, print the information requested in ink, neatly, and legibly to expedite processing of the form

1. Using the FIRST, MIDDLE INITIAL, LAST NAME format, affix the veteran’s full name.

2. Then, the veteran’s Social Security Number (SSN).

3. Then, if applicable, the VA file number.

4. Then, using the mm/dd/yyyy format, state the veteran’s date of birth.

5. Then, if applicable, the veteran’s service number.

6. Then, if applicable, the insurance number/s. Include letter prefix.

7. Then, report the veteran’s mailing address. Include the number and street or rural route, P.O. Box, City, State, ZIP Code, and Country.

8. Then, the veteran’s telephone number. Include the area code.

9. Then, the veteran’s e-mail address. This is optional.

After filling out the first section, move on to the next section, “Claimant’s Information.” Complete this section if the claimant is other than the veteran.

10. Using the FIRST, MIDDLE INITIAL, LAST NAME format, affix the claimant’s full name.

11. Then, report the claimant’s mailing address. Include the number and street or rural route, P.O. Box, City, State, ZIP Code, and Country.

12. Then, the claimant’s telephone number. Include the area code.

13. Then, the claimant’s email address. This is optional.

14. Then, the claimant must report their relationship to the veteran.

After filling out the second section, move on to the third section, “Service Organization Information.”

15. Before selecting an organization, see the listing on Page 3 of Form VA 21-22 to see if your organization is recognized by the Department of Veterans Affairs. Affix the name of the service organization recognized.

16. A. Report the name of the official representative acting on behalf of the organization named in Item 15. This is an appointment of the entire organization and does not indicate the designation of only this specific individual to act on behalf of the

B. Job title of person named in item 16A.

17. The email address of the organization named in Item 15.

18. Date of appointment in mm/dd/yyyy format.

Before moving onto the fourth section of Form VA 21-22, “Authorization Information”, affix the veteran’s SSN again.

Make sure to read thoroughly the implications of each authorization request. For section 4 of Form VA 21-22, check the boxes to authorize your consent to the following:

19. Authorization for Representative’s Access to Records Protected by Section 7332, Title 38, U.S.C.

20. Limitation of Consent

21. Authorization to Change Claimant’s Address

After filling out the fourth section, move on to the fifth and last section, “Signatures.” It should be noted that the power of attorney does not require execution before a notary public.

22. A. Signature of Veteran or Claimant. Do not print.

B. Date Signed (mm/dd/yyyy format).

23. A. Signature of Veteran’s Service Organization representative named in Item 16A. Do not print.

B. Date Signed (mm/dd/yyyy format).