VA 21-22a PDF Template

[toc] All documents regulated by the Department of Veterans Affairs in the United States are called VA forms. These forms cover a variety of circumstances for different beneficiaries. They’re used to apply for, explain, and adjust multiple types of benefits for veterans. The Form 21-22a is also called the Appointment of Individual as Claimant’s Representative form. It’s used when a claimant wants another individual to represent them in their claim proceedings.

If a veteran files a claim with the VA, they have the right to get another person to act as their representative. The form is the official way of identifying this representative and getting their contact information. Its main use is to make sure the VA always has a way to contact the representative if there’s any kind of emergency or urgency with regards to the claim.

The form is just two pages long. It’s important to have a good understanding of which parts must be filled out by the claimant, and which parts must be filled out by the representative. All involved parties must be certain that their information is accurate and up-to-date.

This form accomplishes two main goals:

It informs the VA that a claimant will have a representative acting in their stead

It informs the VA that a claimant will have a representative acting in their stead

It gets the contact information of the representative on file so the VA has it in case of emergency

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Two main parties are responsible for filling out the form: the claimant, and the representative for the claimant. Both parties will need to give contact information along with personal information. The type of representative will also need to be noted.

Most representatives are attorneys or agents, but there are some cases in which family members or friends might step in as a representative. If any claimant believes that their claim could be better handled by another party, they have the right to ask that party to represent them. The same is true for any claimants who feel that the claim proceedings and paperwork are too stressful or difficult to manage. Such an option is often exercised by disabled veterans and elderly veterans.

If the representative is an attorney, they should already be familiar with the paperwork involved in your claim. They’ll know what forms they need to procure, what explanations they need to give, and how to expedite the filing process for VA benefits. Because attorneys specialize in knowing the ins and outs of paperwork and the VA’s office, it’s highly recommended that a claimant have one go over their claim application or appeal with them.

There are a number of different reasons a person might use a representative for their case instead of representing themselves. These include, but are not limited to:

The claimant decided to exercise their right to an attorney, and their attorney is now handling all paperwork, information, relevant meetings, and appeals

The claimant decided to exercise their right to an attorney, and their attorney is now handling all paperwork, information, relevant meetings, and appeals

The claimant is elderly or disabled and unable to complete the steps necessary for the filing themselves, so they’re having a representative who can help them

The claimant is elderly or disabled and unable to complete the steps necessary for the filing themselves, so they’re having a representative who can help them

The claimant does not have time to go through the claims process

The claimant does not have time to go through the claims process

The claims process is causing undue stress to the claimant, so they’re opting to have a representative help instead

If a claimant intends to authorize a representative to act for them, this is one of the required forms. After the representative is authorized and the paperwork filed, said representative can then take care of the rest of the paperwork necessary for the claims process. In the case of an attorney, the representative will ask the claimant questions to fill out their forms, and they’ll streamline the paperwork and filing process.

Claimants who fail to file this form will not have an authorized representative who can act in their stead.

The first part of the form will be filled out by the claimant, while the representative will take care of the second part.

For the claimant:

Write the VA file numbers of your claim case in Box 1 at the top of the form.

Write the VA file numbers of your claim case in Box 1 at the top of the form.

In Boxes 2 and 3, write your name, address, the name of the veteran, and the veteran’s service numbers. If you are both the claimant and the veteran, just write your name in both boxes.

In Boxes 2 and 3, write your name, address, the name of the veteran, and the veteran’s service numbers. If you are both the claimant and the veteran, just write your name in both boxes.

Check the branch of service that the veteran was involved in using Box 6. In Box 7A, you’ll write the name of whichever party is acting as your representative. You’ll then use Box 7B to note whether the individual is a service organization representative, individual providing representation under Section 14.630, agent, or attorney. For service organization representatives, you’ll need to write the name of the organization on the included blank.

Check the branch of service that the veteran was involved in using Box 6. In Box 7A, you’ll write the name of whichever party is acting as your representative. You’ll then use Box 7B to note whether the individual is a service organization representative, individual providing representation under Section 14.630, agent, or attorney. For service organization representatives, you’ll need to write the name of the organization on the included blank.

Sign in Box 7D. If you want the representative to have access to confidential health information, check the Authorization box in Question 9. If you don’t want this authorization, just skip the question. If you do decide to have the information disclosed, you’ll use Box 10 to place any limitations on the information you want to be shared.

Sign in Box 7D. If you want the representative to have access to confidential health information, check the Authorization box in Question 9. If you don’t want this authorization, just skip the question. If you do decide to have the information disclosed, you’ll use Box 10 to place any limitations on the information you want to be shared.

Check the authorization box in Question 11.

Check the authorization box in Question 11.

Sign and date the form.

For the representative:

Sign in Box 7C. Write your full address in Box 8. If you are an attorney or an agent, list any limitations on the representation in Box 15.

Sign in Box 7C. Write your full address in Box 8. If you are an attorney or an agent, list any limitations on the representation in Box 15.

Sign the bottom of the form and date the signature.