An Appointment of an Individual as Claimant’s Representative form is used to recognize an individual as a representative of a veteran who has an active claim with the Department of Veterans Affairs. Formally referred to as a VA Form 21-22a, this document allows the Department to identify a veteran’s representative and retain their information on file for further contact. This form will allow the Department to contact the veteran’s representative when corresponding about the active claim. This form will also require personal information of both the claimant and the representative, including the type of representative that is being put on file (agent, attorney, etc.).
A VA Form 21-22a is known as an Appointment of Individual as Claimant’s Representative form. It will be used by the United States Department of Veterans Affairs. This form is necessary to recognize someone as a representative of a veteran who has a claim with the Department of Veterans Affairs. This form will allow the department to identify the representative and have their contact information on file.
Both the claimant and their representative will need to include their information on this form. This includes information about what kind of representative the individual is, whether they are an attorney, agent, or another type of representative. Both parties will also need to sign the form and date it before it can be submitted to and recognized by the Department of Veteran Affairs.
The VA Form 21-22a is used when a veteran would like to appoint an individual to assist him or her with a claim or veterans benefits. If the veteran would like a service organization to assist him or her with the claim instead of an individual, the veteran should complete VA Form 21-22 Appointment of Veterans Service Organization as Claimant's Representative instead. These forms are available at: www.va.gov/vaforms.
A VA Form 21-22a contains the following sections:
To complete a VA Form 21-22, you need to provide the following information:
The U.S. Department of Veterans Affairs will not disclose any of the requested information other than what has been authorized by the Privacy Act of 1974 or Title 38, Code of Federal Regulations 1.576 for routine uses such as civil and criminal law enforcement, litigation in which the United States is a party or has an interest, the administration of VA programs and delivery of VA benefits, verification of identity and status, and personnel administration) as identified in the VA system of records, 58VA21/22/28, Compensation, Pension, Education, and Vocational Rehabilitation and Employment Records-VA, published in the Federal Register.
The VA cannot conduct or sponsor a collection of information unless a valid OMB control number is displayed. OMB Control No. 2900-0321.
