How to complete a VA Form 21 22 (Step by Step)

To complete a VA Form 21-22, you need to provide the following information:

• Veterans Information
  • Name of veteran (first, middle, last)
  • Veterans social security number
  • VA file number
  • Veteran's date of birth (month, day, year)
  • Veteran's service number
  • Branch of service
  • Veterans mailing address (number and street or rural route, city, or P.O., state, and ZIP code)
  • Veteran's phone number
  • Veteran's email address
• Claimant's Information
  • Claimant's name
  • Claimant's mailing address
  • Claimant's telephone number
  • Claiman't email address
  • Relationship to veteran
• Service Organization Information
  • Name of individual appointed as representative
  • Whether an individual is an attorney, agent, Section 14.630 representative, or service organization representative
  • If individuals are providing representation under 38 CFR 14.630, provide signature and dates
  • Address of individual appointed as claimant's representative
• Authorization Information
  • Authorization for VA facility to give veterans representative access to records protected by Section 7332, Title 38, U.S.C. (information or treatment records related to drug abuse, alcoholism, alcohol abuse, infection with the human immunodeficiency virus (HIV), or sickle cell anemia.
  • Limitation of consent
  • Authorization for representative to act on claimant's behalf to change claimant's address
• Conditions of Appointment
  • Signature of claimant
  • Date of signature
  • Limitation on representation (unless limited by an agent or attorney, this power of attorney revokes all previously existing powers of attorney)
  • Signature of representative
  • Date of signature