VA Form 21-22a: Appointment of Individual as Claimant's Representative

What VA Form 21-22a is for

Use this form to appoint an individual, usually an accredited attorney or claims agent, to represent you before VA. Check the person's accreditation in VA's official search before you sign. VA's representation guidance says attorneys and agents may charge fees, and this form does not replace reviewing their fee agreement.

Appointing a Veterans Service Organization instead of an individual? That is VA Form 21-22. Fill out Form 21-22.

Parts someone else completes

The person you appoint completes Section III, items 16A to 16E: their name, the type of representative, and their address, phone and email. An agent or attorney who limits the representation writes it in Item 24, and they sign and date items 25A and 25B. Read Item 24 before you sign: unless an agent or attorney limits it, this appointment revokes all earlier powers of attorney. Items 17 and 18 apply only to representation under 38 CFR 14.630, and you both sign them in that case.

What you fill in by hand

The filler never asks for your Social Security number, VA file number, date of birth or signature. You write those in by hand. Leave these boxes for yourself:

• Item 2: veteran's Social Security number (and the copies at the top of pages 2 and 3)
• Item 3: VA file number
• Item 4: veteran's date of birth
• Item 5: service number
• Item 11: claimant's date of birth
• International phone numbers under items 8 and 14
• Items 23A and 23B: your signature and date
• Items 17A and 17B

Where to send it

• Both signatures belong on the form before it goes to VA: yours in 23A and 23B, and the representative's in 25A and 25B.
• Online: VA's appointment tool can prepare the form. If it gives you a PDF to sign, finish both signatures and submit it through QuickSubmit in AccessVA.
• Compensation claims by mail: Department of Veterans Affairs, Evidence Intake Center, PO Box 4444, Janesville, WI 53547-4444.
• Pension and survivor benefit claims by mail: Department of Veterans Affairs, Pension Intake Center, PO Box 5365, Janesville, WI 53547-5365. A Board appeal: Department of Veterans Affairs, Board of Veterans' Appeals, PO Box 27063, Washington, DC 20038.
• In person: bring the signed form to a VA regional office.
• Keep a copy. Confirm with your representative that VA recognizes the appointment, and keep working on any claim or appeal deadline meanwhile.

Claim Raven does not submit forms to VA. You review the filled PDF, sign and date it, and send it to VA yourself. Claim Raven is independent and is not affiliated with VA.

Official form and guide

• VA's page for Form 21-22a on VA.gov
• VA Form 21-22 example and how to fill it out

This filler uses the July 2023 edition of the form.