VA Form 10-0462: Political Activities Fact Sheet and Certification

VA Form 10-0462 is the U.S. Department of Veterans Affairs Political Activities Fact Sheet and Certification, listed under VHA on VA's form page. It applies to VA Voluntary Service (VAVS) personnel, including volunteers, and any other personnel who provide information or assistance to VA veteran patients on voter registration. The fact sheet lists what they may and may not do, and the certification records that the signer has read and understood it.

The form is one page: three things personnel may do, three things they may not do, a certification paragraph that mentions the Hatch Act and the local Regional Counsel, and lines for a printed name, signature and date. It is a form for VA volunteers and personnel, not a Veterans benefit application.

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Top of page 1 of VA Form 10-0462: Political Activities Fact Sheet and Certification, as printed by VA

What's on VA Form 10-0462

Who the rules cover

An opening statement naming VAVS personnel, including volunteers, and any other personnel who provide voter registration information or assistance to VA veteran patients.

You MAY

Provide a form or other information to register to vote or obtain an absentee ballot, help complete and mail the form or complete the ballot itself, and direct a veteran patient to the state or local government office responsible for voter registration.

You MAY NOT

Discuss partisan politics, promote or give a personal opinion on a candidate, party or issue, wear partisan political buttons, pins or ribbons in a VA facility, or direct persons to voter registration run by a partisan entity such as a political party, union or special interest group.

Certification

A statement that the signer has read and understands what is and is not permissible, that the Hatch Act may place other limitations, and that the list is not an exhaustive list of do's and don'ts under the Hatch Act.

Name, signature and date

A printed name (Last, First, Middle Initial), a signature and a date.

How VA Form 10-0462 is completed

1
Read the fact sheet
Read both lists: what personnel may do and may not do when giving voter registration help to VA veteran patients.
2
Read the certification
It covers the Hatch Act note and where to send questions about voter registration assistance.
3
Print your name
Enter your name in the order the form asks: Last, First, Middle Initial.
4
Sign and date it
Sign on the SIGN line and enter the date.

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Where it goes and edition

Where it goes

The form prints no mailing address, fax number or submission instructions.

Questions

The certification says to address any questions on providing voter registration assistance to the local Regional Counsel.

Edition

The footer reads VA FORM SEP 2008, matching the September 2008 revision date on VA's form page. The PDF prints no OMB control number.

Who uses VA Form 10-0462?

VAVS volunteers
The form says VA Voluntary Service personnel, including volunteers, who provide information or assistance to VA veteran patients on voter registration follow the rules it lists.
Other personnel helping with voter registration
The rules also cover any other personnel who provide voter registration information or assistance to VA veteran patients.
The person giving assistance signs
The certification is written by the person providing voter registration assistance, who prints a name, signs and dates it. VA veteran patients receive the help and do not sign this form.
The local Regional Counsel
The certification says questions on providing voter registration assistance are addressed to the local Regional Counsel.

The opening line and the certification say who the form is for.

Official sources and the blank

Official VA form page
The agency’s own page for Form 10-0462.
Blank PDF
The official blank form, to print or fill by hand.

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Questions about Form 10-0462

What is VA Form 10-0462?

It is the Political Activities Fact Sheet and Certification, a one page VHA form listing what VA Voluntary Service personnel and other personnel may and may not do when helping VA veteran patients with voter registration.

Who signs VA Form 10-0462?

The person providing voter registration assistance, such as a VAVS volunteer. They print their name, sign and date the certification.

What does the form allow?

Providing a form or other information to register to vote or obtain an absentee ballot, helping complete and mail it or complete the ballot, and directing a veteran patient to the state or local voter registration office.

What does the form not allow?

Discussing partisan politics, promoting or giving an opinion on a candidate, party or issue, wearing partisan political buttons, pins or ribbons in a VA facility, and directing persons to voter registration run by a partisan entity.

Does the form list every Hatch Act rule?

No. The certification says the Hatch Act may place other limitations and that the requirements are not intended as an exhaustive list of do's and don'ts under the Hatch Act.

Who answers questions about voter registration help?

The certification says questions on providing voter registration assistance are addressed to the local Regional Counsel.

VA Form 10-0462: Political Activities Fact Sheet and Certification