VA Form VA21: Application for Accreditation as Service Organization Representative

VA Form VA21 is the U.S. Department of Veterans Affairs Application for Accreditation as Service Organization Representative. The form's Privacy Act notice says the information is solicited under 38 U.S.C. 5902, which authorizes VA to recognize representatives of approved organizations for the preparation, presentation, and prosecution of claims, and that it lets VA determine eligibility for accreditation as a representative of a recognized service organization.

The form is one page with two sections. Section I is executed by the designee, the person to be accredited, and covers name and addresses, military service, method of qualification, the organization to be represented and other affiliations. Section II is executed by the proper certifying officer of the recognized organization. VA's form page lists it as related to VACO. You can fill out the PDF free in your browser on this page and download the result without an account.

Top of page 1 of VA Form VA21: Application for Accreditation as Service Organization Representative, as printed by VA

What's on VA Form VA21

Items 1 to 2B: name and addresses

The designee's last, first and middle name, home address and business address.

Items 3 to 6: service and qualification

Branch of service, with boxes from Army to Space Force, a Non-Veteran box and Other, the dates of all active service, character of discharge, and the method of qualification: completed appropriate training or experience representing claimants.

Items 7A to 7E: the organization

The name of the organization the designee will represent, the email and phone number at the organization, and the designee's relationship to it.

Items 8 to 9B: other affiliations

Whether the designee is accredited to any other organization, employed in any civil or military department or agency of the U.S. Government, or ever held a Federal position involving action on claims in VA or the Veterans Administration.

Agreement and Items 10 and 11

An agreement that neither the designee nor the organization will charge or accept any fee or other gratuity for services rendered a claimant or divulge confidential information except as provided by law, then the designee's ink signature and date.

Section II: Items 12 to 15

The certification and recommendation, the certifying officer's ink signature and title, the organization's name, the officer's address and the date of signature.

How VA Form VA21 is completed

1
Read the notices
The top of the form holds the Privacy Act and Paperwork Reduction Act notice and estimates the burden at 15 minutes per response.
2
The designee fills in Section I
Type or print Items 1 to 9B, checking the boxes that apply and naming any other organization, agency or department where the form asks.
3
The designee signs
After the agreement paragraph, the designee signs Item 10 in ink for a new certification and enters the date in Item 11 as MM/DD/YYYY.
4
The certifying officer completes Section II
The officer checks primary accreditation, cross-accreditation or recertification, then signs Item 12 in ink and fills in Items 13 to 15.

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Sending it and edition details

Where it goes

Neither the form nor VA's form page prints a mailing address or an online way to submit it.

Questions about the form

The form says you can call 1-800-827-1000 to get information on where to send comments or suggestions about this form.

Penalty

The form cites 18 U.S.C. 1001 for making any statement of a material fact knowing it to be false.

Edition

The MAR 2023 edition supersedes VA Form 21, FEB 2020, which the form says will not be used. It shows OMB No. 2900-0018 with Exp. Date: March 31, 2026.

Who completes VA Form VA21?

The designee
Section I is headed To be executed by designee, and asks the designee to type or print. The designee signs Item 10 in ink, which the form marks for new certifications only.
Members and paid employees of the organization
Item 7D asks whether the designee is a member in good standing of the organization, or a paid employee working for it not less than 1000 hours annually.
County or tribal veterans service officers
Item 7E asks about paid county or tribal employees who work for that government not less than 1000 hours annually, have completed VA-approved state training and examination, and receive regular state supervision and monitoring or annual training.
The organization's certifying officer
Section II is executed by the proper certifying officer of the recognized organization, who certifies that the designee is of good character and reputation and is qualified by training or experience to present claims.
Representatives seeking cross-accreditation or recertification
Item 8 asks about accreditation to other organizations, and Section II offers cross-accreditation based on another organization's accreditation, or recertification of a representative's qualifications.

The form is filled in by a designee and a recognized service organization, not by a claimant.

Official sources and the blank

Official VA form page
The agency’s own page for Form VA21.
Blank PDF
The official blank form, to print or fill by hand.

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Questions about Form VA21

What is VA Form VA21 used for?

The form says the information enables VA to determine eligibility for accreditation as a representative of a recognized service organization, under 38 U.S.C. 5902.

Who signs VA Form VA21?

The designee signs Item 10 in ink for new certifications, and the proper certifying officer of the recognized organization signs Item 12 in ink in Section II.

Can an accredited representative charge a fee?

The form's agreement says neither the designee nor the organization will charge or accept any fee or other gratuity for services rendered a claimant, and that a breach is sufficient basis for revocation of accreditation.

Can someone who is not a Veteran use the form?

Item 3, branch of service, includes a Non-Veteran box next to the service branches.

Where do I send VA Form VA21?

Neither the form nor VA's form page prints a mailing address. The form gives 1-800-827-1000 for information on where to send comments or suggestions about the form.

VA Form VA21: Application for Accreditation as Service Organization Representative