21-0972
Alternate Signer Certification (VA Form 21-0972)
VA Form 21-0972 is the U.S. Department of Veterans Affairs Alternate Signer Certification. VA's form page says to use it if you're signing an application form for benefits on behalf of a Veteran or non-Veteran. The form calls that person the alternate signer, and says it is completed by the individual signing the benefit application form on behalf of the veteran/claimant.
The PDF has three pages. Page 1 lists the VA forms that will be accepted along with it, grouped by benefit, from appeals and compensation to pension, dependents and survivors benefits. Pages 2 and 3 hold the certification in Sections I to V. The form says to submit it along with the appropriate benefit application form, together with any supporting documents or evidence.
VA's page says the form can also be submitted online. You can fill out the PDF free in your browser on this page and download the result without an account.
A notice listing the forms accepted along with VA Form 21-0972, such as VA Form 21-526EZ for compensation, VA Form 21P-527EZ for pension, VA Forms 20-0995, 20-0996 and 10182 for appeals and VA Form 21-686c for dependents.
Items 1 to 6 ask for the Veteran's name, Social Security number, VA file number if applicable, date of birth, whether a claim was ever filed with VA and service number if applicable.
Completed if the claimant is other than the veteran. Items 7 to 12 ask for the claimant's name, mailing address, Social Security number, relationship to the Veteran (spouse, parent or child), telephone and email.
Items 13 to 17 ask for the alternate signer's name, mailing address, telephone, email and relationship to the veteran/claimant.
Item 18 asks the signer to check all that apply: the veteran/claimant is under 18 years of age, mentally incompetent as the form describes, or physically unable to sign the claims form.
The alternate signer's declaration of intent, the required signature in Item 19A, the date in Item 19B and optional remarks in Item 20, followed by the Privacy Act and respondent burden notices.
Page 1 lists the application forms that will be accepted along with VA Form 21-0972, by benefit.
Enter the Veteran's details, and Section II only if the claimant is other than the veteran. If completed by hand, the form asks for ink, neat and legible printing, one letter per box and fully filled check boxes.
Complete Section III and check at least one relationship box in Item 17, then check all that apply in Section IV.
The declaration says the signer may be asked to confirm the truthfulness of the answers under penalty of perjury. Sign Item 19A, which the form marks as required, and date Item 19B.
The declaration lists evidence VA may request, such as a court order, documentation of a fiduciary appointment, a durable or health care power of attorney, or an affidavit or notarized statement from an institution or caregiver.
Send it along with the appropriate benefit application form and any supporting documents, or submit it online through VA's form page.
You get the real form, filled in a browser tab, with nothing standing between you and the finished PDF.
The form says to submit it along with the appropriate benefit application form. It does not print a separate mailing address of its own.
VA's form page says you can submit your form online instead of sending the paper form.
The form points to www.va.gov, ASK VA at https://ask.va.gov and the toll-free number 1-800-827-1000 (TTY:711).
The May 2026 edition supersedes the FEB 2023 edition. It carries OMB Control No. 2900-0849, which expires 05/31/2029, and a respondent burden of 15 minutes.
21-526EZ
345 fields, 15 pages
21P-527EZ
477 fields, 17 pages
21-0966
49 fields, 2 pages
20-0995
136 fields, 7 pages
21-686c
625 fields, 15 pages
21P-534EZ
626 fields, 20 pages
Item 17 lists four kinds of alternate signer, and the form asks the signer to check at least one box.
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The form says it is completed by the individual signing the benefit application form on behalf of the veteran/claimant, called the alternate signer.
The form says to submit it along with the appropriate benefit application form, plus any supporting documents or evidence. Page 1 lists the forms that will be accepted with it.
Item 17 lists a court-appointed representative, an attorney in fact or agent under durable power of attorney, a person responsible for the care of the veteran/claimant, and a manager or principal officer of an institution responsible for that care.
The declaration lists examples such as an SSN or Taxpayer Identification Number, a court certificate or order, documentation of a fiduciary appointment, a durable or health care power of attorney, or an affidavit or notarized statement about the care provided.
The form has one signature line, Item 19A, for the authorized signer, with the date in Item 19B.
Yes. VA's form page says you can submit your form online instead of sending the paper form.
