VA21a
Application for Accreditation as a Claims Agent or Attorney
VA Form VA21a is the U.S. Department of Veterans Affairs Application for Accreditation as a Claims Agent or Attorney. It is filled in by a person applying to VA for accreditation as a claims agent or attorney, and it goes to VA's Office of the General Counsel. The Privacy Act notice says the information will enable VA to determine initial eligibility for accreditation as a claims agent or attorney to represent claimants before VA.
The form is four pages. It asks for personal, military service, employment and education details, bar and agency admissions, a set of yes or no background questions, three character references and a signed certification. Page 4 holds the Privacy Act and respondent burden notices. You can fill out the PDF free in your browser on this page and download the result without an account.
Name, home address, phone number and email, employment status with a work address if employed, date and place of birth, branch of service, character of discharge and the dates of all active military service.
Employment for the past five years, including volunteer work and self-employment, with employer, position, dates and supervisor. Education covers high school graduation and every college or university attended, with degrees and majors.
Whether you are a member in good standing of the bar of the highest court of a state or territory, and whether you are admitted to practice before any state or federal agency or federal court, with each jurisdiction, date of admission and membership or registration number.
Yes or no questions on convictions, courts-martial, pending charges, discipline at school or work, past representation before an agency, discipline or bars from practice, and past VA accreditation. For questions 13 to 15 the form says to include nolo contendere pleas but omit traffic fines of $300 or less, violations before your 16th birthday and expunged convictions.
A question on any condition or impairment that could affect the ability to represent claimants, a question for claims agent applicants on physical limitations affecting a written examination, and three character references with name, address, email and relationship.
A certification that the statements and entries are true and correct, a warning that a willfully false statement or certification is a criminal offense under 18 U.S.C. 1001, an ink signature and the date signed.
The instructions say to provide the applicable personal and employment data, and to attach supplementary pages if more space is needed.
The form says to read each question and give complete answers to all questions that apply. For each question answered Yes, it asks for a detailed statement of the relevant facts and dates, with copies of relevant documents.
Item 25 asks for the full names, addresses and current email addresses of three people who are not immediate family members.
Sign the certification in ink and enter the date. The form says unsigned or incomplete applications will not be processed.
Send the completed application to the Office of the General Counsel (022D) address printed in the instructions.
The form says responses are to be updated as necessary before accreditation, and that failure to disclose the requested information may result in denial of accreditation under 38 C.F.R. 14.629.
You get the real form, filled in a browser tab, with nothing standing between you and the finished PDF.
Department of Veterans Affairs, Office of the General Counsel (022D), 810 Vermont Avenue, NW, Washington, D.C. 20420.
The form gives [email protected] only for comments on the burden estimate and says not to send your completed VA Form 21a to that address.
VA's form page offers a downloadable PDF and does not list an online version of this form.
The APR 2025 edition says previous versions of this form will not be used. It carries OMB No. 2900-0605, which expires 04/30/2028, and an estimated burden of 45 minutes.
The form's instructions name two kinds of applicants and the office that receives the application.
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It is the application for accreditation as a claims agent or attorney. The Privacy Act notice says the information will enable VA to determine initial eligibility for accreditation to represent claimants before VA.
The form says attorney applicants are in good standing with a State bar and are not required to take an examination administered by VA as a prerequisite to accreditation.
The form says claims agent applicants need a score of 75 percent or more on a written examination administered by VA, after an affirmative determination of character and fitness.
The form asks for a detailed statement setting out all relevant facts and dates, along with copies of relevant documents, for each question answered Yes.
The form lists Department of Veterans Affairs, Office of the General Counsel (022D), 810 Vermont Avenue, NW, Washington, D.C. 20420.
No. The instructions say unsigned or incomplete applications will not be processed, and the signature line asks for an ink signature.
