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The VA Form 21A serves as a vital tool for individuals seeking accreditation as claims agents or attorneys to represent claimants before the Department of Veterans Affairs. It requires applicants to provide essential personal information, including their name, contact details, and employment status, followed by a detailed history of military service and education. The form emphasizes transparency, asking applicants to disclose any legal issues or disciplinary actions, thereby ensuring that only qualified individuals are accredited to assist veterans. Claims agent applicants must achieve a passing score on a written examination, while attorneys need to be in good standing with their state bar, a distinction that simplifies their accreditation process. Detailed instructions for completing the form guide applicants in providing complete responses, making it clear that unsigned or incomplete submissions will not be processed. Once completed, the form should be sent to the designated office within the VA, ensuring that all relevant documentation is attached if additional space is required. Understanding the requirements and carefully completing the VA Form 21A are crucial steps for anyone looking to support veterans in navigating their benefits and claims effectively.

Va 21A Example

Form Approved, OMB No. 2900-0605

Expiration Date: Mar. 31, 2022

Respondent Burden: 45 minutes

APPLICATION FOR ACCREDITATION AS A CLAIMS AGENT OR ATTORNEY

INSTRUCTIONS: Please provide the applicable personal and employment data, then read each question and provide complete answers to all questions that apply to you. If additional space is needed, please attach a supplementary page(s). After providing all of the requested information, sign and date your application. Unsigned or incomplete applications will not be processed. Send completed applications to: Department of Veterans Affairs, Office of the General Counsel (022D), 810 Vermont Avenue, NW, Washington, D.C. 20420. After an affirmative determination of character and fitness for practice before VA, claims agent applicants must achieve a score of 75 percent or more on a written examination administered by VA as a prerequisite to accreditation. Claims agent applicants will be given written instructions for arranging to take the examination if initial eligibility is established. Attorney applicants must be in good standing with a State bar and are not required to take an examination administered by VA as a prerequisite to accreditation.

1. LAST NAME - FIRST NAME - MIDDLE NAME

2A. HOME ADDRESS (street, city, state, ZIP Code)

2B. PHONE NUMBER (Including area code)

2C. E-MAIL ADDRESS

3A. EMPLOYMENT STATUS

EMPLOYED (Complete Item 3B)

UNEMPLOYED (Skip Item 3B)

SELF-EMPLOYED (Skip Item 3B)

STUDENT (Skip Item 3B)

3B. WORK ADDRESS (street, city, state, ZIP Code)

4.DATE OF BIRTH (Month, day, year)

5.PLACE OF BIRTH (City, State, Country)

6. BRANCH OF SERVICE

7. CHARACTER OF DISCHARGE

 

 

8. LIST DATES OF ALL ACTIVE MILITARY SERVICE

9.EMPLOYMENT (Provide information for past five years - use additional sheets if necessary)

A. EMPLOYER NAME AND ADDRESS

B. EMPLOYER PHONE NO.

C. POSITION TITLE

D. EMPLOYMENT

E. NAME OF SUPERVISOR

(street, city, state, ZIP Code)

(Include area code)

DATES

 

(Month/Day/Year)

 

 

 

 

 

 

EXTENSION:

 

 

 

 

 

 

 

 

 

EXTENSION:

 

 

 

EXTENSION:

10.EDUCATION (Provide information for high school graduation and list all colleges or universities attended and degrees received)

A. NAME AND ADDRESS OF INSTITUTION

(street, city, state, ZIP Code)

B. DATES ATTENDED

(Month/Year)

C. DEGREE RECEIVED/MAJOR

VA FORM

21a

PREVIOUS VERSIONS OF THIS FORM WILL NOT BE USED.

APR 2020

 

11A. ARE YOU CURRENTLY A MEMBER IN GOOD

11B. IF "YES," LIST EACH JURISDICTION IN WHICH ADMITTED, THE DATE OF ADMISSION, AND

STANDING OF THE BAR OF THE HIGHEST COURT

MEMBERSHIP OR REGISTRATION NUMBER.

 

OF A STATE OR TERRITORY OF THE UNITED STATES?

 

 

 

 

 

JURISDICTION IN WHICH ADMITTED

DATE OF ADMISSION

MEMBERSHIP OR REGISTRATION NO.

YES

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

12A. ARE YOU CURRENTLY ADMITTED TO PRACTICE

12B. IF "YES," LIST EACH AGENCY OR FEDERAL COURT TO WHICH ADMITTED, THE DATE OF

BEFORE ANY STATE OR FEDERAL AGENCY OR ANY

ADMISSION, AND MEMBERSHIP OR REGISTRATION NUMBER.

 

FEDERAL COURT?

 

 

 

 

 

 

AGENCY IN WHICH ADMITTED

DATE OF ADMISSION

MEMBERSHIP OR REGISTRATION NO.

YES

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

BACKGROUND INFORMATION: Truthfulness and candor are essential elements of good moral character and reputation relevant to practice before the Department

of Veterans Affairs. It is in your best interest; therefore, to provide the Office of the General Counsel with all available information in responding to the questions asked

below. For each question answered "YES," provide a detailed statement setting forth all relevant facts and dates along with copies of relevant documents.

Your responses must be updated as necessary prior to your accreditation. Failure to disclose the requested information may result in denial of accreditation under 38 C.F. R. § 14.629 or in disciplinary proceedings under 38 C.F.R. § 14.633 if you are already accredited.

For questions 13 through 15 your answers should include convictions resulting from a plea of nolo contendere (no contest), but omit (1) traffic fines of $300 or less,

(2) any violation of law committed before your 16th birthday, and (3) any conviction for which the record was expunged under Federal or state law.

13A. HAVE YOU EVER BEEN CONVICTED,

13B. IF "YES," PROVIDE THE DATE, EXPLANATION OF THE VIOLATION, PLACE OF OCCURRENCE, AND THE NAME

IMPRISONED, SENTENCED TO

AND ADDRESS OF THE MILITARY AUTHORITY OR COURT INVOLVED.

PROBATION OR PAROLE?

(Include felonies,

 

firearms or explosives violations, misdemeanors,

 

and all other offenses.)

 

 

YES

NO

 

 

 

14A. HAVE YOU EVER BEEN CONVICTED,

14B. IF "YES," PROVIDE THE DATE, EXPLANATION OF THE VIOLATION, PLACE OF OCCURRENCE, AND THE NAME

BY A MILITARY COURT-MARTIAL? (If no

AND ADDRESS OF THE MILITARY AUTHORITY OR COURT INVOLVED.

military service, answer "NO,")

 

 

YES

NO

 

 

 

15A. ARE YOU NOW UNDER CHARGES

15B. IF "YES," PROVIDE THE DATE, EXPLANATION OF THE VIOLATION, PLACE OF OCCURRENCE, AND THE NAME

FOR ANY VIOLATION OF LAW?

AND ADDRESS OF THE MILITARY AUTHORITY OR COURT INVOLVED.

YES

NO

 

 

 

 

16. HAVE YOU EVER BEEN SUSPENDED, EXPELLED OR ASKED TO RESIGN OR WITHDRAW FROM ANY EDUCATIONAL INSTITUTION, OR HAVE YOU RESIGNED OR WITHDRAWN FROM ANY SUCH INSTITUTION IN TIME TO AVOID DISCIPLINE, SUSPENSION, OR EXPULSION FOR CONDUCT INVOLVING DISHONESTY, FRAUD, MISREPRESENTATION, OR DECEIT?

YESNO

17. HAVE YOU EVER BEEN DISCIPLINED, REPRIMANDED, SUSPENDED OR TERMINATED IN ANY JOB FOR CONDUCT INVOLVING DISHONESTY, FRAUD, MISREPRESENTATION, DECEIT, OR ANY VIOLATION OF FEDERAL OR STATE LAWS OR REGULATIONS?

YESNO

18. HAVE YOU EVER RESIGNED, RETIRED FROM, OR QUIT A JOB WHEN YOU WERE UNDER INVESTIGATION OR INQUIRY FOR CONDUCT WHICH COULD HAVE BEEN CONSIDERED AS INVOLVING DISHONESTY, FRAUD, MISREPRESENTATION, DECEIT, OR VIOLATION OF FEDERAL OR STATE LAWS OR REGULATIONS, OR AFTER RECEIVING NOTICE OR BEING ADVISED OF POSSIBLE INVESTIGATION, INQUIRY, OR DISCIPLINARY ACTION FOR SUCH CONDUCT?

YES

NO

 

19. HAVE YOU EVER FUNCTIONED AS A REPRESENTATIVE, AGENT, OR ATTORNEY BEFORE A STATE OR FEDERAL DEPARTMENT OR AGENCY?

YES

NO

VA FORM 21a, APR 2020, PAGE 2

PREVIOUS VERSIONS OF THIS FORM WILL NOT BE USED.

20. HAVE YOU EVER BEEN REPRIMANDED, SUSPENDED, OR BARRED FROM PRACTICE BEFORE ANY COURT, BAR, OR FEDERAL OR STATE

AGENCY, OR HAVE YOU RESIGNED MEMBERSHIP IN THE BAR OF ANY COURT, OR FEDERAL OR STATE AGENCY TO AVOID REPRIMAND, SUSPENSION, OR DISBARMENT FOR CONDUCT INVOLVING DISHONESTY, FRAUD, MISREPRESENTATION, OR DECEIT?

YESNO

21.HAVE YOU EVER APPLIED FOR ACCREDITATION BY THE DEPARTMENT OF VETERANS AFFAIRS AS A REPRESENTATIVE OF A VETERANS SERVICE ORGANIZATION, AGENT, OR ATTORNEY?

YESNO

22.IF YOU WERE PREVIOUSLY ACCREDITED AS A REPRESENTATIVE OF A VETERANS SERVICE ORGANIZATION, WAS THAT ACCREDITATION TERMINATED OR SUSPENDED AT THE REQUEST OF THE ORGANIZATION?

YESNO

23A. DO YOU HAVE ANY CONDITION OR IMPAIRMENT (SUCH AS SUBSTANCE ABUSE, ALCOHOL ABUSE, OR A MENTAL, EMOTIONAL, NERVOUS, OR BEHAVIORAL DISORDER OR CONDITION) THAT IN ANY WAY CURRENTLY AFFECTS, OR, IF UNTREATED OR NOT OTHERWISE ACTIVELY MANAGED, COULD AFFECT YOUR ABILITY TO REPRESENT CLAIMANTS IN A COMPETENT AND PROFESSIONAL MANNER?

YESNO

23B. IF YOU ANSWERED "YES," TO ITEM 23A, PLEASE DESCRIBE THE CONDITION OR IMPAIRMENT, AND ANY TREATMENT YOU RECEIVED IN THE PAST YEAR OR RECEIVE NOW. IF YOU HAVE BEEN UNDER THE CARE OR SUPERVISION OF A HEALTH-CARE PROFESSIONAL, SUBMIT A STATEMENT BY THE HEALTH-CARE PROFESSIONAL SPECIFYING YOUR CURRENT DIAGNOSIS, TREATMENT REGIMEN, AND PROGNOSIS, AND ITS BEARING ON YOUR FITNESS TO REPRESENT CLAIMANTS BEFORE THE DEPARTMENT OF VETERANS AFFAIRS.

24A.

DO YOU HAVE ANY PHYSICAL LIMITATIONS WHICH WOULD INTERFERE WITH YOUR COMPLETION OF A WRITTEN EXAMINATION ADMINISTERED UNDER

THE SUPERVISION OF A VA DISTRICT COUNSEL (Claims agent applicants only) ?

 

YES

NO

 

 

24B.

IF "YES," PLEASE STATE THE NATURE OF SUCH LIMITATIONS AND PROVIDE DETAILS OF ANY SPECIAL ACCOMMODATIONS DEEMED NECESSARY.

25. CHARACTER REFERENCES

(Please provide the full names, addresses, and current phone numbers of three individuals who are not immediate family members and who have personal knowledge of your character and qualifications to serve as a claims agent or attorney.)

NAME

ADDRESS

PHONE NUMBER (Include area code)

RELATIONSHIP TO

APPLICANT

EXTENSION:

EXTENSION:

EXTENSION:

CERTIFICATION: I CERTIFY THAT the statements and entries on this form are true and correct. (A willfully false statement or certification is a criminal offense and is punishable by law [18 U.S.C. 1001]).

SIGNATURE OF APPLICANT (Ink Signature)

DATE SIGNED

VA FORM 21a, APR 2020, PAGE 3

PREVIOUS VERSIONS OF THIS FORM WILL NOT BE USED.

PRIVACY ACT INFORMATION: The information requested on this form is solicited under Section 5904, Title 38, United States Code and Section 14.629(b) of Title 38, Code of Federal Regulations. It will enable VA to determine initial eligibility for accreditation as a claims agent or attorney to represent claimants before VA. Any information on this form may be disclosed outside VA only if authorized under the Privacy Act, including the routine uses identified in the VA system of records, 01VA022, Accreditation Records--VA, published in the Federal Register. Routine disclosures may be made for the following purposes: civil or criminal law enforcement or investigation; congressional communications; communications relevant to the delivery of VA benefits; verification of identity and status; litigation conducted by the Department of Justice; and communication with employing entities and governmental licensing organizations concerning information relevant to employment or licensing of a prospective, present, or former representative, claims agent or attorney. Providing the requested information is voluntary; however, failure to furnish information may delay or prevent action on the application.

RESPONDENT BURDEN: VA may not conduct or sponsor, and respondent is not required to respond to this collection of information unless it displays a valid OMB Control Number. Public reporting burden for this collection of information is estimated to average 45 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. If you have comments regarding this burden estimate or any other aspect of this collection of information send your comments to VA Clearance Officer (005R1B), 810 Vermont Avenue, NW, Washington, D.C. 20420. Please do not send applications for accreditation to this address.

VA FORM 21a, APR 2020, PAGE 4

PREVIOUS VERSIONS OF THIS FORM WILL NOT BE USED.
Get Va 21A PDF Form

Form Characteristics

Fact Name Detail
Form Approval The VA Form 21A is approved by the Office of Management and Budget (OMB) and carries the approval number 2900-0605.
Expiration Date This form's expiration date is March 31, 2022.
Respondent Burden It typically takes about 45 minutes to complete this application.
Application Purpose This form is for individuals seeking accreditation as claims agents or attorneys to represent veterans before the Department of Veterans Affairs.
Submission Address Completed applications should be sent to the Department of Veterans Affairs, Office of the General Counsel, at 810 Vermont Avenue, NW, Washington, D.C. 20420.
Exam Requirement Claims agent applicants must achieve a minimum score of 75% on a VA-administered exam for accreditation.
Attorney Requirements Attorneys need to be in good standing with a state bar but do not take the VA exam for accreditation.
Legal Governance This form is governed by 38 C.F.R. § 14.629 and 38 C.F.R. § 14.633 regarding disclosures and disciplinary proceedings.
Privacy Act Information The information collected is under Section 5904, Title 38, U.S. Code, and is subject to Privacy Act regulations concerning disclosure.

Guidelines on Utilizing Va 21A

Filling out the VA Form 21A is a straightforward process, but attention to detail is essential. Ensure that all necessary information is complete and accurate. Once you finish the form, you'll submit it to the appropriate department for processing. An incomplete application may lead to delays in your accreditation.

  1. Enter your name: Fill in your last name, first name, and middle name.
  2. Provide your home address: Include street, city, state, and ZIP code.
  3. List your phone number: Ensure to include the area code.
  4. Input your email address: Make sure the email is active and correct.
  5. Indicate your employment status: Choose one from employed, unemployed, self-employed, or student. If employed, complete the next step.
  6. If employed, include your work address: Provide the street, city, state, and ZIP code.
  7. Enter your date of birth: Use the format of month, day, and year.
  8. State your place of birth: Include the city, state, and country.
  9. Specify your branch of service.
  10. Describe your character of discharge.
  11. List all active military service dates: Include start and end dates.
  12. Detail your employment over the past five years: Provide employer name, address, phone number, position title, employment dates, and supervisor’s name and address.
  13. Fill out your education history: Provide details of high school graduation, colleges or universities attended, and degrees obtained.
  14. Answer membership questions: Indicate if you are currently a member in good standing in any State bar.
  15. Answer admission questions: Include if you are currently admitted to practice before any agency or federal court.
  16. Respond to background questions: Answer all questions 13-23 honestly, providing additional details where required.
  17. Provide character references: List three individuals with their names, addresses, phone numbers, and relationship to you.
  18. Certification: Sign and date the form, certifying that the information provided is true and correct.

After completing these steps, ensure to review your application for any errors before submitting it to the Department of Veterans Affairs, Office of the General Counsel.

What You Should Know About This Form

What is the purpose of the VA 21A form?

The VA 21A form is an application for accreditation as a claims agent or attorney who can represent claimants before the Department of Veterans Affairs. It requires personal and employment data from the applicant, along with detailed responses to several questions regarding their background. This form plays a critical role in establishing the eligibility and suitability of applicants for accreditation, ensuring that individuals who wish to assist veterans in their claims possess the necessary character and qualifications.

What information do I need to provide on the VA 21A form?

Applicants must fill out a variety of personal details on the VA 21A form. Information required includes names, contact information, employment status, and relevant military service details. Additionally, applicants must disclose their employment history for the past five years, educational backgrounds, and any prior legal or disciplinary actions. It is essential to answer all questions thoroughly and truthfully, as any omissions can affect the processing of the application.

Are there specific qualifications I must meet to be accredited?

Yes, there are different qualifications for claims agent applicants and attorney applicants. Claims agents must achieve a score of 75 percent or higher on a written examination administered by the VA as a prerequisite for accreditation. They will receive instructions for exam scheduling upon initial eligibility determination. Conversely, attorney applicants must be members in good standing with a state bar but are not required to take an examination. Such distinctions emphasize the varying requirements tailored to different roles within the accreditation process.

What happens if I fail to provide required information on the VA 21A form?

Incompleteness or lack of necessary signatures on the VA 21A form can lead to delays or potential denial of the application. Unsigned or incomplete applications will not be processed, which underlines the importance of providing comprehensive and accurate information. Therefore, to facilitate a smooth accreditation process, applicants should ensure that every section of the form is filled out and that all questions are answered to the best of their ability.

Common mistakes

Filling out the VA Form 21A requires attention to detail. One common mistake people make is failing to provide a complete and accurate home address. Incomplete or inaccurate addresses can lead to delays in processing applications and may hinder communication with the Department of Veterans Affairs.

Another mistake is neglecting to sign the application. Unsigned applications cannot be processed, leading to frustration and potential delays in accreditation. Applicants should double-check to ensure that they have signed and dated the form, as required.

Many applicants also overlook providing a comprehensive employment history. The application requires detailed information about employment for the past five years, including employer names, addresses, and positions held. Missing this information can result in an application being considered incomplete.

Additionally, applicants sometimes forget to disclose required background information. It is crucial to answer questions regarding criminal history and any disciplinary actions candidly. Providing incomplete or misleading information could lead to disqualification for accreditation.

Another frequent error involves the education section of the form. Applicants may forget to include all relevant educational institutions attended, along with degrees received. Thoroughly documenting educational history can help establish qualifications for the position.

Some applicants misinterpret the requirements for character references. Providing insufficient details about the referees or not including three suitable references can jeopardize the application process. It’s essential to choose individuals who can speak directly to both character and qualifications.

Finally, applicants often skip reading the form's instructions entirely. Thoroughly understanding the requirements before filling out the form is vital. Doing so can significantly reduce the likelihood of common mistakes and lead to a smoother application process.

Documents used along the form

The VA Form 21A is a critical document for individuals seeking accreditation as claims agents or attorneys to represent clients before the Department of Veterans Affairs. However, it is often accompanied by other forms and documents that provide essential supplementary information. Understanding these additional documents can help streamline the accreditation process.

  • VA Form 21-22: This form designates an individual as a representative for a claimant. It allows authorized agents to help veterans and their families navigate the benefits system, ensuring they receive the assistance needed for successful claims.
  • VA Form 21-534: Used specifically by surviving spouses and children, this form applies for dependency and indemnity compensation or death pension benefits. It helps ensure that the family of a deceased veteran can access critical financial support.
  • VA Form 21-526EZ: This is the application used by veterans to apply for disability compensation. When submitted alongside the VA Form 21A, it helps establish the claims agent's role in assisting veterans with their applications to secure benefits.
  • VA Form 21-4138: Often referred to as the "Statement in Support of Claim," this form allows veterans to provide additional details in support of their claims. Claims agents may help gather and submit these statements to strengthen the case presented to the VA.

Each of these forms serves a unique purpose in the broader context of a veteran's claim for benefits. Being aware of them can facilitate a more efficient process for both the applicants and their representatives as they work through the intricacies of the VA system.

Similar forms

  • VA Form 21-526EZ: This form is used for applying for disability compensation benefits. Like the VA 21A, it requires personal information and specifics about the applicant's military service and health conditions.
  • VA Form 10-10EZ: This application is for health care benefits. Similar to the VA 21A, it asks for details about the applicant's military background and personal identification.
  • VA Form 21-8951: This form is used for beneficiaries already receiving compensation and need to request a change. Both forms require thorough personal and employment information to process the requests correctly.
  • VA Form 21-4192: This is the Request for Employment Information in Connection with Claim for Disability Benefits. Like the VA 21A, it needs employer details and information about the applicant's employment history to evaluate claims.
  • VA Form 21-0781: This is the Statement in Support of Claim for Service Connection for PTSD. Similar to the VA 21A, it requires detailed background information regarding service-related issues and personal circumstances.

Dos and Don'ts

When filling out the VA 21A form, here are five important things to do and avoid:

  • Do carefully read each question before answering to ensure you understand what is being asked.
  • Don't leave any questions unanswered. Incomplete applications will not be processed.
  • Do provide truthful and complete information, especially regarding any legal issues or past conduct.
  • Don't skip the signature and date at the end of the application; an unsigned form will lead to delays.
  • Do attach any necessary supplementary pages if you need more space to answer questions.

Misconceptions

Misconception 1: The VA 21A form is only for attorneys.

This form is designed for both claims agents and attorneys seeking accreditation to represent claimants before the Department of Veterans Affairs. Claims agents must take a written exam, while attorneys do not need to take this exam if they are in good standing with a state bar.

Misconception 2: Unsigned applications will be processed anyway.

All applications must be signed and completed to be processed. If a form is unsigned or lacks necessary information, it will be returned without any action taken.

Misconception 3: You only need to provide basic information.

The application requires detailed personal, employment, and background information. This includes answers to questions regarding criminal history and military service. Incomplete information may lead to delays or denial of accreditation.

Misconception 4: The VA does not check the truthfulness of your application.

Truthfulness is essential when filling out the VA 21A form. Inaccurate or misleading information can affect your accreditation and may lead to disciplinary action if you are already accredited.

Key takeaways

Here are some key takeaways regarding filling out and using the VA Form 21A:

  • Complete All Sections: Ensure that every applicable section of the form is filled out completely. Incomplete or unsigned applications will not be processed.
  • Truthfulness is Crucial: Honesty is required when disclosing background information. Failing to provide all relevant facts can negatively impact your accreditation.
  • Education and Employment Details: List your education history and employment for the last five years accurately. Attach additional sheets if needed.
  • Examination Requirements for Claims Agents: If applying as a claims agent, be prepared to pass a written examination with a score of at least 75% after your character and fitness assessment.
  • Submission Instructions: Mail your completed application to the Department of Veterans Affairs, Office of the General Counsel at the specified address in Washington, D.C.

It is in your best interest to follow these steps carefully to ensure a smooth application process.

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