Manage Your Representative for VA Claims

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Let's Pre-Fill Your Form

To conveniently pre-fill a downloadable form with this representative's information and more, please answer the following questions.

If you don't want to do that, another option is to download a blank form and fill it out manually. Blank forms are available at the bottom of this page after closing this popup window.

Are you separated from the military?


Your Current Mailing Address

Is this your current mailing address?

Don't worry, you don't have to correct your address to continue. To update your address at a later time, go to the VA/DoD eBenefits dashboard and use the Update Personal Contact Information for DEERS and VA Outreach feature.

Are you also the Claimant?

Download Your Form

The following form may contain Personally Identifiable Information (PII):

Print and complete one (1) copy of the VA Form 21-22a. Mail or hand-deliver it to either your servicing VA regional office or your agent, attorney, or non-licensed individual representative to submit on your behalf. Find the address of your local VA regional office.

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