Skip to Content
Learn what the PACT Act means for your VA benefits

About VA Form 21-22a

Form name: Appointment of Individual As Claimant's Representative
Related to: Burials and memorials, Careers and employment, Disability, Education and training, Family member benefits, Health care, Housing assistance, Life insurance, Pension, Service member benefits
Form last updated: June 2022

When to use this form

If you want to have an individual help you with your claim or benefits, have that person complete and submit this form.

Downloadable PDF

Download VA Form 21-22a (PDF)