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About VA Form 21-4502

Form name: Application for Automobile or Other Conveyance and Adaptive Equipment (UNDER 38 U.S.C. 3901-3904)
Related to: Disability
Form last updated: April 3, 2019

When to use this form

Use VA Form 21-4502 if you’re a Veteran with a disability and you want to apply for compensation for a vehicle that meets your needs. This may include a specially equipped vehicle for you to drive or adaptive equipment to help you get in and out of your vehicle.

Downloadable PDF

Download VA Form 21-4502 (PDF)
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