Appointment of Veterans Service Organization as Claimant's Representative 'and' Appointment of Individual as Claimant's Representative

Appointment of Veterans Service Organization as Claimant's Representative (VA Form 21-22) and Appointment of Individual as Claimant's Representative (VA Forms 21-22a)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0321 can be found here:

Documents and Forms

Document Name Document Type
Form VA Form 21-22 Appointment of Veterans Service Organization as Claimant's Representative 'and' Appointment of Individual as Claimant's Representative Form
VA Form 21-22 Appointment of Veterans Service Organization as Claimant 21-22(6-1-2018).pdf www.va.gov/vaforms Form
VA Form 21-22A Appointment of Individual as Claimant's Representative 21-22A(6-1-18).pdf www.va.gov/vaforms Form

Information Collection (IC) Details

IC Title:	Appointment of Veterans Service Organization as Claimant's Representative 'and' Appointment of Individual as Claimant's Representative	Agency IC Tracking Number:	2900-0321

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 38 CFR 14.631 38 CFR 1.525

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	VA Form 21-22	Appointment of Veterans Service Organization as Claimant's Representative	21-22(6-1-2018).pdf	www.va.gov/vaforms	Yes	No	Fillable Printable
Form	VA Form 21-22A	Appointment of Individual as Claimant's Representative	21-22A(6-1-18).pdf	www.va.gov/vaforms	Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records
Title: 58VA21/22/28 Compensation, Pension, Education, Vocational Rehabilitation and Employment Records	FR Citation: 77 FR 42593

Number of Respondents: 319,005	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	319,005	-12,395	331,400
Annual IC Time Burden (Hours)	26,583	-1,033	27,616
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.