Application for Automobile or Other Conveyance and Adaptive Equipment (Under 38 U.S.C. 3901-3904) (VA Form 21-4502)

OMB 2900-0067

VA Form 21-4502 is used to gather information that is necessary to determine the entitlement of veterans and servicepersons to automobile and adaptive equipment benefits. Without this information, VA would be unable to properly authorize benefits. VA Form 21-4502 is being revised to include new standardization data points; to include optical character recognition boxes. This is a non-substantive change.

The latest form for Application for Automobile or Other Conveyance and Adaptive Equipment (Under 38 U.S.C. 3901-3904) (VA Form 21-4502) expires 2021-03-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form 21-4502 Application for Automobile or Other Conveyance and Adaptive Equipment (Under 38 U.S.C. 3901-3904) (VA Form 21-4502) Form
30-Day FRN - 2900-0067 (2024).pdf Supplementary Document
2024-09728, 60-Day FRN (2900-0067), VAF21-4502.pdf Supplementary Document
2900-0067, Supporting Statement (VAF21-4502).docx Supporting Statement A
Application for Automobile or Other Conveyance and Adaptive Equipment (Under 38 U.S.C. 3901-3904) (VA Form 21-4502) Form

All Historical Document Collections

202404-2900-002 Approved with change	Revision of a currently approved collection	2024-07-16
202009-2900-022 Approved without change	Reinstatement with change of a previously approved collection	2021-06-03
201712-2900-004 Approved without change	Extension without change of a currently approved collection	2017-12-07
201408-2900-015 Approved without change	Revision of a currently approved collection	2014-10-15
201404-2900-013 Withdrawn and continue	Revision of a currently approved collection	2014-07-30
201401-2900-007 Withdrawn and continue	Revision of a currently approved collection	2014-02-28
201309-2900-008 Withdrawn and continue	Revision of a currently approved collection	2013-09-19
201107-2900-005 Approved without change	Extension without change of a currently approved collection	2011-10-06
200802-2900-008 Approved without change	Extension without change of a currently approved collection	2008-08-22
200511-2900-010 Approved without change	Extension without change of a currently approved collection	2005-11-18
200211-2900-007 Approved without change	Extension without change of a currently approved collection	2002-11-08
200003-2900-009 Approved without change	Extension without change of a currently approved collection	2000-03-20
199701-2900-004 Approved without change	Extension without change of a currently approved collection	1997-01-24
199311-2900-009 Approved without change	Extension without change of a currently approved collection	1993-11-08
199012-2900-001 Approved without change	Revision of a currently approved collection	1990-12-03
198711-2900-006 Approved without change	Extension without change of a currently approved collection	1987-11-23
198501-2900-004 Approved without change	Reinstatement with change of a previously approved collection	1985-01-02
198112-2900-006 Approved without change	Revision of a currently approved collection	1981-12-30
198101-2900-021 Approved with change	No material or nonsubstantive change to a currently approved collection	1981-01-22
197703-2900-007 Approved without change	Revision of a currently approved collection	1977-03-31
197510-2900-012 Approved without change	Revision of a currently approved collection	1975-10-14
197502-2900-004 Approved without change	Revision of a currently approved collection	1975-02-07