The VA 21A form is a crucial document designed for individuals seeking accreditation as claims agents or attorneys with the Department of Veterans Affairs. It collects comprehensive personal and employment data, in addition to requiring complete answers to specific questions related to an applicant's eligibility and fitness for the role. Interested professionals must provide all requested information accurately, adhering to guidelines to ensure the process leads to their potential accreditation. Begin the journey towards helping veterans by clicking the button below to fill out your VA 21A form.
The VA Form 21a serves a pivotal function in the accreditation process for individuals aspiring to represent veterans as claims agents or attorneys. This detailed form seeks various pieces of information, encompassing personal and employment data, alongside probing questions about the applicant's history and character. Applicants are required to disclose their educational background, employment history for the past five years, and any military service, including character of discharge and service dates. A significant aspect of the form is the evaluation of the applicant's moral character and fitness for practice before the VA, underscored by questions about legal convictions, military court-martial convictions, and any charges or investigations related to violations of law. Additionally, lawyers must confirm their good standing with a state bar, while claims agent applicants must pass a written examination by the VA, supporting the thorough vetting process to ensure competent and trustworthy representation of veterans. The procedure highlights the importance of truthfulness, as failure to provide complete and accurate information might result in denied accreditation or subsequent disciplinary action. This form underscores the stringent standards set by the Department of Veterans Affairs to safeguard the interests of veterans seeking claims assistance.
Form Approved, OMB No. 2900-0605
Expiration Date: Mar. 31, 2022
Respondent Burden: 45 minutes
APPLICATION FOR ACCREDITATION AS A CLAIMS AGENT OR ATTORNEY
INSTRUCTIONS: Please provide the applicable personal and employment data, then read each question and provide complete answers to all questions that apply to you. If additional space is needed, please attach a supplementary page(s). After providing all of the requested information, sign and date your application. Unsigned or incomplete applications will not be processed. Send completed applications to: Department of Veterans Affairs, Office of the General Counsel (022D), 810 Vermont Avenue, NW, Washington, D.C. 20420. After an affirmative determination of character and fitness for practice before VA, claims agent applicants must achieve a score of 75 percent or more on a written examination administered by VA as a prerequisite to accreditation. Claims agent applicants will be given written instructions for arranging to take the examination if initial eligibility is established. Attorney applicants must be in good standing with a State bar and are not required to take an examination administered by VA as a prerequisite to accreditation.
1. LAST NAME - FIRST NAME - MIDDLE NAME
2A. HOME ADDRESS (street, city, state, ZIP Code)
2B. PHONE NUMBER (Including area code)
2C. E-MAIL ADDRESS
3A. EMPLOYMENT STATUS
EMPLOYED (Complete Item 3B)
UNEMPLOYED (Skip Item 3B)
SELF-EMPLOYED (Skip Item 3B)
STUDENT (Skip Item 3B)
3B. WORK ADDRESS (street, city, state, ZIP Code)
4.DATE OF BIRTH (Month, day, year)
5.PLACE OF BIRTH (City, State, Country)
6. BRANCH OF SERVICE
7. CHARACTER OF DISCHARGE
8. LIST DATES OF ALL ACTIVE MILITARY SERVICE
9.EMPLOYMENT (Provide information for past five years - use additional sheets if necessary)
A. EMPLOYER NAME AND ADDRESS
B. EMPLOYER PHONE NO.
C. POSITION TITLE
D. EMPLOYMENT
E. NAME OF SUPERVISOR
(street, city, state, ZIP Code)
(Include area code)
DATES
(Month/Day/Year)
EXTENSION:
10.EDUCATION (Provide information for high school graduation and list all colleges or universities attended and degrees received)
A. NAME AND ADDRESS OF INSTITUTION
B. DATES ATTENDED
(Month/Year)
C. DEGREE RECEIVED/MAJOR
VA FORM
21a
PREVIOUS VERSIONS OF THIS FORM WILL NOT BE USED.
APR 2020
11A. ARE YOU CURRENTLY A MEMBER IN GOOD
11B. IF "YES," LIST EACH JURISDICTION IN WHICH ADMITTED, THE DATE OF ADMISSION, AND
STANDING OF THE BAR OF THE HIGHEST COURT
MEMBERSHIP OR REGISTRATION NUMBER.
OF A STATE OR TERRITORY OF THE UNITED STATES?
JURISDICTION IN WHICH ADMITTED
DATE OF ADMISSION
MEMBERSHIP OR REGISTRATION NO.
YES
NO
12A. ARE YOU CURRENTLY ADMITTED TO PRACTICE
12B. IF "YES," LIST EACH AGENCY OR FEDERAL COURT TO WHICH ADMITTED, THE DATE OF
BEFORE ANY STATE OR FEDERAL AGENCY OR ANY
ADMISSION, AND MEMBERSHIP OR REGISTRATION NUMBER.
FEDERAL COURT?
AGENCY IN WHICH ADMITTED
BACKGROUND INFORMATION: Truthfulness and candor are essential elements of good moral character and reputation relevant to practice before the Department
of Veterans Affairs. It is in your best interest; therefore, to provide the Office of the General Counsel with all available information in responding to the questions asked
below. For each question answered "YES," provide a detailed statement setting forth all relevant facts and dates along with copies of relevant documents.
Your responses must be updated as necessary prior to your accreditation. Failure to disclose the requested information may result in denial of accreditation under 38 C.F. R. § 14.629 or in disciplinary proceedings under 38 C.F.R. § 14.633 if you are already accredited.
For questions 13 through 15 your answers should include convictions resulting from a plea of nolo contendere (no contest), but omit (1) traffic fines of $300 or less,
(2) any violation of law committed before your 16th birthday, and (3) any conviction for which the record was expunged under Federal or state law.
13A. HAVE YOU EVER BEEN CONVICTED,
13B. IF "YES," PROVIDE THE DATE, EXPLANATION OF THE VIOLATION, PLACE OF OCCURRENCE, AND THE NAME
IMPRISONED, SENTENCED TO
AND ADDRESS OF THE MILITARY AUTHORITY OR COURT INVOLVED.
PROBATION OR PAROLE?
(Include felonies,
firearms or explosives violations, misdemeanors,
and all other offenses.)
14A. HAVE YOU EVER BEEN CONVICTED,
14B. IF "YES," PROVIDE THE DATE, EXPLANATION OF THE VIOLATION, PLACE OF OCCURRENCE, AND THE NAME
BY A MILITARY COURT-MARTIAL? (If no
military service, answer "NO,")
15A. ARE YOU NOW UNDER CHARGES
15B. IF "YES," PROVIDE THE DATE, EXPLANATION OF THE VIOLATION, PLACE OF OCCURRENCE, AND THE NAME
FOR ANY VIOLATION OF LAW?
16. HAVE YOU EVER BEEN SUSPENDED, EXPELLED OR ASKED TO RESIGN OR WITHDRAW FROM ANY EDUCATIONAL INSTITUTION, OR HAVE YOU RESIGNED OR WITHDRAWN FROM ANY SUCH INSTITUTION IN TIME TO AVOID DISCIPLINE, SUSPENSION, OR EXPULSION FOR CONDUCT INVOLVING DISHONESTY, FRAUD, MISREPRESENTATION, OR DECEIT?
YESNO
17. HAVE YOU EVER BEEN DISCIPLINED, REPRIMANDED, SUSPENDED OR TERMINATED IN ANY JOB FOR CONDUCT INVOLVING DISHONESTY, FRAUD, MISREPRESENTATION, DECEIT, OR ANY VIOLATION OF FEDERAL OR STATE LAWS OR REGULATIONS?
18. HAVE YOU EVER RESIGNED, RETIRED FROM, OR QUIT A JOB WHEN YOU WERE UNDER INVESTIGATION OR INQUIRY FOR CONDUCT WHICH COULD HAVE BEEN CONSIDERED AS INVOLVING DISHONESTY, FRAUD, MISREPRESENTATION, DECEIT, OR VIOLATION OF FEDERAL OR STATE LAWS OR REGULATIONS, OR AFTER RECEIVING NOTICE OR BEING ADVISED OF POSSIBLE INVESTIGATION, INQUIRY, OR DISCIPLINARY ACTION FOR SUCH CONDUCT?
19. HAVE YOU EVER FUNCTIONED AS A REPRESENTATIVE, AGENT, OR ATTORNEY BEFORE A STATE OR FEDERAL DEPARTMENT OR AGENCY?
VA FORM 21a, APR 2020, PAGE 2
20. HAVE YOU EVER BEEN REPRIMANDED, SUSPENDED, OR BARRED FROM PRACTICE BEFORE ANY COURT, BAR, OR FEDERAL OR STATE
AGENCY, OR HAVE YOU RESIGNED MEMBERSHIP IN THE BAR OF ANY COURT, OR FEDERAL OR STATE AGENCY TO AVOID REPRIMAND, SUSPENSION, OR DISBARMENT FOR CONDUCT INVOLVING DISHONESTY, FRAUD, MISREPRESENTATION, OR DECEIT?
21.HAVE YOU EVER APPLIED FOR ACCREDITATION BY THE DEPARTMENT OF VETERANS AFFAIRS AS A REPRESENTATIVE OF A VETERANS SERVICE ORGANIZATION, AGENT, OR ATTORNEY?
22.IF YOU WERE PREVIOUSLY ACCREDITED AS A REPRESENTATIVE OF A VETERANS SERVICE ORGANIZATION, WAS THAT ACCREDITATION TERMINATED OR SUSPENDED AT THE REQUEST OF THE ORGANIZATION?
23A. DO YOU HAVE ANY CONDITION OR IMPAIRMENT (SUCH AS SUBSTANCE ABUSE, ALCOHOL ABUSE, OR A MENTAL, EMOTIONAL, NERVOUS, OR BEHAVIORAL DISORDER OR CONDITION) THAT IN ANY WAY CURRENTLY AFFECTS, OR, IF UNTREATED OR NOT OTHERWISE ACTIVELY MANAGED, COULD AFFECT YOUR ABILITY TO REPRESENT CLAIMANTS IN A COMPETENT AND PROFESSIONAL MANNER?
23B. IF YOU ANSWERED "YES," TO ITEM 23A, PLEASE DESCRIBE THE CONDITION OR IMPAIRMENT, AND ANY TREATMENT YOU RECEIVED IN THE PAST YEAR OR RECEIVE NOW. IF YOU HAVE BEEN UNDER THE CARE OR SUPERVISION OF A HEALTH-CARE PROFESSIONAL, SUBMIT A STATEMENT BY THE HEALTH-CARE PROFESSIONAL SPECIFYING YOUR CURRENT DIAGNOSIS, TREATMENT REGIMEN, AND PROGNOSIS, AND ITS BEARING ON YOUR FITNESS TO REPRESENT CLAIMANTS BEFORE THE DEPARTMENT OF VETERANS AFFAIRS.
24A.
DO YOU HAVE ANY PHYSICAL LIMITATIONS WHICH WOULD INTERFERE WITH YOUR COMPLETION OF A WRITTEN EXAMINATION ADMINISTERED UNDER
THE SUPERVISION OF A VA DISTRICT COUNSEL (Claims agent applicants only) ?
24B.
IF "YES," PLEASE STATE THE NATURE OF SUCH LIMITATIONS AND PROVIDE DETAILS OF ANY SPECIAL ACCOMMODATIONS DEEMED NECESSARY.
25. CHARACTER REFERENCES
(Please provide the full names, addresses, and current phone numbers of three individuals who are not immediate family members and who have personal knowledge of your character and qualifications to serve as a claims agent or attorney.)
NAME
ADDRESS
PHONE NUMBER (Include area code)
RELATIONSHIP TO
APPLICANT
CERTIFICATION: I CERTIFY THAT the statements and entries on this form are true and correct. (A willfully false statement or certification is a criminal offense and is punishable by law [18 U.S.C. 1001]).
SIGNATURE OF APPLICANT (Ink Signature)
DATE SIGNED
VA FORM 21a, APR 2020, PAGE 3
PRIVACY ACT INFORMATION: The information requested on this form is solicited under Section 5904, Title 38, United States Code and Section 14.629(b) of Title 38, Code of Federal Regulations. It will enable VA to determine initial eligibility for accreditation as a claims agent or attorney to represent claimants before VA. Any information on this form may be disclosed outside VA only if authorized under the Privacy Act, including the routine uses identified in the VA system of records, 01VA022, Accreditation Records--VA, published in the Federal Register. Routine disclosures may be made for the following purposes: civil or criminal law enforcement or investigation; congressional communications; communications relevant to the delivery of VA benefits; verification of identity and status; litigation conducted by the Department of Justice; and communication with employing entities and governmental licensing organizations concerning information relevant to employment or licensing of a prospective, present, or former representative, claims agent or attorney. Providing the requested information is voluntary; however, failure to furnish information may delay or prevent action on the application.
RESPONDENT BURDEN: VA may not conduct or sponsor, and respondent is not required to respond to this collection of information unless it displays a valid OMB Control Number. Public reporting burden for this collection of information is estimated to average 45 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. If you have comments regarding this burden estimate or any other aspect of this collection of information send your comments to VA Clearance Officer (005R1B), 810 Vermont Avenue, NW, Washington, D.C. 20420. Please do not send applications for accreditation to this address.
VA FORM 21a, APR 2020, PAGE 4
Filling out the VA 21A form is an essential step for aspiring claims agents or attorneys who wish to represent claimants before the Department of Veterans Affairs. This detailed form requests a variety of information, ranging from personal and employment data to background questions. It's designed to assess your qualifications, character, and fitness for the role of a claims agent or attorney. Completing this form meticulously is crucial to ensure your application progresses smoothly. Here’s a step-by-step guide to help you navigate through the form:
Upon completing and reviewing your application for accuracy and completeness, send it to the Department of Veterans Affairs, Office of the General Counsel, at the address provided on the form. Following an initial eligibility assessment, claims agent applicants may be required to pass a written examination, while attorney applicants must verify their good standing with a state bar. This rigorous process ensures that only qualified individuals represent claimants in matters before the Department of Veterans Affairs.
What is the VA Form 21A and who needs to fill it out?
The VA Form 21A, officially titled "Application for Accreditation as a Claims Agent or Attorney," is a detailed document that individuals must complete if they wish to become accredited to legally represent Veterans in their claims for VA benefits. This accreditation is mandatory for anyone who wants to prepare, present, or prosecute claims before the Department of Veterans Affairs (VA). Claims agents and attorneys, who play a critical role in assisting Veterans to navigate through the complexities of VA claims, must fill out this form. It requires personal, educational, and professional information and includes checks for character and fitness for the practice before the VA. Attorneys have to be in good standing with their state bar but do not need to take a VA-administered exam, unlike claims agent applicants who do require testing following an initial eligibility confirmation.
How does one submit the VA Form 21A?
Upon completing the VA Form 21A, including answering all applicable questions and attaching any additional required details, the form should be signed and dated. An incomplete or unsigned application will not be processed. The completed form must be sent to the Department of Veterans Affairs, Office of the General Counsel (022D), at 810 Vermont Avenue, NW, Washington, D.C. 20420. It is crucial to provide complete and accurate information to avoid delays or denial in the accreditation process.
What happens after submitting the VA Form 21A?
After submission, the application undergoes a review for an affirmative determination of character and fitness by the VA. For claims agent applicants who establish initial eligibility, the next step is achieving a score of 75 percent or more on a written examination administered by the VA. Successful attorney applicants, who must be in good standing with a state bar, are not required to take this examination. Final accreditation allows the individual to legally represent Veterans in their claims for VA benefits.
Are there any fees associated with the accreditation process after submitting VA Form 21A?
The VA Form 21A does not mention any fees required for submitting the application or for the accreditation process itself. However, it is important for applicants to stay informed about any updates or changes to this process by consulting the VA’s Office of the General Counsel or its website. Keep in mind that while the VA does not charge for accreditation, preparing for and taking any required examination (for claims agents) could incur costs related to study materials or courses.
What should an applicant do if they have a history of legal or employment issues?
The VA places a high importance on truthfulness and candor throughout the application process. Applicants with a history of convictions, military court-martials, unresolved legal charges, or disciplinary actions in education or employment are required to disclose this information on the form. They must provide a detailed statement of all relevant facts and dates, along with copies of relevant documents. Failure to disclose such information could result in denial of accreditation or disciplinary action if accreditation has already been granted. It is in the applicant's best interest to provide thorough and honest responses to ensure a fair assessment by the VA.
Filling out the VA Form 21a, the application for accreditation as a claims agent or attorney, can be a meticulous process that requires attention to detail. Applicants often make mistakes that can lead to delays or the outright denial of their application. Understanding these common pitfalls can help ensure the application process goes smoothly.
One widespread mistake involves providing incomplete information. The VA Form 21a asks for detailed responses to questions related to personal and employment data, military service, education, and more. Failing to provide comprehensive answers, or skipping sections that applicants mistakenly believe do not apply to them, can stall the process. The Department of Veterans Affairs emphasizes the importance of completeness, designing the form to gather essential information to verify an applicant’s eligibility and qualifications.
Another error occurs with the background information section. Applicants should approach questions 13 through 15, which inquire about convictions, military court-martials, and current charges, with utmost transparency. Omitting details or providing false information not only hampers the credibility of the application but can also lead to denial of accreditation or disciplinary proceedings if inaccuracies are discovered post-accreditation. The form explicitly instructs to include all relevant facts and dates, along with supporting documents, highlighting the need for truthfulness and candor.
A further issue is related to the certification and signature part of the form. The VA Form 21a carries a requirement for an ink signature, emphasizing the formality and personal affirmation of the information provided. Some applicants might overlook the necessity for a physical signature, opting instead for digital forms of authentication that are not accepted for this particular application. This oversight can make the difference between an application moving forward in the process or being returned as incomplete.
Last but not least, applicants often neglect the importance of the character references section. This part of the form requires the names, addresses, and phone numbers of three individuals who can attest to the applicant's qualifications and character. Choosing references who lack familiarity with the applicant's professional conduct or ethical standards, or failing to notify these individuals that they might be contacted by the Department of Veterans Affairs, can weaken the application. The references serve as a testament to the applicant’s suitability for the role, and their insights can be pivotal in the accreditation decision.
In conclusion, carefully completing the VA Form 21a, paying close attention to all instructions, and providing thorough and truthful information are crucial steps in achieving accreditation as a claims agent or attorney. Avoiding these common mistakes can significantly improve the odds of a favorable review and expedite the process.
When applying for accreditation as a claims agent or attorney with the VA, using Form 21A, several other forms and documents are often needed to complete the process. This collection ensures a thorough review of the applicant's qualifications and background. Understanding these documents can simplify the application process.
Each of these documents serves a unique purpose, contributing to a comprehensive evaluation of an applicant's qualifications and readiness to competently represent veterans. Familiarity with these forms and proper preparation can significantly streamline the application process for accreditation.
The Uniform Bar Exam (UBE) Application exhibits similarities with the VA 21A form, particularly in the meticulous background and educational verification process. Just as the VA 21A form requires detailed personal, educational, and employment history to assess the suitability of a claims agent or attorney for VA accreditation, the UBE application demands comprehensive academic and professional background information to evaluate a candidate's eligibility to practice law. Both forms necessitate disclosure of legal standing and any disciplinary actions that might affect their qualification.
The Medical License Application, used by physicians to obtain a license to practice within a state, parallels the VA 21A form in its emphasis on character and fitness evaluation. Applicants must provide extensive professional history, including any disciplinary actions or legal issues that could impact their practice. Similar to the process for VA accreditation, the medical license application requires thorough scrutiny to ensure the integrity and competence of practitioners.
A Financial Industry Regulatory Authority (FINRA) Registration form for broker-dealers and investment advisers shares the VA 21A form’s focus on ethical standards and background checks. Applicants must disclose comprehensive employment history, education, and any criminal or regulatory actions against them, ensuring only individuals with high ethical standards manage or advise on investments.
The Security Clearance Application form (SF-86) bears resemblance to the VA 21A form through its rigorous background investigation. Both documents seek to establish the trustworthiness of individuals by examining their past actions, including legal issues and employment history. This thorough vetting process is critical in determining an individual’s eligibility for handling sensitive information or representing veterans.
The Commercial Driver’s License (CDL) Application process is akin to the VA 21A form in the sense that both require disclosure of past legal issues, including traffic violations, to evaluate an applicant’s responsibility and adherence to laws. The CDL application, like the VA 21A, aims to ensure that only qualified and reliable individuals are granted licensure.
The Professional Engineering (PE) License Application process mirrors the VA 21A form in its rigorous assessment of an applicant's educational background, work experience, and ethical standing. Aspiring engineers, like claims agents or attorneys, must illustrate their competence and integrity through a comprehensive application process that reviews their qualifications and disciplinary history.
The Application for Public Trust Position (SF-85P) entails a thorough evaluation of a candidate’s suitability for a position of trust, much like the VA 21A form. It demands detailed personal information, employment history, and background checks to safeguard the integrity of public service, paralleling the aim of ensuring veterans' representatives meet high standards of reliability and honesty.
The United States Patent and Trademark Office (USPTO) Bar Application, for those seeking to represent inventors before the USPTO, requires an exhaustive disclosure of legal, professional, and academic history, similar to the VA 21A form. This ensures that only qualified individuals with upstanding character are permitted to navigate the complexities of patent law.
The Mortgage Loan Originator (MLO) License Application underscores thorough background checks and ethical scrutiny akin to the VA 21A form. Applicants must reveal their financial history, criminal background, and any previous regulatory actions to ascertain their honesty and financial integrity, crucial for advising on or managing mortgage products.
Lastly, the Federal Firearms License (FFL) Application parallels the VA 21A form in its requirement for detailed personal information and an extensive background check to ensure applicants adhere to strict federal regulations and standards, emphasizing the protection of public safety and trust similar to the objectives of the VA 21A form’s accreditation process.
When completing the VA Form 21A for accreditation as a claims agent or attorney, there are several important guidelines to follow and pitfalls to avoid. Ensuring accurate and complete information is crucial for the successful processing of your application. Below are ten do's and don'ts to help you navigate this process:
Understanding the VA Form 21A and its requirements is crucial for those seeking accreditation as claims agents or attorneys. However, misconceptions about the process and the form itself are common. Here are seven key misconceptions clarified to provide accurate information.
In reality, the form is designed for individuals seeking accreditation as claims agents or attorneys to represent claimants before the Department of Veterans Affairs. Specific qualifications, including character and fitness for practice before VA, are required.
While it is true that attorney applicants must be in good standing with a state bar, and are not typically required to take an examination administered by VA, this does not apply to claims agent applicants, who must achieve a score of 75 percent or more on a written examination.
The process can be lengthy, involving thorough checks of character and fitness, possibly including an examination for claims agents. Applicants should prepare for a period of review after submitting their application.
Unsigned or incomplete applications will not be processed, as clearly stated in the instructions. Completeness and accuracy are vital when submitting the application.
Applicants must disclose all relevant legal history, with specific exceptions as noted in the form. Failure to provide complete and truthful information may result in denial of accreditation.
While the initial application is mailed to the Department of Veterans Affairs, Office of the General Counsel, further communication methods may vary, especially for updates or additional information requests.
The form requires detailed information about the applicant's education and employment history over the past five years, indicating the importance of these aspects in determining eligibility and suitability for accreditation.
Addressing these misconceptions helps ensure that applicants understand the requirements and implications of the VA Form 21A application process, fostering a smoother, more informed path toward accreditation.
When preparing to fill out the VA 21A form for accreditation as a claims agent or attorney with the Department of Veterans Affairs, consider the following key takeaways to ensure a smooth and compliant submission process:
By carefully following these guidelines and providing thorough, honest responses, applicants can navigate the accreditation process more effectively and contribute to maintaining high standards of representation for veterans.
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