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 VA Form 21 22a Veterans Benefits Administration VA Gov 2019-2023

VA Form 21 22a Veterans Benefits Administration VA Gov 2019-2023

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Where to send comments or suggestions about this form. VA Form 21-22a FEB 2019 Page 2 FOR ALL COMPENSATION CLAIMS MAIL OR FAX THIS FORM TO THE FOLLOWING ADDRESS Mail your form to Department of Veterans Affairs Claims Intake Center P. VETERAN S NAME First Middle Initial Last 4. VETERAN S DATE OF BIRTH MM/DD/YYYY 3. VA FILE NUMBER 2. 630 See required statement below. Signatures are required in Items 15A and 16A SERVICE ORGANIZATION REPRESENTATIVE Specify organization below Skip to Item 17 if the...
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