Va Form 21-22 - Appointment Of Veterans Service Organization As Claimant'S Representative Page 2

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RECOGNIZED SERVICE ORGANIZATIONS

Membership in an organization is not a prerequisite to appointment of the organization as claimant's representative.

The following is a listing of national, regional, or local organizations recognized by the Secretary of Veterans Affairs in the preparation,

presentation, and prosecution of claims under laws administered by the Department of Veterans Affairs.

African American PTSD Association

National Association for Black Veterans, Inc.

American Legion

National Veterans Legal Services Program

American Red Cross

National Veterans Organization of America

AMVETS

Navy Mutual Aid Association

American Ex-Prisoners of War, Inc.

Paralyzed Veterans of America, Inc.

American GI Forum, National Veterans Outreach Program

Polish Legion of American Veterans, U.S.A.

Armed Forces Services Corporation

Swords to Plowshares, Veterans Rights Organization, Inc.

Army and Navy Union, USA

The Retired Enlisted Association

Associates of Vietnam Veterans of America

The Veterans Assistance Foundation, Inc.

Blinded Veterans Association

The Veterans of the Vietnam War, Inc. & The Veterans

Catholic War Veterans of the U.S.A.

Coalition

Disabled American Veterans

United Spanish War Veterans of the United States

Fleet Reserve Association

United Spinal Association, Inc.

Gold Star Wives of America, Inc.

Veterans of Foreign Wars of the United States

Italian American War Veterans of the United States, Inc.

Veterans of World War I of the U.S.A., Inc.

Jewish War Veterans of the United States

Vietnam Era Veterans Association

Legion of Valor of the United States of America, Inc.

Vietnam Veterans of America

Marine Corps League

West Virginia Department of Veterans Assistance

Military Officers Association of America (MOAA)

Wounded Warrior Project

Military Order of the Purple Heart

National Amputation Foundation, Inc.

National Association of County Veterans Service Officers, Inc.

Although agency titles vary, the following States and possessions maintain veterans service agencies which are recognized to present

claims.

Alabama

Hawaii

Minnesota

North Dakota

Tennessee

American Samoa

Idaho

Mississippi

Northern Mariana Islands

Texas

Arizona

Illinois

Missouri

Ohio

Utah

Arkansas

Iowa

Montana

Oklahoma

Vermont

California

Kansas

Nebraska

Oregon

Virginia

Colorado

Kentucky

Nevada

Pennsylvania

Virgin Islands

Connecticut

Louisiana

New Hampshire

Puerto Rico

Washington

Delaware

Maine

New Jersey

Rhode Island

West Virginia

Florida

Maryland

New Mexico

South Carolina

Wisconsin

Georgia

Massachusetts

New York

South Dakota

Wyoming

Guam

Michigan

North Carolina

PRIVACY ACT NOTICE: VA will not disclose information collected on this form to any source other than what has been authorized under the

Privacy Act of 1974 or Title 38, Code of Federal Regulations 1.576 for routine uses (i.e., civil or criminal law enforcement, congressional

communications, epidemiological or research studies, the collection of money owed to the United States, litigation in which the United States is a party

or has an interest, the administration of VA programs and delivery of VA benefits, verification of identity and status, and personnel administration) as

identified in the VA system of records, 58VA21/22/28, Compensation, Pension, Education, and Vocational Rehabilitation and Employment Records -

VA, published in the Federal Register. Your obligation to respond is voluntary. However, the requested information is considered relevant and necessary

to recognize a service organization as your representative and/or identify disclosable records. VA uses your SSN to identify your claim file. Providing

your SSN will help ensure that your records are properly associated with your claim file. Giving us your SSN account information is voluntary. Refusal

to provide your SSN by itself will not result in the denial of benefits. VA will not deny an individual benefits for refusing to provide his or her SSN

unless the disclosure of the SSN is required by Federal Statute of law in effect prior to January 1, 1975, and still in effect. The responses you submit are

considered confidential (38 U.S.C. 5701). Information submitted is subject to verification through computer matching programs with other agencies.

RESPONDENT BURDEN: We need this information to recognize the service organization you name to act on your behalf in the preparation,

presentation, and prosecution of claims for VA benefits (38 U.S.C. 5902). We will also use the information to identify any VA records that we may

disclose to the service organization (38 U.S.C. 5701(b)). Title 38, United States Code, allows us to ask for this information. We estimate that you will

need an average of 5 minutes to review the instructions, find the information, and complete this form. VA cannot conduct or sponsor a collection of

information unless a valid OMB control number is displayed. You are not required to respond to a collection of information if this number is not

displayed. Valid OMB control numbers can be located on the OMB Internet Page at If desired, you can call

1-800-827-1000 to get information on where to send comments or suggestions about this form.

VA FORM 21-22, OCT 2014