Alternate Signer Certification (VA Form 21-0972)

OMB 2900-0849

VA Form 21-0972 is used to collect the alternate signer information necessary for VA to accept benefit application forms signed by individuals on behalf of veterans and claimants. The information collected is used to contact the alternate signer for verification purposes.

The latest form for Alternate Signer Certification (VA Form 21-0972) expires 2023-01-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form VA Form 21-0972 Alternate Signer Certification Form
2023-00585.pdf Supplementary Document
2022-24321.pdf Supplementary Document
2900-0849, Supporting Statement (VAF 21-0972).docx Supporting Statement A
Alternate Signer Certification Form

All Historical Document Collections

202210-2900-006 Approved without change	Revision of a currently approved collection	2023-01-17
201903-2900-014 Approved without change	Reinstatement without change of a previously approved collection	2019-12-10
201603-2900-010 Approved without change	New collection (Request for a new OMB Control Number)	2016-07-18