VA Form 21-22 allows a Veteran, Service Member, or eligible dependent to appoint an accredited Veterans Service Organization (VSO) as their representative before the U.S. Department of Veterans Affairs (VA). By completing this form, you authorize the Veterans Assistance Commission of Cook County (VACCC) to assist you with preparing, submitting, and monitoring VA claims and appeals, as well as communicating with the VA on your behalf regarding benefit-related matters.

Completing the Form

Section I – Veteran's Information

• Complete all requested Veteran information, including name, Social Security Number, VA file number (if applicable), date of birth, and contact information.
• If you are a surviving spouse, dependent child, or dependent parent seeking survivor benefits, the Veteran's information should still be entered in this section.

Section II – Claimant Information (If Different Than Veteran)

• Complete this section only if the claimant is someone other than the Veteran, such as a surviving spouse, dependent child, fiduciary, guardian, or other authorized representative.
• If applicable, provide the claimant's name and contact information as requested on the form.

Appointing Your Representative

In the section requesting the name of the Veterans Service Organization, please leave this blank when you submit it to the VACCC. Our staff will fill this section with the correct information required for official submission to the VA.

What a Power of Attorney Allows

By signing VA Form 21-22, you authorize your accredited representative to:

• Assist with preparing and submitting VA claims, appeals, and supporting documentation.
• Communicate directly with the VA regarding your benefits.
• Review information contained within your VA claims file when necessary.
• Receive copies of certain VA correspondence related to your claims.
• Advocate on your behalf throughout the claims and appeals process.

A Power of Attorney does not allow a representative to make financial decisions, access personal bank accounts, or act on matters unrelated to your VA benefits.

Signature

Please review the form carefully before signing. The claimant must sign and date the form in the appropriate signature section. Unsigned forms cannot be accepted by the VA.

Once completed, please submit the form and any supporting documentation to VACVSO@cookcountyil.gov. A member of our Veterans Benefits Services team will review your submission and contact you to schedule an appointment if additional assistance is needed.

Note: A completed VA Form 21-22 and VA Form 21-0966 (Intent to File) are the minimum documents required for VACCC to begin assisting you with most VA compensation, pension, and survivor benefit claims.