21 4502-2026

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The document is a VA Form 21-4502, which serves as an application for veterans or service members to request an automobile or other conveyance and adaptive equipment under 38 U.S.C. 3901-3904. It outlines the eligibility criteria, required information, and instructions for completing the form. The form includes sections for personal details, disability qualifications, and certification of eligibility by the VA. Additionally, it provides guidelines on adaptive equipment that may be reimbursed and emphasizes the importance of obtaining VA authorization before purchasing a vehicle.

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Click ‘Get Form’ to open the 21 4502 in the editor.
Begin by filling out Section I. Enter your VA file number and Social Security number in fields 1A and 1B respectively.
Provide your full name, address, and branch of service. Ensure you specify if you are on active duty.
Complete questions regarding your military service, including place and date of entry and release from active duty.
Indicate whether you have applied for VA disability compensation and provide the location of the VA office handling your file.
In Item 9, select the type of conveyance you are applying for by checking the appropriate box.
Sign and date the form in Section I before submitting it to the relevant VA office for processing.

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