VA Form 21-0972

Alternate Signer Certification

Power of AttorneyOfficial VA form on VA.gov

Who fills it

representative

Journey phase

Keeping Your Award Current

Estimated time

10-15 minutes.

When to file

Each time another person signs a VA form on the veteran's behalf. File alongside the form being signed.

The veteran cannot sign due to illness, injury, or mental incapacity, but is not under a court guardianship. A spouse, adult child, or trusted person signs for them.

Gather before you start

—The veteran's full legal name, SSN, VA File Number

—The alternate signer's name, address, relationship to veteran

—Reason the veteran cannot sign (specific physical/mental condition)

—A doctor's statement or court order confirming incapacity (best practice)

Attach with the form

—Doctor's statement or court documentation confirming the veteran's inability to sign (recommended, sometimes required)

Section I - Veteran Identification

1 field

Blocks 1-3Veteran name, SSN, VA File NumberPII

The veteran on whose behalf you are signing.

Example

(veteran's legal name)

Common mistakes

Mismatched name/SSN with VA records - certification rejected.

Section II - Alternate Signer Information

1 field

Blocks 4-7Alternate signer name, address, phone, relationshipPII

Your name and contact info. Your relationship to the veteran (spouse, parent, adult child, sibling, friend, attorney, etc.). VA accepts close family relationships without additional documentation; less-close relationships may require a court order.

Example

e.g., Jane Smith, spouse, 123 Main St, Phoenix AZ 85001

Common mistakes

Vague relationship ("friend") for someone unrelated to the veteran - VA may require court documentation of authority.

Section III - Reason Veteran Cannot Sign

1 field · 1 citation

Block 8Specific reason the veteran cannot sign

Be specific: "Stroke 2024 - left arm paralysis prevents signing", "Advanced dementia - lacks capacity per Dr. Smith's 2025 evaluation", "Hospitalized for surgery 03/15/2026 - unable to sign for 30 days post-op". Vague reasons get rejected.

Example

Specific medical condition + impact on ability to sign

Common mistakes

Vague "veteran is sick" - VA rejects. Name the specific condition and how it prevents signing.
Using this form to substitute for fiduciary appointment - if veteran lacks capacity to manage benefits, file VA Form 21-555 (fiduciary).

Authority

38 CFR 14.631 - Form, content, and revocation of POA appointments.

Section IV - Certification

1 field

Block 9Certification by alternate signer

You certify under penalty of perjury that (a) the veteran is unable to sign for the reason stated, (b) you are signing in good faith on the veteran's behalf, (c) you have no fraudulent intent.

Example

(certification language pre-printed)

Common mistakes

Signing for personal benefit (e.g., changing direct deposit to your own account) - federal fraud. Use fiduciary process if you need that authority.

Section V - Signature

1 field

Blocks 10-11Alternate signer signature and datePII

Sign and date as the alternate signer. The form being signed (e.g., 21-526EZ) gets your signature in the veteran's signature block PLUS this 21-0972 attached.

Example

(your signature and date)

Common mistakes

Signing only the underlying form without attaching this 21-0972 - VA returns the package as improperly signed.
Signing under the veteran's name (forging) instead of as alternate signer - federal crime.

Statutory & regulatory authority

38 CFR 14.631 - Form, content, and revocation of POA appointments.

38 USC 5101 - Standardized form requirement.

VA Form 21-0972

Alternate Signer Certification

Power of AttorneyOfficial VA form on VA.gov

Who fills it

representative

Journey phase

Keeping Your Award Current

Estimated time

10-15 minutes.

When to file

Each time another person signs a VA form on the veteran's behalf. File alongside the form being signed.

The veteran cannot sign due to illness, injury, or mental incapacity, but is not under a court guardianship. A spouse, adult child, or trusted person signs for them.

Gather before you start

—The veteran's full legal name, SSN, VA File Number

—The alternate signer's name, address, relationship to veteran

—Reason the veteran cannot sign (specific physical/mental condition)

—A doctor's statement or court order confirming incapacity (best practice)

Attach with the form

—Doctor's statement or court documentation confirming the veteran's inability to sign (recommended, sometimes required)

Section I - Veteran Identification

1 field

Blocks 1-3Veteran name, SSN, VA File NumberPII

The veteran on whose behalf you are signing.

Example

(veteran's legal name)

Common mistakes

Mismatched name/SSN with VA records - certification rejected.

Section II - Alternate Signer Information

1 field

Blocks 4-7Alternate signer name, address, phone, relationshipPII

Example

e.g., Jane Smith, spouse, 123 Main St, Phoenix AZ 85001

Common mistakes

Vague relationship ("friend") for someone unrelated to the veteran - VA may require court documentation of authority.

Section III - Reason Veteran Cannot Sign

1 field · 1 citation

Block 8Specific reason the veteran cannot sign

Example

Specific medical condition + impact on ability to sign

Common mistakes

Vague "veteran is sick" - VA rejects. Name the specific condition and how it prevents signing.
Using this form to substitute for fiduciary appointment - if veteran lacks capacity to manage benefits, file VA Form 21-555 (fiduciary).

Authority

38 CFR 14.631 - Form, content, and revocation of POA appointments.

Section IV - Certification

1 field

Block 9Certification by alternate signer

You certify under penalty of perjury that (a) the veteran is unable to sign for the reason stated, (b) you are signing in good faith on the veteran's behalf, (c) you have no fraudulent intent.

Example

(certification language pre-printed)

Common mistakes

Signing for personal benefit (e.g., changing direct deposit to your own account) - federal fraud. Use fiduciary process if you need that authority.

Section V - Signature

1 field

Blocks 10-11Alternate signer signature and datePII

Sign and date as the alternate signer. The form being signed (e.g., 21-526EZ) gets your signature in the veteran's signature block PLUS this 21-0972 attached.

Example

(your signature and date)

Common mistakes

Signing only the underlying form without attaching this 21-0972 - VA returns the package as improperly signed.
Signing under the veteran's name (forging) instead of as alternate signer - federal crime.

Statutory & regulatory authority

38 CFR 14.631 - Form, content, and revocation of POA appointments.

38 USC 5101 - Standardized form requirement.

VA Form 21-0972

Alternate Signer Certification

Power of AttorneyOfficial VA form on VA.gov

Who fills it

representative

Journey phase

Keeping Your Award Current

Estimated time

10-15 minutes.

When to file

Each time another person signs a VA form on the veteran's behalf. File alongside the form being signed.

The veteran cannot sign due to illness, injury, or mental incapacity, but is not under a court guardianship. A spouse, adult child, or trusted person signs for them.

Gather before you start

—The veteran's full legal name, SSN, VA File Number

—The alternate signer's name, address, relationship to veteran

—Reason the veteran cannot sign (specific physical/mental condition)

—A doctor's statement or court order confirming incapacity (best practice)

Attach with the form

—Doctor's statement or court documentation confirming the veteran's inability to sign (recommended, sometimes required)

Section I - Veteran Identification

1 field

Blocks 1-3Veteran name, SSN, VA File NumberPII

The veteran on whose behalf you are signing.

Example

(veteran's legal name)

Common mistakes

Mismatched name/SSN with VA records - certification rejected.

Section II - Alternate Signer Information

1 field

Blocks 4-7Alternate signer name, address, phone, relationshipPII

Example

e.g., Jane Smith, spouse, 123 Main St, Phoenix AZ 85001

Common mistakes

Vague relationship ("friend") for someone unrelated to the veteran - VA may require court documentation of authority.

Section III - Reason Veteran Cannot Sign

1 field · 1 citation

Block 8Specific reason the veteran cannot sign

Example

Specific medical condition + impact on ability to sign

Common mistakes

Vague "veteran is sick" - VA rejects. Name the specific condition and how it prevents signing.
Using this form to substitute for fiduciary appointment - if veteran lacks capacity to manage benefits, file VA Form 21-555 (fiduciary).

Authority

38 CFR 14.631 - Form, content, and revocation of POA appointments.

Section IV - Certification

1 field

Block 9Certification by alternate signer

You certify under penalty of perjury that (a) the veteran is unable to sign for the reason stated, (b) you are signing in good faith on the veteran's behalf, (c) you have no fraudulent intent.

Example

(certification language pre-printed)

Common mistakes

Signing for personal benefit (e.g., changing direct deposit to your own account) - federal fraud. Use fiduciary process if you need that authority.

Section V - Signature

1 field

Blocks 10-11Alternate signer signature and datePII

Sign and date as the alternate signer. The form being signed (e.g., 21-526EZ) gets your signature in the veteran's signature block PLUS this 21-0972 attached.

Example

(your signature and date)

Common mistakes

Signing only the underlying form without attaching this 21-0972 - VA returns the package as improperly signed.
Signing under the veteran's name (forging) instead of as alternate signer - federal crime.

Statutory & regulatory authority

38 CFR 14.631 - Form, content, and revocation of POA appointments.

38 USC 5101 - Standardized form requirement.

VA Form 21-0972

Alternate Signer Certification

Power of AttorneyOfficial VA form on VA.gov

Who fills it

representative

Journey phase

Keeping Your Award Current

Estimated time

10-15 minutes.

When to file

Each time another person signs a VA form on the veteran's behalf. File alongside the form being signed.

The veteran cannot sign due to illness, injury, or mental incapacity, but is not under a court guardianship. A spouse, adult child, or trusted person signs for them.

Gather before you start

—The veteran's full legal name, SSN, VA File Number

—The alternate signer's name, address, relationship to veteran

—Reason the veteran cannot sign (specific physical/mental condition)

—A doctor's statement or court order confirming incapacity (best practice)

Attach with the form

—Doctor's statement or court documentation confirming the veteran's inability to sign (recommended, sometimes required)

Section I - Veteran Identification

1 field

Blocks 1-3Veteran name, SSN, VA File NumberPII

The veteran on whose behalf you are signing.

Example

(veteran's legal name)

Common mistakes

Mismatched name/SSN with VA records - certification rejected.

Section II - Alternate Signer Information

1 field

Blocks 4-7Alternate signer name, address, phone, relationshipPII

Example

e.g., Jane Smith, spouse, 123 Main St, Phoenix AZ 85001

Common mistakes

Vague relationship ("friend") for someone unrelated to the veteran - VA may require court documentation of authority.

Section III - Reason Veteran Cannot Sign

1 field · 1 citation

Block 8Specific reason the veteran cannot sign

Example

Specific medical condition + impact on ability to sign

Common mistakes

Vague "veteran is sick" - VA rejects. Name the specific condition and how it prevents signing.
Using this form to substitute for fiduciary appointment - if veteran lacks capacity to manage benefits, file VA Form 21-555 (fiduciary).

Authority

38 CFR 14.631 - Form, content, and revocation of POA appointments.

Section IV - Certification

1 field

Block 9Certification by alternate signer

You certify under penalty of perjury that (a) the veteran is unable to sign for the reason stated, (b) you are signing in good faith on the veteran's behalf, (c) you have no fraudulent intent.

Example

(certification language pre-printed)

Common mistakes

Signing for personal benefit (e.g., changing direct deposit to your own account) - federal fraud. Use fiduciary process if you need that authority.

Section V - Signature

1 field

Blocks 10-11Alternate signer signature and datePII

Sign and date as the alternate signer. The form being signed (e.g., 21-526EZ) gets your signature in the veteran's signature block PLUS this 21-0972 attached.

Example

(your signature and date)

Common mistakes

Signing only the underlying form without attaching this 21-0972 - VA returns the package as improperly signed.
Signing under the veteran's name (forging) instead of as alternate signer - federal crime.

Statutory & regulatory authority

38 CFR 14.631 - Form, content, and revocation of POA appointments.

38 USC 5101 - Standardized form requirement.