Change Log for VA Form 21P-4703, Fiduciary Agreement

Change Log.docx

Fiduciary Agreement (21P-4703)

Change Log for VA Form 21P-4703, Fiduciary Agreement

OMB: 2900-0319

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Change Log for VA Form 21-4703, Fiduciary Agreement

Location of Change

Change from

Change to

Page 2- 1st statement

You are being appointed as a Federal Fiduciary for the VA beneficiary listed above. As a Federal Fiduciary, you are responsible for receiving the beneficiary’s VA income and ensuring the beneficiary’s just debts are paid. Please initial in the “Initial” column next to each statement of understanding you agree to.

You are under consideration as a Federal Fiduciary for the VA beneficiary listed above. As a Federal Fiduciary, you are responsible for receiving the beneficiary’s VA benefits and ensuring the beneficiary’s expenses are paid.

Page 2- ‘Initial’ column on right side of page

Initial column

Initial column removed

Page 2- statement above signature lines

The field examiner has explained my responsibilities and I have received a copy of this form.

By signing this form, I acknowledge that I have read, understand, and agree to the above statements. I further agree to serve as fiduciary if confirmed. My appointment as fiduciary is not effective unless it is confirmed in writing by the Department of Veterans Affairs.






File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorBohr, Gina, VBAVACO
File Modified0000-00-00
File Created2021-01-28

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