Form 21-4502 Application for Automobile or Other Conveyance and Adapt

Application for Automobile or Other Conveyance and Adaptive Equipment (Under 38 U.S.C. 3901-3904) (VA Form 21-4502)

VA Form 21-4502 (OMB Exp. 7-31-24)

Application for Automobile or Other Conveyance and Adaptive Equipment (Under 38 U.S.C. 3901-3904) (VA Form 21-4502)

OMB: 2900-0067