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

OMB 2900-0067

OMB 2900-0067

VA Form 21-4502 is used to gather information that is necessary to determine the entitlement of veterans and servicepersons to automobile and adaptive equipment benefits. Without this information, VA would be unable to properly authorize benefits. VA Form 21-4502 is being revised to include new standardization data points; to include optical character recognition boxes. This is a non-substantive change.

The latest form for Application for Automobile or Other Conveyance and Adaptive Equipment (Under 38 U.S.C. 3901-3904) (VA Form 21-4502) expires 2021-03-31 and can be found here.

All Historical Document Collections
Reinstatement with change of a previously approved collection 2021-06-03
Approved without change
Extension without change of a currently approved collection 2017-12-07
Approved without change
Revision of a currently approved collection 2014-10-15
Withdrawn and continue
Revision of a currently approved collection 2014-07-30
Withdrawn and continue
Revision of a currently approved collection 2014-02-28
Withdrawn and continue
Revision of a currently approved collection 2013-09-19
Approved without change
Extension without change of a currently approved collection 2011-10-06
Approved without change
Extension without change of a currently approved collection 2008-08-22
Approved without change
Extension without change of a currently approved collection 2005-11-18
Approved without change
Extension without change of a currently approved collection 2002-11-08
Approved without change
Extension without change of a currently approved collection 2000-03-20
Approved without change
Extension without change of a currently approved collection 1997-01-24
Approved without change
Extension without change of a currently approved collection 1993-11-08
Approved without change
Revision of a currently approved collection 1990-12-03
Approved without change
Extension without change of a currently approved collection 1987-11-23
Approved without change
Reinstatement with change of a previously approved collection 1985-01-02
Approved without change
Revision of a currently approved collection 1981-12-30
Approved with change
No material or nonsubstantive change to a currently approved collection 1981-01-22
Approved without change
Revision of a currently approved collection 1977-03-31
Approved without change
Revision of a currently approved collection 1975-10-14
Approved without change
Revision of a currently approved collection 1975-02-07

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