The following information about this VA form comes from the VA forms database, and any changes are updated here nightly. Contact the form administration for further information.
Link to form
http://www.vba.va.gov/pubs/forms/VBA-21-4502-ARE.pdf
Form number
21-4502
Row ID
2430
Form title
Application for Automobile or Other Conveyance and Adaptive Equipment (Fillable)
Issue date
Revision date
Form administration
VBA
Number of pages
4
Deleted
False
Form name
Application for Automobile or Other Conveyance and Adaptive Equipment (UNDER 38 U.S.C. 3901-3904)
Form Language
English
Related to
Benefits
VA disability compensation
When to use

Use VA Form 21-4502 if you’re a Veteran with a disability and you want to apply for compensation for a vehicle that meets your needs. This may include a specially equipped vehicle for you to drive or adaptive equipment to help you get in and out of your vehicle.

Helpful links
Eligibility for VA disability benefits
Find out if you qualify for compensation for a presumptive disability or other service-connected conditions.
How to file a VA disability claim
Find out how to file a claim for disability compensation or increased disability compensation.
File additional forms for your disability claim
Find out if you need to complete additional forms for your disability claim.
VA automobile allowance and adaptive equipment
Find out if you can get a VA automobile allowance if you’re a Veteran living with a service-connected disability that prevents you from driving.