How to Fill Out VA Form 21P-4718a: Bank Certification and Filing

To fill out VA Form 21P-4718a, complete Items 1 through 3 with your name as fiduciary, the beneficiary’s name, and the VA file number; bring the form to each bank holding the beneficiary’s funds so an officer can certify the account balances in Items 4 through 7; then sign the authorization on page two and send the form to the VA Fiduciary Hub covering the beneficiary’s state within 30 days of the end of your accounting period.¹

The form is one page of account data plus a second page of authorizations. You can download it as a PDF from the VA’s forms page at va.gov. Before you touch it, gather your fiduciary appointment letter, the beneficiary’s VA file number (this is a separate VA identifier, not the veteran’s Social Security number), and a list of every account at every institution where the beneficiary’s VA funds are held. If funds sit at more than one bank, you need a separate Form 21P-4718a for each institution, because each bank can only certify the accounts it holds.

What You Fill In Before Going to the Bank

Only three items at the top belong to you:

Item 1, Name of Fiduciary: your full legal name (first, middle, last).
Item 2, Name of Beneficiary: the veteran’s full legal name (first, middle, last).
Item 3, VA File Number: the identifier the VA assigned to the beneficiary’s case, which appears on correspondence from the Fiduciary Hub.

Do not fill anything else on page one. The rest of that page is the bank’s to complete.

What the Bank Officer Completes

Call the branch before you arrive. Explain that you need a bank officer to certify account balances on a VA fiduciary form. Some branches handle these routinely; others route the request to a manager or a compliance officer, and that can take days. Bring your fiduciary appointment letter so the bank can verify your authority before disclosing account details.

Items 4 through 7 capture the institution’s certification:

Item 4A, Name of Financial Institution: the bank or credit union’s full legal name.
Item 4B, Address of Financial Institution: the branch’s physical address.
Item 4C, Contact Person: a name and phone number (with area code) for someone at the institution who can answer follow-up questions from the VA.
Item 5, Date of Accuracy: the specific date on which the balances in Item 6 were accurate.
Item 6, Account Information: a table with columns for account type, account number, depositor account title, balance (including interest earned), amounts, dates, current interest rate, and interest earned or paid during the period. Each account gets its own row. Write “None” in the account number column if no account exists.
Item 7, Bank Officer Certification: an authorized bank official signs in ink at 7A, prints their title at 7B, and dates the certification at 7C. This is the bank’s legal confirmation that the reported balances match its internal records.¹

Look closely at Item 6 before you leave the branch. The depositor account title on the form must match the bank’s records exactly. VA field examiners use this line to confirm that the veteran’s funds are held in a properly titled fiduciary account rather than commingled with the fiduciary’s personal money, and a mismatch is one of the fastest ways to trigger follow-up questions.

Signing the Authorization on Page Two

Page two is your consent for the VA to obtain the beneficiary’s financial records directly from the bank. That step exists because the Right to Financial Privacy Act generally prohibits federal agencies from getting a person’s bank records without customer consent or a legal process like a subpoena.²

Item 8 notifies you of two rights: you can withhold consent to the disclosure, and you can seek damages, attorney’s fees, and costs if either the VA or the bank violates the Right to Financial Privacy Act. In practice, withholding consent is not a workable option, because refusing to sign is treated as refusing to account for the funds.

Item 9A is your signature authorizing the named institution to verify the certificate and provide copies of financial records to the VA. The legal basis printed on the form is 38 U.S.C. 5502(b), which gives the Secretary of Veterans Affairs the authority to require fiduciaries to disclose financial information about the beneficiary’s estate.³ Sign in ink and date it.

Where To Send the Completed Form

The completed form goes to the VA Fiduciary Hub with jurisdiction over the beneficiary’s location. The specific mailing address appears on the letter the VA sent when it requested the form. The six domestic hubs and the states they cover are:

Salt Lake City: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, Wyoming.
Lincoln: Kansas, Nebraska, North Dakota, Oklahoma, South Dakota, Texas.
Milwaukee: Arkansas, Illinois, Iowa, Louisiana, Minnesota, Missouri, Wisconsin.
Columbia: Florida, Georgia, North Carolina, South Carolina.
Louisville: Alabama, Kentucky, Mississippi, Puerto Rico, Tennessee, Virginia, Washington D.C., West Virginia.
Indianapolis: Connecticut, Delaware, Indiana, Maine, Maryland, Massachusetts, Michigan, New Hampshire, New Jersey, New York, Ohio, Pennsylvania, Rhode Island, Vermont.

Beneficiaries in the Philippines are served by a fiduciary activity in Manila. If you’ve misplaced the VA’s letter, call the Fiduciary Program at 888-407-0144 to confirm the correct address.⁴

The VA also offers the Fiduciary Accountings Submission Tool (FAST), an online portal where fiduciaries can submit accountings, review past filings, and provide revisions.⁵ Because Form 21P-4718a requires a wet-ink bank officer signature and your own signature, electronic filing generally means scanning and uploading the signed original. Keep the paper copy either way.

When It Is Due

Fiduciaries must submit annual accountings and any supporting documents within 30 days after the end of the accounting period set by the Hub Manager. If the VA notifies you that a previous accounting has a discrepancy, you have 14 days from the date of that notice to submit a corrected or supplemental accounting.⁶

Do not schedule the bank visit for the last day. Officers sometimes need to pull records or route the form through internal compliance, and that can add several business days. Give yourself at least a week of cushion.

Practical Tips Before You Mail It

Photocopy the completed, signed form before it leaves your hands. If the original is lost in transit or the hub requests a duplicate, you will not have to send the bank officer back to redo Item 7.

Reread Item 6 one more time against a current bank statement. The balance, the account number, and the depositor account title all need to line up with what the bank shows on paper. The point of this form is that the two sources agree.

Keep the copies with your other fiduciary records for as long as you serve. The VA retains its copies for the duration of the appointment, and matching sets on both sides make future accountings much easier to prepare.

If You Don’t File

The VA can suspend benefit payments to any fiduciary who neglects or refuses to provide an accounting after reasonable notice, and a suspended fiduciary can be removed and replaced.³ Federal law also treats a willful refusal to file proper accountings as prima facie evidence of embezzlement of VA funds, which carries up to five years in prison and fines.⁷ Filing on time, with balances that match the bank’s records, keeps you out of both categories.

1
Department of Veterans Affairs. VA Form 21P-4718a – Certificate of Balance on Deposit and Authorization to Disclose Financial Records
2
Office of the Law Revision Counsel. 12 USC Chapter 35 – Right to Financial Privacy
3
Office of the Law Revision Counsel. 38 USC 5502 – Payments to and Supervision of Fiduciaries
4
Veterans Benefits Administration. Contact Us – Fiduciary
5
Veterans Benefits Administration. Fiduciary Accountings Submission Tool (FAST)
6
eCFR. 38 CFR 13.280 – Accountings
7
govinfo. 38 USC 6101 – Misappropriation by Fiduciaries