Forms


The following forms are available to private attorneys who want to participate or who are already participating as a Judicare attorney:

Participating Attorney Sign-Up Form

IRS Form W-9
An IRS Form W-9 is required of all participating attorneys.  Please complete and return your W-9 to Judicare.

IRS Standard Mileage Rates for 2019
Mileage will be reimbursed at the IRS rate in effect at the time the case is billed.

Application for Accreditation as a Claim Agent or Attorney for the Dept. of Veterans Affairs.

Appointment of Veterans Service Organization as Claimant's Representative.

Authorization and Certification Form for the client's citizenship

Request for Final Payment of Legal Services Form 

Authorization to Proceed for Legal Services and Brief Counsel and Advice Form

Statement of Facts Form for when the client is the petitioner in a court case

Pro Bono Case Closing Report Form

Social Security Billing Attachment Form



Downloads
Filename Description Date Added File Size
  Application for Accreditation as a Claims Agent or Attorney for the Dept. of Veterans Affairs
10/10/2014 576.9 KB
  Authorization & Certification of Citizenship Form for Client
12/23/2019 188.8 KB
  Authorization to Proceed for Legal Services and Brief Counsel and Advice Form
12/23/2019 57 KB
  Request for Taxpayer Identification Number and Certification
10/10/2014 109.6 KB
  Participating Attorney Sign-Up Form 2019 - online form
07/24/2019 593.4 KB
  Pro Bono Case Closing Report Form
12/23/2019 501.4 KB
  Request for Final Payment of Legal Services
12/23/2019 154.1 KB
  Social Security Billing Attachment Form
12/23/2019 402.4 KB
  Statement of Facts Form for Clients who are petitioners
12/23/2019 280.9 KB
  Appointment of Veterans Service Organization as Claimant's Representative
10/10/2014 599.5 KB