Notice of Appeal

• Legal Form Number: 1
• Court: United States Court of Appeals For Veterans Claims
• Section: Court of Appeals for Veteran Claims

The following named Appellant appeals to the Court from a final Board of Veterans' Appeals (Board) decision.

The Board's decision was dated ______________________________.

Appellant's printed name SSN or VA claims file number

Appellant's telephone number

Appellant's address Appellant's email address

If other than Appellant, your name/relationship to Appellant

Signature* of person filing this notice

Only if this NOA is filed by a representative, check one of the following:

My Notice of Appearance is attached.

Representative's printed name Representative' s telephone number

Representative' s fax number

Representative' s address Representative' s email address

Form 1

(Rev. 04/2021)

There is a$50 filing fee for an appeal. Please wa it to pay until you have received your USCAVC case number. You may

pay through pay.gov (http://www.uscourts.cavc.gov/fee_filingfee.php) or you may send acheck or money order, payable

to "US Court of Appeals for Veterans Claims." DO NOT SEND CASH.To request awaiver of the filing fee, email, fax,

or mail the Court a completed Form 4 (Declaration of Financial Hardship).

You may file an NOA by either (1) emailing it to self-rep@uscourts.cavc.gov fo r self-represented parties, or

esubmission@uscourts.cavc.gov for represented parties, OR (2) faxing it to (202) 501-5848, OR (3 ) mailing it to: Clerk,

US Court of Appeals for Veterans Claims, 625 Indiana Avenue, NW, Suite 900, Washington, DC 20004-2950.

UNITED STATES COURT OF APPEALS FOR VETERANS CLAIMS

Notice of Appeal (NOA)

By initialing here, Appellant requests that the

Court send all appeal-related documents by

email instead of mail.

(initial)

The NOA must be received by the Court, or properly addressed an d postmarked by the U.S. Postal Service, not later th an

120 days after the date on which the Board mailed notice of the deci sion being appealed. The Court may accept an NOA

filed after that date as timely in limited circumstances. See

Court Rules of Practice and Procedure 4 and 25.

My representation is limited to the filing of this NOA, and I aver to the Court, in accordance with Rule 46(b)(2),

that Appellant has been advised, or alternatively will be advised, of Appellant’s responsibility to abide by the

Court's Rules of Practice and Procedure, including the need to timely serve and submit for filing a brief.

(Complete items below).

INSTRUCTIONS

(*You may electronically sign by typing "/s/" and then your name in the signature block above: for example, /s/John Doe, or you may

sign with an electronic signature from a commercial provider such as DocuSign, Adobe Sign, SignRequest,etc.)