Notice of Appeal

Legal Form Number1
CourtUnited States Court of Appeals For Veterans Claims
SectionCourt 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.)

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