Petition for Extraordinary Relief Form

• Legal Form Number: 5
• Court: United States Court of Appeals For Veterans Claims
• Section: Court of Appeals for Veteran Claims

1

Redact all Social Security numbers, dates of birth, financial account numbers, and name(s) of any minor child(ren).

UNITED STATES COURT OF APPEALS FOR VETERANS CLAIMS(CAVC)

INSTRUCTIONS

A petitionfor extraordinaryreliefis a writtenrequestforspecific action that you want the Court to take

to resolve your situation.

Yourpetition must (1) clearly explain your situation,(2) state what relief you are requesting, that is,

what you wantthe Courtto do for you, (3) provideall the important facts necessaryforthe Courtto

fullyunderstandthe situation, and (4) attach copies of any order, decision or any other documents

necessary to understand and support the petition.

A. Fill OutPages 2-4: Yourpetitionmay be typed or legibly handwritten. Youmay addextra pages as

necessary(see paragraphB below).

B. Length:Petitions may not exceed 20 pages. You may include relevantattachmentstoyour petition. These

attachments are not counted against the 20-page limit.

C. Signature: You must sign your petition (see page 4).

D. HowTo File:You may file a petitionby (pick one option):

(1) emailing it toself-rep@uscourts.cavc.gov; or

(2) faxing it to (202) 501-5848; or

(3) mailingit toClerk,U.S. Court of Appeals for Veterans Claims, 625 Indiana Avenue, NW, Suite 900,

Washington, DC 20004-2950

E. How To Contact You: Initial belowifyou want the Court to send all petition-related documents to your

email instead ofby U.S. mail.Place your initials here:_______ If you do not initial this form, the Court will

mail all petition-related documents to your mailing address.

F. Payment of Fees: There is a $50 filingfee fora petition. Please wait to pay until you have received

your CAVC case number. You may pay through pay.gov (http://www.uscourts.cavc.gov/fee_filingfee.php)

or you may send a check or money order, payable to “US Court of Appeals for Veterans Claims.” DO NOT

SEND CASH.If you are eligible, you may request a waiver of the filing fee by emailing, faxing, or

mailing the Court a completed Form 4 (Declaration of Financial Hardship), available at

http://www.uscourts.cavc.gov/documents/Form_4.pdf.

G. Action on thePetition: If your petitioncomplieswith theseprocedures,the Clerkwill file your petition.

H. Accessing Your Case:Onceyou have received your CAVC case number, you can access yourcase by going

to the CAVC home page athttp://www.uscourts.cavc.govand selecting “Docket Search.”

I. Privacy:Pursuant to Rule 6,and to protect your privacy, any documentsyou submitwith a VAclaims

filenumber or other personal identifier (suchas Social Security number, date of birth, financial account number,

nameof minor child)must be redacted. Redact sensitive personal informationby removing, obscuring, or

blackeningout the personal information.