Rules of Practice and Procedure effective September 15, 2011 - page 72

The following named appellant appeals to the Court from a final Board of Veterans' Appeals
(BVA) decision. The Board's decision was dated
Appellant's printed name
VA claims file number
Appellant's telephone number
Appellant's address
Signature of person filing this notice
Only if this Notice of Appeal is filed by a representative, check one of the following:
[ ]
My Notice of Appearance is attached.
[ ] My representation is limited to the filing of this Notice of Appeal, and I aver to the
Court, in accordance with Rule 46(b)(2), that the appellant has been advised, or
alternatively will be advised, of the 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).
Representative's printed name
Representative's phone number
Representative's fax number
Representative's address
Representative's email address
Send this Notice of Appeal (NOA)
(original only) to:
US Court of Appeals for Veterans
625 Indiana Avenue, NW, Suite 900
Washington, DC 20004-2950
The NOA will be timely if it is properly
addressed to the Court and bears a
legible postmark affixed by the United
States Postal Service (USPS) within 120
days after the mailing date of the BVA
decision that you are appealing. A
postage-metered date imprint other than
one affixed by USPS does not qualify.
You may send this NOA by facsimile
transmission to (202) 501-5848 or by
means other than US mail. If you do
that, or if you mail the NOA and it does
not bear a legible USPS postmark, the
NOA will be late if it arrives at the Court
after the 120-day time limit.
There is a $50 filing fee for an appeal.
Send a check or money order, payable to
"US Court of Appeals for Veterans
Claims," with this NOA. Do not send
cash. To request a waiver of the filing
fee, attach a completed Form 4
(Declaration of Financial Hardship).
Form 1 (Rev. 08/11)
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