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Patterns

Help users to…

Keep a record of submitted information

Use: Deployed
This pattern provides the user with a printable record of their submission.

Usage

When to use this pattern

When you are collecting information from users on a long form. The pattern provides the user with a printable record of their submission data. A printed record provides a reference for future use and helps to confirm a completed form was submitted to VA.

The pattern must display the name of the form, the date of the submission, a confirmation number, a copy of the data used in the form submission, and a task list outlining the next steps in the form submission process.

Examples

Confirmation page summary

An example confirmation page showing a printable copy of their form status, a downloadable PDF, and a task list

The confirmation page provides a way for the user to ‘Print this page’, see their submission status and download a copy of their submission PDF. There is also a task list displaying known next steps.

An example print preview of their form confirmation details

Note that breadcrumbs should be excluded from the print preview/final printout, and that the content fills 100% of the print width.

Application for authorization to release medical information

VA Form 21-4142

Submitted on: [Month Day, 20XX]
Received on: [Month Day, 20XX]
Download available until: [Month Day, 20XX]

Next step: We'll review your form. If we need more information, we'll contact you.

If you have questions, call us at (TTY: ). We're here Monday through Friday, 8:00 a.m. to 9:00 p.m. ET.

Note that the download link includes the expiration date for the file download (60 days from submission, as described in the research findings below).

How to design and build

How this pattern works

On the confirmation page

  • Create a summary of the action completed. Include a success alert that accurately describes the action just completed. For example, for forms that have to travel through several systems before it gets to the system of record you can say, Form submission started on Date
    • The alert should give a time frame for when the user should expect the next communication from VA about their form submission.
    • The alert should also include a confirmation number.
    • The alert should also include a link where they can go to check the status of the application. This would include a link to My VA.
  • Include a copy of the submitted information. Include a copy of the information submitted on the form. Be sure to mask out SSN, VA File number, and Alien Registration numbers on this copy.
    • An HTML representation of a form submission is required in addition to a PDF download in order to make form submission data more easily available to users of assistive technology.
  • Inform users to print the confirmation for their records. Notify users that they can print this confirmation page.
  • Include a “Print this page” primary button. A printed record provides a reference for future use. The “Print this page” button appears at the bottom of the summary page.
  • Include a “What to expect next” task list. This task list should tell the user what VA is doing next with their form submission. When the user needs to complete additional forms as part of their process, provide clear guidance on next steps. Follow the Help users to navigate multiple related forms pattern.

Placement

The pattern should load at the top of the page beneath the h1 in this order:

  1. Form submission started alert
  2. Download a PDF copy of the form
  3. Information you submitted on this form accordion
  4. Print this confirmation page
  5. What to expect process list

On My VA

Include a link to download the form when available through the submission status on My VA. More on how to implement this pattern can be found in the Help users to stay informed of their form submission status pattern.

Components used in this pattern

Code usage

When to consider something else

Forms that are submitted by unauthenticated users should not display links to claim status tool or My VA on the confirmation page as those submissions will not be immediately tracked or connected to a profile account.

If a user fills out a claim or benefit form unauthenticated or on paper, once VA associates the form with their record, it will show up in the Claim Status Tool. This could take 7-10 days.

Content considerations

Review the USWDS Keep a record pattern for content considerations. The print styling differs between the VA and USWDS systems, but their high-level guidance is still relevant.

Accessibility considerations

This pattern provides a copy of the submission in a collapsible and accessible accordion. When the page is printed, the information is also displayed even if the accordion is still closed. This helps make the page more accessible by providing a copy of the form submission outside of a PDF. A user may still save this page as a PDF, but we can’t guarantee the individual accessibility methods of individual browsers and printer settings.

Review the USWDS Keep a record pattern for accessibility considerations.

Research findings

In 2024, VFF/MY VA Form Status Research found that a majority of Veterans indicated they would download a copy of their form submission. But, they were equally confused about the expiration date next to the PDF in My VA.

  • The majority of participants expressed a desire to download a copy of their form submission (10 of 12), and 5 of 12 participants also indicated they would want to print a copy of their form submission. With the option to download a PDF copy of the form they submitted, there was uncertainty about the significance of the date in the associated link. In My VA, the download link will only be available for 60 days due to data security concerns.

Adoption

Forms using this pattern: 22 of 73 (30%)

  • 10182 - Request a Board Appeal
  • 20-0995 - Supplemental Claim Form
  • 20-10206 - Privacy Act
  • 20-10207 - Request for priority processing
  • 21-0538 - Dependency Verification
  • 21-0779 - Request for Nursing Home Information (Aid & Attendance)
  • 21-0845 - Authorization to Disclose Personal Information to a Third Party
  • 21-0966 - Intent to file a claim
  • 21-0972 - Sign VA claim forms as an alternate signer
  • 21-10210 - Lay or Witness Statement
  • 21-2680 - Examination for Housebound Status or Permanent Need for Regular Aid & Attendance
  • 21-4138 - Statement in support of claim
  • 21-4140 - Income Verification for Disability Benefits
  • 21-4142 - Authorization to Disclose Information to the VA
  • 21P-0537 - Verify your marital status for DIC benefits
  • 21P-0847 - Request to be substitute claimant
  • 22-10275 - Commit to the Principles of Excellence for educational institutions
  • 26-1880 - Request a VA home loan Certificate of Eligibility (COE)
  • 26-4555 Application in Acquiring Specially Adapted Housing or Special Home Adaptation Grant
  • Benefits Delivery at Discharge
  • Chapter 31 - Veteran Readiness & Employment - 28-1900
  • Higher Level Review
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Last updated: Mar 19, 2026