Fillable Printable VA Form 10-0462

VA Form 10-0462

POLITICAL ACTIVITIES FACT SHEET

AND CERTIFICATION

VA Voluntary Service (VAVS) personnel, including volunteers, and any other personnel, who provide information

or assistance to VA veteran patients on voter registration must abide by the following rules.

You MAY:

o Provide a form or other information to register to vote or to obtain an absentee ballot from the

appropriate state.

o Assist in completing and mailing the form to register to vote or obtain an absentee ballot, or in

completing the ballot itself.

o Direct a veteran patient to the state or local government office or entity responsible for voter

registration, for example, State Secretary of State, State Board of Elections.

You MAY NOT:

o Discuss partisan politics, promote a particular candidate, party or issue, or even express a personal

opinion on a candidate, party or issue in response to a question from a patient.

o Wear any partisan political buttons, pins, or ribbons in a VA facility.

o Direct persons to any voter registration being conducted by a partisan entity, for example a

political party, union or special interest group.

CERTIFICATION: I have read and understand what is and is not permissible in connection with my

providing voter registration assistance. I understand that the Hatch Act may place other limitations on my

ability to engage in partisan political activities and that the above requirements are not intended as an

exhaustive list of do's and don'ts under the Hatch Act. I understand that I should address any questions I

have on providing voter registration assistance to the local Regional Counsel.

PRINT NAME (Last, First, Middle Initial)

SIGN DATE

VA FORM

SEP 2008

10-0462

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