How to fill out Virginia VSA 11

What DMV puts in front of an owner once its own records say the mileage has gone backwards. The reading submitted was lower than one already recorded, and the department has stopped. This form is where the owner chooses between two outcomes: accept a title branded NOT ACTUAL at the higher reading, or have the title held while evidence is gathered. It is not a form anybody plans to meet - it appears at the counter.

Written against VSA 11 (04-25-2016), issued under 49 CFR 580.5 and Va. Code 46.2-629. A brand is permanent and it follows the vehicle, not the owner. A seller who accepts NOT ACTUAL to get a transaction finished has not made a paperwork concession - they have changed what the car is worth for every future sale, and DMV says so on the form itself in bold.

Two documents, and they are not the same thing. Take the blank VSA 11 from the dmv.virginia.gov copy so you get the revision that is current today.

Step 1 · the form itself Blank VSA 11 — Odometer Discrepancy Acknowledgement PDF at dmv.virginia.gov · new tab

Filled in

What a completed one looks like

This is the actual VSA 11, rendered from the PDF the Virginia Department of Motor Vehicles publishes and completed end to end: letterhead, every field, and the blocks at the foot.

Amber — you write it
Grey — not yours to fill
Numbered — explained below

The Virginia DMV VSA 11 filled in: owner Corinne T. Ashby with a telephone number and customer number, a 2015 Honda CR-V identified by the last four digits of its VIN, the second option ticked to hold the title while research is done, an owner-provided reading of 96318 against a system reading of 124704, and the owner's signature dated 08/12/2026. — The second option taken - title held, evidence to follow. Only one of the two mileage boxes on that line is the owner's; the reading from system beside it is written by the DMV representative.

Field by field

Every line, in the order you meet it

1
You fill this in
Owner information
Name, telephone and DMV customer number, exactly as DMV holds them.
Watch out: A telephone number is asked for here and it is not decoration - if the second option is taken, this is how the review comes back to you.
2
You fill this in
Year, make and the last four
Vehicle year, make, and only the last four digits of the VIN.
Watch out: Four digits. The box is narrow because DMV already has the vehicle open on its screen.
3
You fill this in
Choosing between the two boxes
Accept the brand and finish today, or have the title held while you find records.
Watch out: Decide before you tick. The first option ends the argument permanently and the second one delays the title indefinitely.
4
You fill this in
The reading from the vehicle
Under the second option only, the figure actually showing on the instrument, written by the owner.
Watch out: The box beside it is the department's. Leave it - a number in a DMV representative's box written in your hand is the kind of thing that gets a file looked at harder.
5
You fill this in
Owner signature and date
One signature, one date, and the form is done.
Watch out: The certification is the standard Virginia one - true and correct, under penalty of perjury, with false statements a criminal violation.

At a glance

What goes where

On the form	What to put in it
Owner information	Full legal name in last, first, mi, suffix order or a business name, a telephone number, and the DMV customer number, FEIN or SSN.
Odometer acknowledgement	Vehicle year, vehicle make, and - unusually - only the last 4 digits of the vehicle identification number.
The explanation	Two printed paragraphs. The first sets out that the federal Truth in Mileage Act regulations require the person in whose name a vehicle is titled to disclose the mileage on a transfer. The second says the reading provided is less than a previous reading, that the title certificate will use the higher odometer reading, that it will be branded NOT ACTUAL, and that the branding decreases the market value of the vehicle.
Option one - accept the brand	A tick accepting the NOT ACTUAL branding with the higher reading and agreeing not to pursue changes, with a note that this option can also be selected where the odometer is broken or not functional and may possibly void the vehicle's warranty. A box beside it takes the odometer reading from system, completed by an authorised DMV representative.
Option two - hold the title	A tick acknowledging that the reading has been recorded as not actual with the higher figure and that the title is being held, that no title will issue until additional supporting documentation is provided and research is completed, and that DMV's review process is final and may still result in a not actual brand. Two boxes here - the reading from the vehicle, provided by the owner, and the reading from system, provided by DMV.
Owner signature	One signature line, one date, and a DMV USE ONLY strip at the foot for the vehicle title number and a clerk's stamp.

What gets this one rejected

•Ticking neither box. The instruction in italics is that you must check one of the boxes below, and the form does nothing until one is marked.
•Ticking both. They are opposite outcomes - one accepts the brand now, the other suspends the title while it is disputed.
•Writing the whole VIN where the box asks for four digits. The box is sized for the last four and a full number will not fit in it.
•Filling in a reading from system yourself. Both of those boxes are marked as the authorised DMV representative's.
•Expecting to appeal afterwards. The second option states in terms that DMV's review process is final.

Rules that decide whether it is accepted

•The higher figure always wins in the interim. Pursuant to DMV policy the certificate uses the higher odometer reading, whichever route is chosen. The dispute is about the brand, not about the number that gets printed.
•Evidence is documents, not memory. Inspection records, maintenance records and work orders are the kind of thing DMV names elsewhere when it invites a customer to come back with proof.
•A broken odometer is a legitimate answer. Option one explicitly covers a vehicle whose odometer is broken or not functional, and warns that choosing it may void the vehicle's warranty.

Every line here was read off VSA 11 (04-25-2016) itself — the PDF is here — and off the Virginia Department of Motor Vehicles pages. This is plain-language help with a form, not legal advice, and where our wording and the agency's differ, theirs governs.

Back to all Virginia seller paperwork, or what selling a car in Virginia involves.

How to fill out Virginia VSA 11

What a completed one looks like

Every line, in the order you meet it

Owner information

Year, make and the last four

Choosing between the two boxes

The reading from the vehicle

Owner signature and date

What goes where

What gets this one rejected

Rules that decide whether it is accepted

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