An Authorization to Disclose Personal Information to a Third Party document is more formally known as a VA Form 21-0845 by the Department of Veterans Affairs. This document is used when someone wishes to have the Department release their personal records, documents, or information to a third party. These documents or records could pertain to health records or other important information that pertains to a veteran’s beneficiaries or for third parties in regards to a claim. Other parties cannot fill out this form; only the veteran him or herself may fill out this form to authorize the release to other parties. This document requires the veteran to disclose personal information in order for them to be positively identified and the proper records to be released.
This form will be used by the Department of Veterans Affairs in the United States. A VA Form 21-0845 is known as an Authorization to Disclose Personal Information to a Third Party. This form should be submitted by someone who wishes to have the Department of Veterans Affairs release their personal information to a third party. This information could be about your beneficiaries or about your claims.
Only the recognized veteran can fill out this form. This person will need to include their personal information so that they can be identified by the U.S. Department of Veterans Affairs. They will also need to include the information for their beneficiary. The filer should carefully select the information they wish to share, as well as the third parties that they wish to share it to. The veteran must sign the form before submitting it.
This form is commonly used when a veteran wishes the VA to disclose personal information to another person or organization.
A VA Form 21-0845 contains the following sections:
To complete a VA Form 21-0845, you need to provide the following information:
Mail to: Department of Veterans Affairs Evidence Intake Center PO Box 4444 Janesville, WI 53547-4444
Fax to: 844-531-7818 (Toll Free) OR Local: 248-524-4260
The information that you share on this form will not be disclosed other than to a source that has been authorized by the Privacy Act of 1974 or Title 38, Code of Federal Regulations 1.576 for routine uses such as the administration of VA programs and delivery of VA benefits, verification of identity and status, and personnel administration as identified in the VA system of records, 58VA21/22/28 Compensation, Pension, Education, and Vocational Rehabilitation and Employment Records.
The VA is estimating that it will take each veteran an average to review the specific instructions, find the information, and complete the form.
