TemplatesOwl
Homepage ↦ Fill Out Your Va 21 0845 Form
Article Structure

The VA Form 21-0845, also known as the Authorization to Disclose Personal Information to a Third Party, serves an essential function within the Department of Veterans Affairs (VA) by enabling veterans to authorize the release of their personal claims or benefit information. This form recognizes the critical importance of privacy, ensuring that personal data remains confidential unless expressly permitted by the individual or required by law. To complete this form, a veteran must provide their identification details, such as name, social security number, and VA file number, alongside the information of the individual or organization designated to receive the information. Importantly, this authorization is specific; only one person or one organization may be selected at a time, and distinct sections clarify what information may be shared. Veterans retain control over their information and can dictate the duration of the release, with options for limited or ongoing disclosure. Furthermore, the document includes a security question for verifying the identity of the authorized recipient at the time of contact with the VA. While the release of personal information is facilitated by this form, it should be noted that the VA cannot accept it from beneficiaries deemed incompetent for VA purposes. Overall, the VA Form 21-0845 is a vital tool that balances the necessity of information sharing with the right to privacy, ensuring veterans’ interests are adequately protected.

Va 21 0845 Example

INFORMATION AND INSTRUCTIONS TO HELP YOU COMPLETE THE AUTHORIZATION TO

DISCLOSE PERSONAL INFORMATION TO A THIRD PARTY

GENERAL INFORMATION

At VA, we recognize and respect the importance of privacy. Personal information that we collect is kept confidential to the extent provided by law. In accordance with the Privacy Act and applicable confidentiality statutes, VA will only disclose the information in its custody or control in the following circumstances: where the individual identifies the particular information and consents to its use; where disclosure of the information is required by law; or where the disclosure is otherwise legally permitted, including release for a purpose compatible with the purpose for which it was collected.

By law, VA must have your written permission (an "authorization") to use or give out your claim or benefit information for any purpose that is not permitted by all applicable legal authorities. You may revoke your written permission at any time, except if VA has already acted based on your permission.

QUESTIONS

1-5

6-9

SPECIFIC INSTRUCTIONS

In this section, give us the veteran's identification information to include name, social security number, VA file number, date of birth and the veteran's service number, if applicable.

In this section, provide the beneficiary/claimant's identification information, who is not the veteran.

 

In Item 10 VA will give your personal benefit or claim information to the person or organization you enter

 

in this box. You may select only one person or one organization. If you designate an organization,

 

you must also identify one or more individuals in that organization to whom VA may disclose your benefit

 

or claim information. This form cannot be used to disclose federal tax information to third parties.

10-13

IMPORTANT: The information provided in Item 6, "Name of Beneficiary/Claimant Who Is Not the Veteran,"

cannot be the same information provided in Item 10.

 

 

Item 13 tells VA the duration of your consent. If you do not want your authorization to be effective indefinitely,

 

tell us when to stop releasing your personal benefit or claim information to your authorized third party in

 

Item 13. Check the box that applies and fill in dates, if applicable.

14Select the security question you would like us to ask your designated third party and provide the answer. This question will be asked each time your designated third party contacts the VA.

WHERE DO I SEND MY COMPLETED WORK?

Send your signed authorization in by utilizing the following methods:

MAIL TO

SUBMIT ONLINE

Department of Veterans Affairs

VA gov: www.va.gov

Evidence Intake Center

Direct Upload via access.va.gov

PO Box 4444

 

Janesville, WI 53547-4444

 

 

 

NOTE: You should make a copy of your signed authorization for your records before mailing it to VA. You can only have one VA Form 21-0845, Authorization to Disclose Personal Information to a Third Party, on file with VA at a time.

WHAT IF I CHANGE MY MIND?

If you change your mind and do not want VA to give out your personal benefit or claim information, you may notify us in writing, or by telephone at 1-800-827-1000 or electronically via the Internet at https://iris.custhelp.va.gov. Upon notification from you VA will no longer give out benefit or claim information (except for the information VA has already given out based on your permission).

APR 2020

21-0845

PAGE 1

VA FORM

 

 

OMB Approved No. 2900-0736 Respondent Burden: 5 minutes Expiration Date: 04/30/2022

AUTHORIZATION TO DISCLOSE PERSONAL INFORMATION

TO A THIRD PARTY

INSTRUCTIONS: Use this form if you want to give the Department of Veterans Affairs (VA) permission to release your personal beneficiary or claim information to a third party. This form may not be executed by any beneficiary recognized as incompetent for VA purposes, nor can VA accept this form from any beneficiary recognized as incompetent for VA purposes.

VA DATE STAMP

(DO NOT WRITE IN THIS SPACE)

SECTION I - VETERAN'S IDENTIFICATION INFORMATION

NOTE: You may either complete the form online or by hand. If completed by hand print the information requested in ink, neatly, and legibly to expedite processing the form.

1.VETERAN'S NAME (First, Middle Initial, Last)

2. VETERAN'S SOCIAL SECURITY NUMBER

3. VA FILE NUMBER (If known)

4. VETERAN'S DATE OF BIRTH (MM/DD/YYYY)

5. VETERAN'S SERVICE NUMBER (If applicable)

SECTION II - BENEFICIARY/CLAIMANT'S IDENTIFICATION INFORMATION

6.NAME OF BENEFICIARY/CLAIMANT WHO IS NOT THE VETERAN (First, Middle Initial, Last)

7.ADDRESS OF BENEFICIARY/CLAIMANT (Number and Street or rural route, P.O. Box, City, State, ZIP Code and Country)

No. &

Street

Apt./Unit Number

State/Province

Country

City

ZIP Code/Postal Code

8.TELEPHONE NUMBER (Include Area Code)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Enter International Phone Number (If applicable)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9. EMAIL ADDRESS (Optional)

 

 

I agree to receive electronic correspondence from VA in regards to my claim.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION III - CONTACT INFORMATION

10.VA IS AUTHORIZED TO DISCLOSE THE INFORMATION SPECIFIED BELOW TO ONE PERSON OR ONE ORGANIZATION LISTED BELOW.

PROVIDE THE NAME AND ADDRESS OF THE PERSON YOU HAVE CHOSEN TO RECEIVE INFORMATION FROM VA IN ITEMS 10A AND 10B OR PROVIDE

THE NAME AND ADDRESS OF THE ORGANIZATION YOU HAVE CHOSEN AND THE NAME OF THE ORGANIZATION'S REPRESENTATIVE IN ITEMS 10C AND 10D.

A. NAME OF PERSON (First, Middle Initial, Last Name)

B. ADDRESS OF PERSON

No. &

Street

Apt./Unit Number

 

 

 

 

 

 

 

 

City

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

State/Province

 

 

 

 

Country

 

 

 

ZIP Code/Postal Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NOTE: An organization may have more than one representative. Include the first and last name of any additional representatives.

C. NAME OF ORGANIZATION (Include name of representative(s))

VA FORM

21-0845

SUPERSEDES VA FORM 21-0845, SEP 2016.

PAGE 2

APR 2020

VETERAN'S SSN

D. ADDRESS OF ORGANIZATION

No. &

Street

Apt./Unit Number

 

 

 

 

 

 

 

 

City

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

State/Province

 

 

 

 

Country

 

 

 

ZIP Code/Postal Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

11.I, THE BENEFICIARY/CLAIMANT AUTHORIZE VA TO CONTACT THE PERSON OR ORGANIZATION LISTED IN ITEM 10A OR 10C FOR THE PURPOSE OF PROVIDING THE FOLLOWING INFORMATION PERTAINING TO MY VA RECORD (Check only one box below to tell VA the specific benefit or claim information you want disclosed)

LIMITED INFORMATION (Go to Item 12)

ANY INFORMATION (Go to Item 13)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

12. IF YOU SELECTED "LIMITED INFORMATION", FILL ALL THAT APPLY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Status of pending claim or appeal

Amount of money owed VA

Other (Specify below)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Current benefit and rate

Request a benefit payment letter

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Payment history

Change of address or direct deposit

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

13. IF YOU SELECTED "ANY INFORMATION", THE TERMS OF SUCH RELEASE OF INFORMATION WILL BE:

One time only

From the date of signing below until

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Specify date - MM, DD, YYYY)

Ongoing until written notice is given to VA to terminate

14.SPECIFY THE SECURITY QUESTION YOU WANT USED WHEN VERIFYING THE IDENTITY OF YOUR DESIGNATED THIRD PARTY. CHECK ONLY ONE SECURITY QUESTION BOX IN ITEM 14A AND PROVIDE THE ANSWER IN ITEM 14B.

A. SECURITY QUESTION

B. ANSWER

The city and state your mother was born in

The name of the high school you attended

Your first pet's name

Your favorite teacher's name

Your father's middle name

SECTION IV - DECLARATION OF INTENT

I CERTIFY THAT the statements on this form are true and correct to the best of my knowledge and belief.

15. VETERAN SIGNATURE (REQUIRED)

16. DATE SIGNED (MM,DD,YYYY)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PRIVACY ACT INFORMATION: VA will not disclose information collected on this form to any source other than what has been authorized under the Privacy Act of 1974 or title 38, Code of Federal Regulations 1.576 for routine uses (i.e., civil or criminal law enforcement, congressional communications, epidemiological or research studies, the collection of money owed to the United States, litigation in which the United States is a party or has an interest, 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 - VA, published in the Federal Register. Your obligation to respond is voluntary. VA uses your SSN to identify your claim file. Providing your SSN will help ensure that your records are properly associated with your claim file. Giving us your SSN account information is voluntary. Refusal to provide your SSN by itself will not result in the denial of benefits. The VA will not deny an individual benefits for refusing to provide his or her SSN unless the disclosure of the SSN is required by Federal Statute of law in effect prior to January 1, 1975, and still in effect.

RESPONDENT BURDEN: We need this information to release your private benefit and/or claim information to a designated third party(ies). The execution of this form does not authorize the release of information other than that specifically described. The information requested on this form will authorize release of the information you specify. Title 38, United States Code, allows us to ask for this information. We estimate that you will need an average of 5 minutes to review the instructions, find the information, and complete this form. VA cannot conduct or sponsor a collection of information unless a valid OMB control number is displayed. You are not required to respond to a collection of information if this number is not displayed. Valid OMB control numbers can be located on the OMB Internet Page at www.reginfo.gov/public/do/PRAMain. If desired, you can call 1-800-827-1000 to get information on where to send comments or suggestions about this form.

VA FORM 21-0845, APR 2020

PAGE 3
Get Va 21 0845 PDF Form

Form Characteristics

Fact Name Fact Description
Purpose The VA Form 21-0845 serves as an authorization for the Department of Veterans Affairs to disclose personal benefit or claim information to a designated third party.
Privacy Compliance This form is governed by the Privacy Act of 1974 and related confidentiality statutes, ensuring personal information remains confidential unless the veteran consents to its release.
Information Required To complete the form, veterans need to provide their identifying details such as name, social security number, and service number, as well as information about the third party.
Limitations on Use The form cannot be used to divulge federal tax information or to authorize disclosure to anyone recognized as incompetent for VA purposes.
Revocation Rights Veterans can revoke their authorization at any time in writing or through specified communication methods, though disclosures already made based on their permission will not be affected.

Guidelines on Utilizing Va 21 0845

After filling out VA Form 21-0845, you will need to submit it to the Department of Veterans Affairs (VA). Attached to the form, you may want to include any necessary supporting documents. Carefully review your completed form for any errors before sending it.

  1. Section I - Veteran's Identification Information:
    • Write the veteran's name (first, middle initial, last).
    • Provide the veteran's social security number.
    • If known, include the VA file number.
    • Enter the veteran's date of birth (MM/DD/YYYY).
    • If applicable, provide the veteran's service number.
  2. Section II - Beneficiary/Claimant's Identification Information:
    • Enter the name of the beneficiary/claimant who is not the veteran.
    • Fill out the beneficiary/claimant's address (number and street, P.O. Box, city, state, ZIP code and country).
    • Provide a telephone number, including area code.
    • If desired, include an email address. Check the box if you agree to receive electronic correspondence from VA.
  3. Section III - Contact Information:
    • Select and fill out either the person's or organization's information to whom VA can disclose your information.
    • For a person, provide their name and address.
    • For an organization, include its name and address as well as any additional representatives you wish to designate.
    • Decide what specific benefit or claim information you want disclosed (limited or any information). If limited, specify what applies. If any, indicate the terms of such release.
    • Choose a security question for verifying the identity of your designated third party and provide the answer.
  4. Section IV - Declaration of Intent:
    • Sign and date the form to certify that the statements are true and correct.

Finally, make a copy of your completed form for your records before sending it to the VA via mail or online submission. Ensure you have only one VA Form 21-0845 on file with the VA at any time.

What You Should Know About This Form

What is the VA Form 21-0845?

The VA Form 21-0845, also known as the Authorization to Disclose Personal Information to a Third Party, allows veterans to give the Department of Veterans Affairs (VA) permission to release their personal benefit or claim information to someone else. This ensures that the information is handled according to the veteran's wishes while complying with privacy laws.

Who can use this form?

This form can be used by veterans who want to allow a specific individual or organization to access their VA claim or benefit information. It is important to note that individuals recognized as incompetent for VA purposes cannot execute this form. If you are unsure about your status, it may be best to consult with a VA representative before proceeding.

How do I fill out the form?

To complete the VA Form 21-0845, you need to provide identifying information for both the veteran and the designated third party. This includes names, social security numbers, and addresses. Additionally, you must specify what type of information you want disclosed and indicate how long the authorization should remain in effect. Take care to fill it out clearly, either online or by hand, to ensure efficient processing.

How long does the authorization last?

The authorization on the form can be set to last indefinitely or for a specific period, based on your preference. If you do not want it to be effective indefinitely, you must specify an end date on the form. If you decide later that you no longer want your information shared, you have the right to revoke your permission by contacting the VA in writing or by phone.

What if I want to change my mind?

If you decide to revoke your authorization, you can do so at any time. Write a note or call the VA at 1-800-827-1000. You can also request a revocation electronically through the VA's website. Your revocation will take effect immediately, except for the information that the VA has already provided to your designated third party based on your previous authorization.

Where should I send the completed form?

You can submit your signed VA Form 21-0845 in a few ways. You can mail it to the VA Evidence Intake Center at PO Box 4444, Janesville, WI 53547-4444. Alternatively, you may submit it online through the VA's direct upload service. Before sending, it is wise to make a copy for your own records, as only one authorization form can be on file at a time.

Common mistakes

Many individuals encounter challenges when completing the VA Form 21-0845, which authorizes the Department of Veterans Affairs (VA) to share personal information with a third party. A common mistake is not providing complete and accurate identification information. When individuals leave out crucial details, such as the veteran's name or social security number, it can result in processing delays. Ensuring that all fields in Section I and Section II are filled out correctly is essential for the form to be accepted.

Another common error occurs in Item 10, where individuals may attempt to designate more than one person or organization. The regulations clearly state that only one recipient can be selected. If multiple names are provided, the VA will likely reject the submission, necessitating a resubmission of the entire form. Therefore, clarity and precision in this section are paramount to avoid unnecessary complications.

Some people also mistakenly believe that Item 6 can contain the same information as Item 10. This is not permitted. The instructions indicate that the name of the beneficiary or claimant must differ from the third-party recipient, which can lead to confusion if overlooked. Failing to differentiate between these parties will cause the form to be deemed incomplete.

Additionally, failing to specify the duration of consent in Item 13 is a prevalent oversight. The instructions provide options for how long the authorization will remain effective. Without this information, the request may not be processed as intended, affecting the timely release of information to the designated third party.

Another mistake relates to the security question specified in Item 14. Individuals sometimes choose security questions that are too common or not memorable. Selecting a specific and unique question will help ensure that the third party can successfully verify their identity when contacting the VA. Inadequate security measures can hinder the information release process.

Finally, some individuals neglect to retain a copy of the signed authorization for their records. This step is important, as it provides a reference in case there are disputes or issues regarding the disclosure of information. It is always advisable to keep an accurate record of any authorization forms submitted to the VA.

Documents used along the form

When submitting the VA Form 21-0845 to authorize the release of personal information, several other forms may also be required or beneficial for a smooth process. Below is a list of related documents.

  • VA Form 21-526EZ: This form is used to apply for disability compensation benefits. It provides the VA with essential information to assess a veteran's claim.
  • VA Form 21-4138: Also known as the Statement in Support of Claim, this document allows veterans to submit personal statements regarding their claims, providing additional context and evidence.
  • VA Form 20-0995: This form is used to request a Higher-Level Review of a decision made by the VA. It is crucial for veterans who believe their claims were incorrectly evaluated.
  • VA Form 21-530: This document is used to apply for burial benefits for veterans. It requires personal and service information to process the request effectively.
  • VA Form 21-22: This is the Appointment of Veterans Service Organization as Claimant's Representative form. It designates someone to assist veterans in their claims process.
  • VA Form 21-4142: This form is used to authorize the release of medical records from private sources. It is essential for substantiating medical claims related to service connection.

Understanding these forms can help streamline the process of managing a claim or obtaining benefits through the VA. Ensure you have the appropriate documentation ready when submitting your requests.

Similar forms

The VA Form 21-0845, which grants permission to the Department of Veterans Affairs to release personal information to a third party, shares similarities with several other documents. Below are five such documents, along with explanations of how they are alike.

  • HIPAA Authorization Form: This document allows for the disclosure of a person's health information to specified individuals or organizations. Like the VA Form 21-0845, it requires the individual’s consent and outlines the limitations regarding the information shared.
  • Power of Attorney (POA): A POA empowers another person to make decisions on your behalf, which often includes accessing personal records. Similar to the VA Form 21-0845, it emphasizes the need for clear identification of the authorized individual and can be revoked by the principal at any time.
  • Release of Information Form: Used in various contexts, this form grants permission to an entity (like an employer or educational institution) to disclose personal records. Like VA Form 21-0845, it protects sensitive information and requires the signer’s explicit approval.
  • Authorization for Release of Educational Records: Often used in educational settings, this document allows schools to share a student's records with designated individuals or organizations. It parallels the VA Form 21-0845 in that both require consent and specify what information can be released.
  • Financial Institution Authorization Form: This form allows a bank or financial institution to share an account holder's information with third parties. Both documents demand the account holder's consent and clarify the scope of information that can be disclosed to ensure privacy is maintained.

Each of these documents serves to authorize the sharing of sensitive information. They all require explicit consent from the individual and allow for revocation of that consent under certain circumstances. Their shared purpose is to safeguard personal information while providing access to designated parties.

Dos and Don'ts

When filling out the VA Form 21-0845, it’s important to pay careful attention to your responses. Here’s a list of dos and don’ts to help guide you through the process.

  • Do complete the form either online or by hand, making sure to use ink if filling it out by hand.
  • Don’t use the same name for the beneficiary/claimant in Item 6 as you do for the designated contact person in Item 10.
  • Do provide accurate identification information, including your name, Social Security number, and VA file number.
  • Don’t list more than one person or organization in Item 10. Choose only one.
  • Do specify the duration of your authorization in Item 13; this ensures clarity around your consent.
  • Don’t forget to include a security question and answer in Item 14 to protect your information.
  • Do keep a copy of your completed form for your records before sending it to the VA.
  • Don’t forget to sign and date the form in the designated sections; without this, the form may not be processed.
  • Do send the completed form via the method that you prefer, whether by mail or online submission.

Following these guidelines will help ensure that your submission is processed smoothly and that your personal information remains protected. Take your time, and double-check your entries to avoid any delays.

Misconceptions

  • Misconception 1: The VA 21-0845 form can be used for any third party.

    • This form specifically allows the release of personal benefit or claim information to only one person or one organization. Individuals cannot choose multiple recipients on this form.

  • Misconception 2: Once the form is submitted, the authorization is permanent.

    • The authorization is not indefinite unless specified. The individual must indicate a specific duration for the consent, which can be revoked at any time.

  • Misconception 3: All personal information can be shared with third parties.

    • Only the information that is specifically requested and authorized can be disclosed. The form does not cover confidential or sensitive data, such as federal tax information.

  • Misconception 4: A beneficiary can complete the form even if recognized as incompetent for VA purposes.

    • The form cannot be executed by any beneficiary deemed incompetent by the VA. This restriction is in place to protect vulnerable individuals.

  • Misconception 5: There is no need to keep a copy of the submitted form.

    • It is advisable to retain a copy of the signed authorization for personal records before sending it to the VA. This serves as proof of the consent given.

  • Misconception 6: The VA will disclose information without prior consent.

    • The VA cannot release personal benefit or claim information without the written permission of the individual, except where mandated by law.

  • Misconception 7: Any individual can be named on the form as a designee.

    • Only one individual or organization can be designated at a time. Moreover, if an organization is appointed, the individual(s) in that organization must be specified for the release of information.

  • Misconception 8: Submitting the form electronically ensures immediate processing.

    • While electronic submissions may be quicker, processing times may vary. It is recommended to allow sufficient time for the VA to receive and process any form submitted.

Key takeaways

  • The VA Form 21-0845 authorizes the VA to release your personal benefit or claim information to a designated third party.
  • Include detailed identification information for both the veteran and the beneficiary or claimant. This includes names, social security numbers, and other identifying details.
  • You may designate only one person or organization on this form. If you choose an organization, name at least one individual in that organization.
  • Do not use this form to disclose federal tax information.
  • Clearly specify the duration of your authorization in Item 13. You can set a specific end date for your authorization if you do not want it to be indefinite.
  • Before sending your completed form, make sure to keep a copy for your own records.
  • If you change your mind about sharing your information, notify the VA in writing or contact them via phone or online to revoke your permission.
  • Always complete the form legibly. Incomplete or unclear forms may delay processing.

Browse Other Templates

LLC Correction Notice,FL LLC Amendments Form,Statement of Limited Liability Correction,LLC Document Correction Request,Florida Limited Liability Amendment Form,Filing for LLC Correction,Limited Liability Company Statement of Update,Official LLC Corre - It can also be used if a document was defectively signed, requiring an explanation of the defect.

Nurse Notes - Document pain assessments and management strategies used.

Osha 5020 - Send two copies to SeaBright Insurance Company.