VA Form 21-0845
Authorization to Disclose Personal Information to a Third Party
You want a family member, caregiver, or helper to be able to call VA and ask questions about your claim or benefits without giving them full representative authority.
- Who fills it
- veteran
- Journey phase
- Keeping Your Award Current
- Estimated time
- 10-15 minutes.
- When to file
- Anytime. File with or before a claim if you want a helper involved from the start.
Official VA form page: https://www.va.gov/find-forms/about-form-21-0845/
Gather before you start
- ▸Third party's full name, address, phone
- ▸Relationship to you
- ▸Specific type of information you authorize VA to share
- ▸Whether authorization is for ongoing or one-time disclosure
Attach with the form
Section I - Veteran Identification
Blocks 1-5Veteran name, SSN, VA File Number, address, phonePII
Your information to identify which VA file to associate this authorization with. The file number appears on any VA correspondence.
(legal name, SSN, VA file number)
Common mistakes
- ×Omitting VA File Number - authorization cannot be matched to the correct file.
Section II - Third Party Information
Blocks 6-9Third party name, relationship, address, phonePII
The person you are authorizing VA to speak with. This can be a family member, close friend, caregiver, or anyone you trust. Their relationship to you (spouse, adult child, sibling, caregiver, friend). Include their full legal name, phone number, and mailing address so VA can reach them and send them correspondence copies if requested.
e.g., Jane Smith, spouse, 123 Main St, Phoenix AZ 85001, (602) 555-0100
Common mistakes
- ×Authorizing someone without their knowledge - they will start receiving calls and mail from VA.
- ×Confusing this with POA - this authorization lets VA talk TO the third party, not let them make decisions FOR you.
Section III - Scope of Authorization
Block 10What information VA can share
You can authorize disclosure of: (1) General benefit status and claim status; (2) Compensation or pension payment amounts; (3) Specific claim decisions; (4) Appeals status; (5) Medical information in VA records. You can also authorize VA to send copies of correspondence (letters, decision notices) to the third party. Be specific about what you want shared - you can limit the scope.
e.g., Authorize VA to discuss claim status, payment amounts, and decisions; send copies of all correspondence to authorized party.
Common mistakes
- ×Not specifying scope - VA defaults to general information only; if you want medical records shared, specify it.
- ×Granting unlimited access when you only need someone to check claim status - narrow the scope to protect your privacy.
Authority
- 38 USC 5701 - Privacy protections for VA beneficiary information; authority for controlled disclosures to third parties.
Section IV - Duration
Block 11How long this authorization is valid
You can authorize disclosure for a specific time period or indefinitely. If you choose indefinitely, you can revoke it anytime in writing. For temporary helpers (e.g., during a hospitalization), specify a limited date range.
e.g., Indefinitely, until revoked. OR: Valid through 12/31/2027.
Common mistakes
- ×Not specifying a duration and then forgetting to revoke when the person is no longer your helper.
- ×Listing a past date as the end date - authorization is then invalid when you submit it.
Section V - Veteran Signature
Block 12Veteran signature and datePII
You must sign and date this form. The third party does NOT sign - this is your authorization as the veteran.
(your signature and date)
Common mistakes
- ×Third party signing instead of the veteran - the veteran must personally authorize; only the veteran can grant this consent.
- ×Forgetting to revoke if the relationship changes - send a written revocation letter to VA at any time.
Statutory and regulatory authority
- 38 CFR 14.631 - Form, content, and revocation of POA appointments.
- 38 USC 5701 - Privacy protections for VA beneficiary information; authority for controlled disclosures to third parties.