Request for and Consent to Release of Information from Claimant's Records (Legacy)
You or your representative needs to release your VA records to a third party, or you are familiar with this older form.
Gather before you start
Section I - Veteran Identification
Blocks 1-3Name, SSN, VA File NumberPII
Your identifying information as the record subject.
(legal name, SSN, VA file number)
- Using this legacy form when VA Form 20-10206 would be more current - both are accepted.
Section II - Records Being Released
Blocks 4-7Specific records and recipient
Identify the specific records to release (C-File, medical records, rating decisions) and the entity to receive them (VSO, attorney, medical provider). Limit the scope to protect your privacy.
e.g., Rating decisions and C&P exam reports to be released to Disabled American Veterans (DAV), 3725 Alexandria Pike, Cold Spring KY 41076.
- Blanket releases of all records without limiting scope - a specific scope provides better privacy protection.
Section III - Claimant Signature
Blocks 8-9Claimant signature and datePII
Sign and date. For new requests, consider using VA Form 20-10206 instead.
(signature/date)
- Not knowing VA Form 20-10206 is the more current form for Privacy Act/FOIA requests.