This is for information disclosure only — it does NOT allow the third party to act on your behalf

Use VA 21-22 or 21-22a instead if you want someone to represent you in claims

You can revoke this authorization at any time by notifying VA in writing

Veterans Affairseasy

VA Information Disclosure Authorization

VA 21-0845 · VA

Authorization allowing VA to share personal information with a non-VA individual or organization designated by the veteran.

Form Details

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Where to Submit This Form

🌐

VA.gov

https://www.va.gov/supporting-forms-for-claims/third-party-authorization-form-21-0845/

Authorize third-party access online.

📬

Mail to VA

Department of Veterans Affairs Evidence Intake Center PO Box 4444 Janesville, WI 53547-4444

📠

Fax to VA

Fax: 844-531-7818

Processing Time

1-2 weeks for VA to update your records with the authorization.

What Happens Next

VA will permit the designated third party to receive information about your claims and benefits. This does not give them power of attorney.

Tips for This Form

✓ This is for information disclosure only — it does NOT allow the third party to act on your behalf
✓ Use VA 21-22 or 21-22a instead if you want someone to represent you in claims
✓ You can revoke this authorization at any time by notifying VA in writing

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Authorization and consent allowing VA to obtain private medical records from non-VA providers for disability claim adjudication.

General Release for Medical Provider Information

VA 21-4142a · VA

Companion form to 21-4142 allowing specific medical professionals to release records to VA for claim processing.

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Disclaimer: BeneFill™ provides form-filling assistance and informational guidance only. It is not affiliated with, endorsed by, or sponsored by the VA or any government agency. The information provided is for general informational purposes and does not constitute legal, medical, financial, or tax advice. Always verify form requirements and submission details directly with the issuing agency.