VA Form 21-0845 will be used to release information in its custody or control in the following circumstances: where the individual identifies the particular information and consents to its use; for the purpose for which it was collected or a consistent purpose (i.e. a purpose which the individual might have reasonably expected).
Based upon recommendations made by The Former PresidentÂs Commission On Care For AmericaÂs Returning Wounded Warriors, The Wounded, Ill, VA continues to look at ways in which we can improve and modernize our disability and compensation systems for severely wounded and injured soldiers and veterans. As a result, we recently developed a form to remove obstacles that prevent VA from sharing claim information with the family members of severely injured service members, who are unable to communicate with VA due to their injuries. This form allows a claimant or beneficiary to authorize release of certain claims information to an agent or person(s) who they designate. We believe this form will aid in the family member(s) in making well-informed decisions regarding a seriously ill or injured beneficiary. It will also allow them to have updated information on certain decisions made regarding claims and payments. We are requesting emergency approval of this form since it is in line with former President Bush's Interagency Task Force on Returning Global War on Terror Heroes, which was a government-wide action plan that was established to improve our care for America's troops and veterans.
US Code:
5 USC 552a
Name of Law: Privacy Act Law
US Code:
38 USC 5701
Name of Law: Confidential nature of claims
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Form VA Form 21-0845 Authorization to Disclose Personal Beneficiary/Claimant Information to a Third Party
VAF 21-0845 emergency justification.doc
Authorization to Disclose Personal Beneficiary/Claimant Information to a Third Party