Information Collection

Authorization to Disclose Personal Beneficiary/Claimant Information to a Third Party

IC 188786 under ICR 200904-2900-007 · OMB 2900-0736.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0736 can be found here:

Documents and Forms

Document Name Document Type
Form VA Form 21-0845 Authorization to Disclose Personal Beneficiary/Claimant Information to a Third Party Form
VA Form 21-0845 Authorization to Disclose Personal Beneficiary/Claimant 21-0845.pdf www.va.gov/vaforms Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Authorization to Disclose Personal Beneficiary/Claimant Information to a Third Party	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 38 CFR 1.576(b) 38 CFR 1.526(a)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	VA Form 21-0845	Authorization to Disclose Personal Beneficiary/Claimant Information to a Third Party	21-0845.pdf	www.va.gov/vaforms	Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 20,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	20,000	20,000
Annual IC Time Burden (Hours)	1,667	1,667
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.