Information Collection

Authorization to Disclose Personal Information to a Third Party (VA Form 21-0845)

IC 188786 under ICR 202111-2900-010 · 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⚠️ Notice: This information collection may be referencing outdated material.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 21-0845 Authorization to Disclose Personal Information to a Third Party (VA Form 21-0845) Form
21-0845 Authorization to Disclose Personal Information to a Thir VAF21-0845 (1-11-23).pdf www.va.gov/vaforms/ Form
21-0845 Authorization to Disclose Personal Information to a Thir VAF21-0845 (1-11-23).pdf www.va.gov/vaforms/ Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Authorization to Disclose Personal Information to a Third Party (VA Form 21-0845)	Agency IC Tracking Number:	2900-0736

Is this a Common Form? No		IC Status: Modified

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	21-0845	Authorization to Disclose Personal Information to a Third Party	VAF21-0845 (1-11-23).pdf	www.va.gov/vaforms/	Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records
Title: Compensation, Pension, Education, and Veterans Readiness and Employment Records-VA (58VA21/22/28)	FR Citation: 87 FR 8740

Number of Respondents: 113,660	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	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	113,660	93,660	20,000
Annual IC Time Burden (Hours)	9,472	7,805	1,667
Annual IC Cost Burden (Dollars)	0	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.