Information Collection

Authorization To Disclose Personal Information To A Third Party

IC 253399 under ICR 202205-2900-005 · OMB 2900-0914.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0914 can be found here:

Documents and Forms

Document Name Document Type
Form VA Form 22-10278 AUTHORIZATION TO DISCLOSE PERSONAL INFORMATION TO A THIRD PARTY Form
VA Form 22-10278 Authorization to Disclose Personal Information to a Thir 22-10278(5-13-22).pdf www.va.gov/vaforms Form
VA Form 22-10278 Authorization to Disclose Personal Information to a Thir 22-10278(5-13-22).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	Agency IC Tracking Number:	2900-NEW

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 38 CFR 1.576(b).

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	VA Form 22-10278	Authorization to Disclose Personal Information to a Third Party - Education Benefits	22-10278(5-13-22).pdf	www.va.gov/vaforms	Yes	No	Fillable Printable

Line of Business: Education

Subfunction: Higher Education

Privacy Act System of Records
Title: 58VA 21/22/28 Compensation Pension Education and Veteran Readiness and Employment Records â VA (58VA21/22/28)	FR Citation: 87 FR 17199

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

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	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.