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The instructions guide completion of veteran identification, beneficiary identification, the authorized recipient selection, permitted duration, and security question details, plus submission methods and expiration.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/template/","Template",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/template/forms/","Forms",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/template/authorization-to-disclose-personal-information-to-a-third-party-va-form-21-0845-instructions/283916/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/authorization-to-disclose-personal-information-to-a-third-party-va-form-21-0845-instructions/283916.png","ImageObject",442,249,{"name":42,"@type":43},"Sage","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-23","2026-09-17",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",11,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"When can VA disclose information to a third party under this authorization?","Question",{"text":63,"@type":64},"VA discloses only under the stated circumstances, including when the individual identifies the information and consents, when disclosure is required by law, or when disclosure is otherwise legally permitted.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"Can you revoke written permission, and what happens after revocation?",{"text":68,"@type":64},"You may revoke your written permission at any time, except when VA has already acted based on your permission. 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If an organization is selected, you must also identify individuals within that organization, and provide any required details for the selected 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collect is kept confidential to the extentprovided by law.In accordance with the Privacy Act and applicable confidentiality statutes,VA will only disclose the information in itscustody or control in the following circumstances:where the individual identifies the particular information and consents to its use;where disclosure of the information is required by law;or where the disclosure is otherwise legally permitted,including release for apurpose compatible with the purpose for which it was collected.  \nBy law,VA must have your written permission(an \"authorization\")to use or give out your claim or benefit information for any purposethat is not permited by all applicable legal authorities.You may revoke your written permission at any time,except if VA has alreadyacted based on your permission.  \n\n| QUESTIONS   | SPECIFIC INSTRUCTIONS   |\n| --- | --- |\n| 1-5   | In this section,give us the veteran's identification information to include name,social security number,VA  \u003Cbr>file number,date of birth and the veteran's service number,if applicable.   |\n| 6-9   | In this section,provide the beneficiary/claimant's identification information,who is not the veteran.   |\n| 10-13   | In Item 10 VA will give your personal benefit or claim information to the person or organization you enter in  \u003Cbr>this box.You may select only one person or one organization.If you designate an organization,you  \u003Cbr>must also identify one or more individuals in that organization to whom VA may disclose your benefit or  \u003Cbr>claim information.This form cannot be used to disclose federal tax information to third parties.  \u003Cbr>IMPORTANT:The information provided in Item 6,\"Name of Beneficiary/Claimant Who Is Not the Veteran,\"  \u003Cbr>cannot be the same information provided in Item 10.  \u003Cbr>ltem 13 tells VA the duration of your consent.If you do not want your authorization to be effective  \u003Cbr>indefinitely,tell us when to stop releasing your personal benefit or claim information to your authorized third  \u003Cbr>party in Item 13.Check the box that applies and fill n dates,if applicable.   |\n| 14   | Select the security question you would like us to ask your designated third party and provide the answer.  \u003Cbr>This question will be asked each time your designated third party contacts the VA.   |\n\n## WHERE DOISEND MY COMPLETED WORK?\n\nSend your signed authorization in by utilizing the following methods:  \n\n| MAIL TO   | SUBMIT ONLINE   |\n| --- | --- |\n| Department of Veterans Affairs  \u003Cbr>Evidence Intake Center  \u003Cbr>PO Box 4444  \u003Cbr>Janesville,WI 53547-4444   | VA gov:www.va.gov  \u003Cbr>Direct Upload via access.va.gov   |\n\nNOTE:You should make a copy of your signed authorization for your records before mailing it to VA.You can only have one VA Form21-0845,Authorization to Disclose Personal Information to a Third Party,on file with VA at a time.  \n## WHAT IFI CHANGE MY MIND?\n\nIf you change your mind and do not want VA to give out your personal benefit or claim information,you may notify us in writing,or bytelephone at 1-800-827-1000 or contact VA online at ASK VA:https://ask.va.gov.Upon notification from you VA will no longer give outbenefit or claim information (except for the information VA has already given out based on your permission).  \nExpiration Date:05/31/2029  \n\n| U.S.Department  \u003Cbr>VA  \u003Cbr>of Veterans Affairs   |  |  |  |  |  |  |  |  | VA DATE STAMP  \u003Cbr>(DO NOT WRITE IN THIS SPACE)   |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |\n| AUTHORIZATION TO DISCLOSE PERSONAL INFORMATION  \u003Cbr>TOA THIRD PARTY   |  |  |  |  |  |  |  |  |  |  |  |  |\n| INSTRUCTIONS:Use this form if you want to give the Department of Veterans Affairs (VA)permission to release your  \u003Cbr>personal beneficiary or claim information to","cbCairK8ewgo5zMU","https://ap.wps.com/l/cbCairK8ewgo5zMU","pdf",908543,"English","# General Information\n## Consent, Revocation, and Legal Disclosure Conditions\n## Questions and Specific Instructions\n## Submission Methods and Mailing Information\n## Changes of Mind and Expiration Date","[{\"question\":\"When can VA disclose information to a third party under this authorization?\",\"answer\":\"VA discloses only under the stated circumstances, including when the individual identifies the information and consents, when disclosure is required by law, or when disclosure is otherwise legally permitted.\"},{\"question\":\"Can you revoke written permission, and what happens after revocation?\",\"answer\":\"You may revoke your written permission at any time, except when VA has already acted based on your permission. After notification, VA will no longer disclose information beyond what was already released under the permission.\"},{\"question\":\"How do you designate who will receive your benefit or claim information?\",\"answer\":\"In the authorization section, select only one person or one organization. If an organization is selected, you must also identify individuals within that organization, and provide any required details for the selected recipient.\"}]","Authorization to Disclose Personal Information to a Third Party - VA Form 21-0845 - Instructions | PDF",1789622402]