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

ICR 201301-2900-003

OMB: 2900-0736

Federal Form Document

IC Document Collections
ICR Details
2900-0736 201301-2900-003
Historical Active 200909-2900-012
VA 2900-0736 VBA-COMP-YM
Authorization to Disclose Personal Beneficiary/Claimant Information to a Third Party
Extension without change of a currently approved collection   No
Approved with change 09/03/2013
Retrieve Notice of Action (NOA) 06/26/2013
  Inventory as of this Action Requested Previously Approved
09/30/2016 36 Months From Approved 08/31/2013
20,000 0 20,000
1,667 0 1,667
0 0 0

VA Form 27-0845 will be used to release information 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).

US Code: 5 USC 552a Name of Law: Privacy Act Law
   US Code: 38 USC 5701 Name of Law: Confidential nature of claims

Not associated with rulemaking

  78 FR 38 02/26/2013
78 FR 123 06/26/2013

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 20,000 20,000 0 0 0 0
Annual Time Burden (Hours) 1,667 1,667 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0

Crystal Rennie 202 632-7492 [email protected]


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.

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