Information Collection

Authorization To Disclose Personal Information To A Third Party (insurance)

IC 220731 under ICR 202401-2900-003 · OMB 2900-0856.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form VA Form 29-0975 AUTHORIZATION TO DISCLOSE PERSONAL INFORMATION TO A THIRD PARTY (INSURANCE)	Form
Form VA Form 29-0975 Authorization to Disclose Personal Information to a Third Party AUTHORIZATION TO DISCLOSE PERSONAL INFORMATION TO A THIRD PARTY (INSURANCE)	Form
Form VA Form 29-0975e ( Authorization to Disclose Personal Information to a Third Party AUTHORIZATION TO DISCLOSE PERSONAL INFORMATION TO A THIRD PARTY (INSURANCE)	Form
VA Form 29-0975 Authorization to Disclose Personal Information to a Thir 29-0975(1-9-24).pdf	Form
VA Form 29-0975 Authorization to Disclose Personal Information to a Thir 29-0975(3-28-24).pdf	Form
VA Form 29-0975e ( Authorization to Disclose Personal Information to a Thir 29-0975e (DocuSign)(1-9-24).pdf	Form
VA Form 29-0975e ( Authorization to Disclose Personal Information to a Thir 29-0975e (DocuSign)(3-28-24).pdf	Form

IC Title:

AUTHORIZATION TO DISCLOSE PERSONAL INFORMATION TO A THIRD PARTY (INSURANCE)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	VA Form 29-0975			www.va.gov/vaforms	Yes	No	Fillable Printable
Form	VA Form 29-0975e (DocuSign)				Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records

Title: 36VA00, Veterans and Armed Forces Personnel U.S. Government Life Insurance Records - VA

FR Citation: 89 FR 2480

Number of Respondents: 1,200

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	1,200	1,200
Annual IC Time Burden (Hours)	100	100
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.

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