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

OMB 2900-0736

VA Form 21-0845 is 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).

The latest form for Authorization to Disclose Personal Information to a Third Party (VA Form 21-0845) expires 2022-04-30 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form 21-0845 Authorization to Disclose Personal Information to a Third Party (VA Form 21-0845) Form
30-Day FRN - 2900-0736 (2023).pdf Supplementary Document
2022-24462, 60-Day FRN (VAF21-0845).pdf Supplementary Document
2900-0736, Supporting Statement (VAF21-0845).docx Supporting Statement A
Authorization to Disclose Personal Information to a Third Party (VA Form 21-0845) Form

All Historical Document Collections

202111-2900-010 Approved without change	Reinstatement with change of a previously approved collection	2023-01-20
201903-2900-015 Approved without change	Extension without change of a currently approved collection	2019-09-12
201602-2900-037 Approved without change	Revision of a currently approved collection	2016-06-23
201301-2900-003 Approved with change	Extension without change of a currently approved collection	2013-06-26
200909-2900-012 Approved without change	Extension without change of a currently approved collection	2009-12-24
200904-2900-007 Approved without change	New collection (Request for a new OMB Control Number)	2009-05-14