Authorization to Disclose Information to a Third Party (Insurance) (VA Forms 29-0975 & 29-0975e)

This form will be used by the Department of Veterans Affairs Insurance Center (VAIC) to enable a third party to act on behalf of the insured Veteran/beneficiary. Many of our customers are of advanced age or suffer from limiting disabilities and need assistance from a third party to conduct their affairs. The information collected provides an optional service and is not required to receive insurance benefits.

The latest form for Authorization to Disclose Information to a Third Party (Insurance) (VA Forms 29-0975 & 29-0975e) expires 2020-11-30 and can be found here.