OMB control number
Authorization to Disclose Information to a Third Party (Insurance) (VA Forms 29-0975 & 29-0975e)
OMB 2900-0856 ยท VA.
OMB 2900-0856
The VA Forms 29-0975 & 29-0975e 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 2027-04-30 and is listed under ICR 202401-2900-003.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form VA Form 29-0975 AUTHORIZATION TO DISCLOSE PERSONAL INFORMATION TO A THIRD PARTY (INSURANCE) | Form |
| SupportState(2900-0856).docx | Supporting Statement A |
| 2024-05553.pdf | Supplementary Document |
| 2024-00494.pdf | Supplementary Document |
 AUTHORIZATION TO DISCLOSE PERSONAL INFORMATION TO A THIRD PARTY (INSURANCE) |
Form |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 202401-2900-003 | Extension without change of a currently approved collection | 2024-03-18 | Approved with change | |
| 202206-2900-018 | No material or nonsubstantive change to a currently approved collection | 2022-06-24 | Approved with change | |
| 202010-2900-011 | Reinstatement with change of a previously approved collection | 2021-02-09 | Approved without change | |
| 201507-2900-007 | New collection (Request for a new OMB Control Number) | 2017-09-14 | Approved without change |