Facility name blanks
Two spaces marked Insert Facility Name, for the VA facility that will access and verify the signer's background and make the inquiries.
10-0459
Credentialing Release of Information Authorization
- Agency
- VA
- Revision
- January 2008
- Fillable fields
- 5
- Pages
- 1
- Official source
- VA form page
- Checked
- October 20, 2026
VA Form 10-0459: Credentialing Release of Information Authorization
VA Form 10-0459 is the U.S. Department of Veterans Affairs Credentialing Release of Information Authorization, listed under VHA on VA's form page. The person signing it authorizes a named VA facility to access and verify their educational background, professional qualifications and suitability for appointment, and to make inquiries with persons, places of employment, education, malpractice carriers, State licensing boards and other government and non-governmental entities.
The form is one page with no separate instructions. It has two blanks for the facility name, four paragraphs of authorization and release wording, and lines for the full name, date and signature. It refers to the signer's fitness for Federal appointment and the privileges the signer has requested, so it is a credentialing form for people applying to work at VA, not a Veterans benefit application.
You can fill out the PDF free in your browser on this page and download the result without an account.
What's on VA Form 10-0459
Authorization to make inquiries
The first paragraph covers the signer's educational background, professional qualifications and suitability for appointment, and information bearing on moral, ethical and professional qualifications and competence.
Consent to release information
The second paragraph consents to release of information about the signer's ability and fitness for Federal appointment, each lawsuit, civil action or other claim for malpractice or negligence, each disciplinary action under consideration or taken, open or concluded investigations and credential status changes.
Disclosure and release from liability
The signer authorizes VA to disclose identifying and other information sufficient to make the inquiries, and releases from liability all those who provide information to VA in good faith and without malice.
Name, date and signature
Lines for the signer's full name, the date and the signature at the bottom of the page.
How VA Form 10-0459 is completed
- 1
Enter the facility name
Fill in both Insert Facility Name blanks with the name of the VA facility doing the credentialing.
- 2
Read the four paragraphs
They describe what the facility may ask about, what may be released to VA officials and what VA may disclose to make its inquiries.
- 3
Enter your full name and date
Fill in the Full Name and Date lines at the bottom of the form.
- 4
Sign the form
Sign on the Signature line below your name.
Why fill Form 10-0459 on indox
You get the real form, filled in a browser tab, with nothing standing between you and the finished PDF.
- Fill the form right in your browser, no software to install
- Free to fill and free to download, with no account
- The official blank straight from the VA, not a copy someone retyped
- Works on a phone, tablet or computer
Where it goes and edition
Where it goes
The form prints no mailing address, fax number or submission instructions. It names the VA facility entered in the Insert Facility Name blanks.
Notices
The PDF prints no OMB control number, Privacy Act notice or burden estimate.
Edition
The footer reads VA FORM JAN 2008, matching the January 2008 revision date on VA's form page.
Related forms
Who uses VA Form 10-0459?
The form's wording names these people and organizations.
Official sources and the blank
Do it all with indox
No tool matches that search.
Questions about Form 10-0459
What is VA Form 10-0459?
It is the Credentialing Release of Information Authorization, a one page VHA form in which the signer authorizes a VA facility to verify their educational background, professional qualifications and suitability for appointment.
Who signs VA Form 10-0459?
The person whose credentials are being verified, on the Full Name, Date and Signature lines. The form refers to the privileges that person has requested and their fitness for Federal appointment.
What information can be released to VA?
The form lists information on each lawsuit, civil action or other claim for malpractice or negligence, each disciplinary action under consideration or taken, any open or previously concluded investigations and any changes in the status of a credential.
Who can the VA facility contact?
The form names persons, places of employment, education, malpractice carriers, State licensing boards and other similar government and non-governmental entities who have or may have relevant information.
Does the form protect people who give information?
The form says the signer releases from liability all those who provide information to the Department of Veterans Affairs in good faith and without malice in response to such inquiries.
Is VA Form 10-0459 a Veterans benefit form?
No. VA's page lists it under VHA, and the form is about verifying a person's qualifications for Federal appointment and requested privileges.