21-0845

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

Agency
VA
Revision
May 2026
Fillable fields
57
Pages
3
Official source
VA form page
Checked
October 20, 2026
Fill 21-0845 online
Page 1 of form 21-0845

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

VA Form 21-0845 is the U.S. Department of Veterans Affairs Authorization to Disclose Personal Information to a Third Party. VA's form page says to use it to authorize VA to share your personal information with a non-VA (third-party) individual or organization. The instructions explain that VA needs written permission, an authorization, to use or give out claim or benefit information for any purpose not permitted by all applicable legal authorities, and that the permission can be revoked at any time, except where VA has already acted on it.

The PDF has three pages: one page of information and instructions, then the authorization in Sections I to IV. It names one person or one organization to receive the information, says whether the release covers limited or any information, and sets a security question VA asks the third party each time they contact VA. The form says it cannot be used to disclose federal tax information, and that only one VA Form 21-0845 can be on file with VA at a time.

VA's page says the authorization can also be submitted online. You can fill out the PDF free in your browser on this page and download the result without an account.

Top of page 1 of VA Form 21-0845: Authorization to Disclose Personal Information to a Third Party, as printed by VA

What's on VA Form 21-0845

Section I: Veteran's identification

Items 1 to 5 ask for the Veteran's name, Social Security number, VA file number if known, date of birth and service number if applicable.

Section II: Beneficiary or claimant

Items 6 to 9 ask for the name and address of a beneficiary or claimant who is not the Veteran, a telephone number and an optional email address, with a box to agree to electronic correspondence.

Section III, Item 10: the third party

The name and address of one person in Items 10A and 10B, or the name and address of one organization and its representatives in Items 10C and 10D.

Items 11 to 13: what is shared and for how long

Limited information, such as the status of a pending claim or appeal, money owed VA, current benefit and rate, a benefit payment letter, payment history or a change of address or direct deposit. Or any information, one time only, ongoing until written notice, or until a set date.

Item 14: security question

One of five questions, such as the name of the high school you attended or your first pet's name, with the answer in Item 14B. VA asks it each time the third party contacts VA.

Section IV: declaration and signature

A certification that the statements are true and correct to the best of your knowledge and belief, the required signature in Item 15 and the date in Item 16, followed by the Privacy Act and respondent burden notices.

How to file VA Form 21-0845

  1. 1

    Read the instruction page

    Page 1 explains each group of items, where to send the form and how to change your mind later.

  2. 2

    Fill in Sections I and II

    Enter the Veteran's details, and Section II only for a beneficiary or claimant who is not the Veteran. If completed by hand, the form asks for ink and neat, legible printing.

  3. 3

    Name the third party and what to share

    Enter one person or one organization in Item 10, check Limited or Any information in Item 11, then complete Item 12 or Item 13.

  4. 4

    Pick a security question

    Check one question in Item 14A and write the answer in Item 14B.

  5. 5

    Sign, date and copy it

    Sign Item 15, which the form marks as required, and date Item 16. The form says to make a copy of the signed authorization for your records before mailing it.

  6. 6

    Mail it or submit online

    Mail it to the Evidence Intake Center in Janesville, Wisconsin, or submit it online through VA.gov or Direct Upload via access.va.gov.

Why fill Form 21-0845 on indox

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  • The official blank straight from the VA, not a copy someone retyped
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Where to send it and changing your mind

By mail

Department of Veterans Affairs, Evidence Intake Center, PO Box 4444, Janesville, WI 53547-4444.

Online

The form lists VA.gov (www.va.gov) and Direct Upload via access.va.gov. VA's form page says you can submit your authorization online instead of sending the paper form.

Changing your mind

The form says you may notify VA in writing, by telephone at 1-800-827-1000, or online at ASK VA: https://ask.va.gov. VA then stops giving out the information, except what it has already given out based on your permission.

Edition

The May 2026 edition supersedes the FEB 2023 edition. It carries OMB Approved No. 2900-0736, which expires 05/31/2029, and a respondent burden of 5 minutes.

Related forms

Who uses VA Form 21-0845?

  • Veterans

    A Veteran who wants VA to release personal benefit or claim information to a third party fills in Section I and signs Item 15.

  • Beneficiaries or claimants who are not the Veteran

    Section II, Items 6 to 9, holds the identification of a beneficiary or claimant who is not the Veteran. Section I still identifies the Veteran.

  • The third party who receives the information

    The one person or one organization named in Item 10. An organization also lists one or more of its representatives by name. The form says the name in Item 6 cannot be the same as in Item 10.

  • Not for beneficiaries rated incompetent

    The form says it may not be executed by any beneficiary recognized as incompetent for VA purposes, nor can VA accept it from one.

The form and its instructions describe who fills in which parts and who receives the information.

Official sources and the blank

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Questions about Form 21-0845

What is VA Form 21-0845 used for?

VA's form page says to use it to authorize VA to share your personal information with a non-VA (third-party) individual or organization.

Can I name more than one person?

The instructions say you may select only one person or one organization. An organization may have more than one representative, and the form asks for the first and last name of each.

How long does the authorization last?

With Any information checked, Item 13 offers one time only, ongoing until written notice is given to VA, or from the date of signing until a date you enter. The instructions say to use Item 13 if you do not want it effective indefinitely.

How do I cancel it?

The form says you may notify VA in writing, by telephone at 1-800-827-1000, or online at ASK VA: https://ask.va.gov. Information VA has already given out based on your permission is not affected.

Can VA Form 21-0845 be used for tax information?

No. The instructions say this form cannot be used to disclose federal tax information to third parties.

Can I have more than one VA Form 21-0845 on file?

No. The form says you can only have one VA Form 21-0845 on file with VA at a time.

Can I submit it online?

Yes. VA's form page says you can submit your authorization online instead of sending the paper form, and the form lists Direct Upload via access.va.gov.