22-10278
Authorization to Disclose Personal Information to a Third Party - Education Benefits (Fillable)
VA Form 22-10278 is the U.S. Department of Veterans Affairs Authorization to Disclose Personal Information to a Third Party for education benefits. VA's form page says to use it to give VA permission to share your personal benefit or claim information with another person or organization. VA's page also says that if VA has determined you are not able to manage your own VA benefits, you can't use this form.
The form says written permission can be revoked at any time, except where VA has already acted on it, and that only one VA Form 22-10278 can be on file with VA at a time.
The PDF has five pages: instructions and the regional mailing addresses on pages 1 and 2, then Sections I to III with the claimant's details, the chosen third party, what may be shared and for how long, a security question and the signature. VA's page says you can also apply online. You can fill out the PDF free in your browser on this page and download the result without an account.
Items 1 to 7: name, Social Security number, VA file number if known, date of birth, mailing address, telephone number with an international option, and an optional email address with consent to electronic correspondence.
One person in Items 8A and 8B, or one organization and its representatives in Items 8C and 8D.
Limited information or all information. The limited choices are status of a pending claim or appeal, current benefit and rate, payment history, amount of money owed VA, change of address or direct deposit (only allowed if the claimant is a minor) and other.
Ongoing until written notice is given to VA to end it, or from the date of signing until a date you enter in MM/DD/YYYY format.
A PIN or password, one of five listed questions, or your own question, with the answer. The instructions say it is asked each time the third party contacts VA.
A certification that the statements are true and correct to the best of your knowledge and belief, the required claimant's signature in Item 13 and the date signed in Item 14.
Pages 1 and 2 explain the authorization, how to change your mind and where to send it. The form says it can be completed online or by hand, in ink, neatly and legibly.
Fill in Section I, then enter one person, or one organization with the names of its representatives, in Item 8.
Check limited or all information in Item 9, the limited choices in Item 10 if any, and the timeframe in Item 11.
Check one box in Item 12A and give the answer in Item 12B.
Sign and date Section III, keep a copy, then submit through AccessVA, mail it to the Regional Processing Office for your region, or apply online through VA's form page.
You get the real form, filled in a browser tab, with nothing standing between you and the finished PDF.
VA's form page says you can apply online instead of filling out and sending the paper form.
VA Regional Office, P.O. Box 4616, Buffalo, NY 14240-4616. Serves CO, CT, DC, DE, IA, IL, IN, KS, KY, MA, MD, ME, MI, MN, MO, MT, NC, ND, NE, NH, NJ, NY, OH, PA, RI, SD, TN, VA, VT, WI, WV, WY, APO/FPO AA, foreign schools and the US Virgin Islands.
VA Regional Office, P.O. Box 8888, Muskogee, OK 74402-8888. Serves AK, AL, AR, AZ, CA, FL, GA, HI, ID, LA, MS, NM, NV, OK, OR, PR, SC, TX, UT, WA, APO/FPO AP, Guam, the Philippines, American Samoa and the Mariana Islands.
The Mail To box above the region charts prints VA Regional Office, P.O. Box 4614, Buffalo, NY 14240 and VA Regional Office, P.O. Box 888, Muskogee, OK 74402. The region charts print the addresses above.
The form says to notify VA in writing through AccessVA, by mail, or by telephone at 1-888-442-4551. VA then stops giving out the information, except what it already gave out.
The current edition is dated DEC 2025. It carries OMB Control No. 2900-0914, which expires 12/31/2028, with an estimated burden of 5 minutes.
The form says the signed authorization can be submitted through AccessVA or mailed to the Regional Processing Office for your region.
22-0993
5 fields, 1 page
21-0845
57 fields, 3 pages
22-1990
155 fields, 7 pages
22-5490
79 fields, 7 pages
The claimant whose education benefit information is shared completes and signs it. VA's page and the form describe the limits.
No tool matches that search.
VA's form page says to use it to give VA permission to share your personal benefit or claim information with another person or organization.
VA's page says that if VA has determined you are not able to manage your own VA benefits, you can't use this form.
The form allows one person or one organization. An organization may have more than one representative, and the form asks for their first and last names.
The instructions say it cannot be used to disclose federal tax information, provide copies of letters and notifications, or allow changes to the claimant's VA record, such as address, email or direct deposit. Item 10 lists change of address or direct deposit as only allowed if the claimant is a minor.
Item 11 offers two choices: ongoing until written notice is given to VA to end it, or from the date of signing until a date you enter.
The form says to notify VA in writing through AccessVA, by mail, or by telephone at 1-888-442-4551. Information VA already gave out based on your permission is not affected.
No. The form says you can only have one VA Form 22-10278 on file with VA at a time.
Yes. VA's form page says you can apply online instead of filling out and sending the paper form.
