Privacy Act and respondent burden notice
The opening text explains the consent rules under the Privacy Act and 38 U.S.C. 5701, OMB Control Number 2900-0028 and an average burden of 7.5 minutes per respondent.
VA3288
Request for and Consent to Release Information from Individual's Records
- Agency
- VA
- Revision
- October 1995
- Fillable fields
- 11
- Pages
- 2
- Official source
- VA form page
- Checked
- October 20, 2026
VA Form VA3288: Request for and Consent to Release Information from Individual's Records
VA Form VA3288 is the U.S. Department of Veterans Affairs Request for and Consent to Release Information from Individual's Records. The individual named on the form requests and authorizes VA to release specific information from their VA records to an organization, agency or individual they name. The Privacy Act statement says signing the form does not authorize the release of information other than that specifically described on it.
The form explains that the Privacy Act of 1974 and VA's confidentiality statute (38 U.S.C. 5701) require individuals to provide written consent before documents or information can be disclosed to third parties not allowed to receive records or information under any other provision of law. It says responding is voluntary, but if the information is not furnished, VA may not be able to comply with the request.
The PDF has two pages: the request on page 1 and a reverse side where additional information may be listed. VA's form page offers the PDF only. 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 VA3288
TO block and identification
The Department of Veterans Affairs TO space, the name of the individual (type or print), the VA file number (include prefix) and the Social Security number.
Recipient
The name and address of the organization or individual to whom the information is to be released.
Information requested
Under the Veteran's request, the form asks to number each item requested and give the dates or approximate dates, the period from and to, covered by each.
Purpose of the release
A box for the purpose or purposes for which the information is to be used. A note says additional information may be listed on the reverse side.
Signature and date
The signature of the individual or person authorized to sign for the individual, with the authority to sign attached, and the date.
How to complete VA Form VA3288
- 1
Identify the records
Fill in the TO space, then type or print the individual's name and enter the VA file number with its prefix and the Social Security number.
- 2
Name the recipient
Enter the name and address of the organization or individual to whom the information is to be released.
- 3
List what to release
Number each item requested and give the dates or approximate dates, from and to, covered by each. Additional information may go on the reverse side.
- 4
State the purpose
Write the purpose or purposes for which the information is to be used.
- 5
Sign and date it
The individual signs, or a person authorized to sign for the individual signs and attaches the authority to sign, for example a POA. Enter the date.
Why fill Form VA3288 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
No address on the form
VA Form VA3288 prints no mailing address, email or fax number for the completed request. VA's form page offers the PDF only.
Comments only
The burden notice lists the VA Clearance Officer (005E3), 810 Vermont Avenue, NW, Washington, DC 20420 for comments only. The form says not to send this form or requests for benefits to this address.
Scope of the consent
The form says signing it does not authorize the release of information other than that specifically described on it.
Edition
The PDF footer reads VA FORM OCT 1995(R) 3288, and VA's form page lists a form revision date of October 1995. It carries OMB No. 2900-0028.
Related forms
21-0845
Authorization to Disclose Personal Information to a Third Party (VA Form 21-0845)
57 fields, 3 pages
10-5345
Request for and Authorization to Release Health Information
61 fields, 2 pages
10-5345a
Individuals' Request for a Copy of Their Own Health Information
43 fields, 1 page
20-10206
Freedom of Information Act (FOIA) or Privacy Act (PA) Request (VA Form 20-10206)
96 fields, 4 pages
VA0710
Authorization for Release of Information—Protected Under the Fair Credit Reporting Act (Title 15, Section 1681)
6 fields, 1 page
Who uses VA Form VA3288?
The form names the people and offices involved in the release.
Official sources and the blank
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Questions about Form VA3288
What is VA Form VA3288 used for?
The individual named on it requests and authorizes VA to release specific information from their VA records to an organization, agency or individual named on the form.
Does it let VA release all of my records?
The Privacy Act statement says signing the form does not authorize the release of information other than that specifically described on it.
Can someone else sign VA Form VA3288?
The signature line reads Signature of Individual or Person Authorized to Sign for Individual, and asks to attach the authority to sign, for example a POA.
How should the requested information be listed?
The form says to number each item requested and give the dates or approximate dates, the period from and to, covered by each.
Is filling out the form required?
The form says responding is voluntary, but if the information is not furnished, VA may not be able to comply with the request.
Can I submit VA Form VA3288 online?
VA's form page offers a downloadable PDF and lists no online version of the form.
Where do I send the completed form?
The form prints no address for the completed request. The Washington, DC address in the burden notice is for comments only, and the form says not to send the form there.