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  • Va Form 21 4171 2020

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Authorization to Disclose Personal Information to a Third Party. Related to: Burials and memorials, Careers and employment, Disability, Education and training, Health care, Housing assistance, Life insurance, Pension, Records. Form last updated: January 2023.

VA Form 21P-4171 is used to gather information that is needed to determine veteran's spouses' eligibility for benefits based on a common law marital relationship. The latest form for Supporting Statement Regarding Marriage (VA Form 21P-4171) expires 2021-03-31 and can be found here.

a spouse based on common-law marriage VA Form 21-4170, Statement of Marital Relationship, and VA Form 21P-4171, Supporting Statement Regarding Marriage. Note: The above referenced forms must be submitted in addition to VA Form 21-686c.

When to use this form. Use VA Form 21-4142 to give us permission to obtain your personal information from a non-VA source like a private doctor or hospital. Examples of personal information may include your medical treatment, hospitalizations, psychotherapy, or outpatient care.

So, if you are writing a buddy statement for a family member with PTSD, you might write, “My brother, [Veteran], currently shows signs of anger issues, anxiety, panic attacks, and insomnia. He has angry outbursts about three times per week.” Be sure to only include facts like this if you know that they're true.

VA Form 21-10210 is used to provide information about an in-service injury or to give an update on the current severity of their service-connected conditions. However, VA form 21-4138 is no longer in use and the VA Form 21-10210 has been updated to replace it.

Use VA Form 21-0781a if you've been diagnosed with PTSD related to or because of personal assault, and you want to apply for related benefits or services.

If you would like to submit an additional statement on your own behalf or if you have more than one witness writing on your behalf, use a separate form (VA Form 21-10210) for each statement.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232