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Get Veteran's Personal Data Information Sheet Please Complete Both ...

E current information on file. Drop off this form in person or mail to our Poughkeepsie Office. Please attach a copy of your Military Separation Papers. Date form completed: PLEASE PRINT PLEASE PRINT VETERAN S Last Name VETERAN S First Name VETERAN S Middle Name VETERAN S Social Security Number VETERAN S Claim Number County of Residence Current Address Current City Current State Current Zip Code Area Code & Telephone Number(s) Home: ( ) - Cell: ( ) -.

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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.

VIS provides access to disability rating and award, benefits provided, benefit payment information from the VBA Corporate Database, and beneficiary information from VBA's Beneficiary Identification and Locator System (BIRLS, now part of VBA Corporate DB) for Veterans and Service members.

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.

Use VA Form 21-4142a to give us permission to get medical provider information from a non-VA source like a private doctor or hospital. This will allow us to gather information like the name and address of a facility and your medical treatment dates.

You can change your address, phone number, or email address online from your VA.gov profile. Use the edit button that's next to the information you want to change.

The paperless, electronic claims submission process on eBenefits allows you to fill out your application, upload all required documentation, and submit your claim with ease.

You can only have one VA Form 21-0845, Authorization to Disclose Personal Information to a Third Party, on file with VA at a time.

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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