The releasor authorizes his/her employer to release employment references including, but limited to, his/her employment history and wages and any information which may be requested relative to his/her employment, employment applications, and other related matters, and to furnish copies of any and all records which the employer may have regarding his/her employment.
Please complete these fields in case we need to contact you about the consent form). TO: Social Security Administration.We will send you a notice, to inform you about your claim, benefit status or benefit amount. This service offers fast, free, and secure online W-2 filing options to CPAs, accountants, enrolled agents, and individuals who process W-2s. To complete this form: • Fill in the name, date of birth, and Social Security Number of the person to whom the information applies. You'll need to fill out an Application for CHAMPVA Benefits (VA Form 10-10d). Get VA Form 10-10d to download. Submit your claim on a VA Form 21-526EZ (Attached). Make sure you complete and sign your application. Please scan and upload a copy of your cover letter and supporting documents, to Orange County Human Resources Division via the secure Box.