Welcome back to Veterans Benefits Done Right. This is Chris Hon and in this video, we're going to discuss form 21-41-42, which is the Authorization Consent to Release Information to the Department of Veterans Affairs. You will need to fill out this form and submit it to the VA. You can download a copy from the website VA.gov or use the copy we have in our workbook. Before we start, I want to let you know that you have controls in this video. You can stop, start, pause, or go back if you missed something and want to hear it again. Now, let's begin. We'll start at the top of the form. The top section provides information on how long it may take you to complete the form. If you have any questions or don't understand anything in this video, feel free to call the VA toll-free at 1-877-1000. Section 1 is called Veteran Claimant Identification. This section requires you to provide your last name and file number. If you don't have a file number, use your social security number. If you've never filed a claim before, leave it blank. The form also asks for the claimant's name if it's not the veteran filling out the form. Provide the last, middle, and first name, as well as the social security number. If you're not the veteran, specify your relationship to the veteran and provide your own social security number. Moving on to Section 2, this is where you'll list the name and address of the sources, such as the physician, hospital, or clinic. Make sure to provide all the necessary information, including the zip code and telephone number. It's important to be thorough and legible to avoid any issues or discrepancies with the information. That's all for now.
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Va release of ination to third party Form: What You Should Know
The contractor will be bound by confidentiality requirements if they wish to access your information or request information from VA. You will have to agree not to reveal the information to third party third parties without first receiving written authorization from the Secretary of Veteran Affairs. VA Form 3286, REQUEST FOR AND CONSENT TO I hereby request and authorize the Department of Defense or its agencies to release this information to the organization authorized to receive my benefit information.  The organization to receive my benefit information must be designated by me under the Federal Employees Health Benefits Program. This form is provided to you “as is” without warranty of any kind, whether express or implied, including but not limited to the warranties of merchantability, fitness for a particular purpose, title, and noninfringement, and without any warranty or representation of any kind as to the accuracy or completeness of the information provided. The data provided will be subject to the Privacy Act of 1974, as amended. This agreement gives you specific rights and only those rights as are set forth in the Privacy Act. Unless otherwise specified in this agreement, your information may be subject to the regulations and disclosure requirements of the Privacy Act. However, VA may obtain certain information about you from the Department of Defense pursuant to an emergency authorization, and such authorization shall limit your rights under the Privacy Act. 11 If at any time you do not consent to VA sending your information, you may notify the Department within 30 days of VA sending such notification. VA will not disclose to the third party or you any information about you unless you specifically agree in writing. Use VA Form 5245, Request for and Consent to Release Information I hereby request and authorize the Department of Justice to release all the information described in paragraphs 1 through 7 listed above, to the organization, or individuals designated by me, under the Federal Employees Health Benefits Program, under the Emergency Federal Employee Health Compensation Program, and under any other Federal benefits program or authority to receive information requested, on any date to the extent that they are deemed necessary by the Secretary of Veterans Affairs or the Department of Defense, or by any other federal agencies upon request (or upon their own determination if they do not receive prior notice from VA), in order to assist or protect Veterans or any other individual from imminent danger or imminent danger of death or serious physical injury.
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Video instructions and help with filling out and completing Va release of information to third party
