Authorization To Disclose Personal Information To A Third Party (insurance)

Authorization to Disclose Information to a Third Party (Insurance) (VA Forms 29-0975 & 29-0975e)

OMB: 2900-0856

IC ID: 220731

Documents and Forms
Document Name
Document Type
Form
Form
Form
Form
Form
Information Collection (IC) Details

View Information Collection (IC)

AUTHORIZATION TO DISCLOSE PERSONAL INFORMATION TO A THIRD PARTY (INSURANCE)
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form VA Form 29-0975 Authorization to Disclose Personal Information to a Third Party 29-0975(3-28-24).pdf www.va.gov/vaforms Yes No Fillable Printable
Form VA Form 29-0975e (DocuSign) Authorization to Disclose Personal Information to a Third Party 29-0975e (DocuSign)(3-28-24).pdf Yes No Fillable Printable

General Government Legislative Functions

36VA00, Veterans and Armed Forces Personnel U.S. Government Life Insurance Records - VA  89 FR 2480

1,200 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 1,200 0 0 0 0 1,200
Annual IC Time Burden (Hours) 100 0 0 0 0 100
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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