Department of veterans affairs, legal, united states federal legal forms and united states legal forms. Request for dd 214 or other military records nara sf 180. The va form 21 4142 is known as an authorization and consent to release information to the department of veterans affairs va. Va form 21 4142, authorization and consent to release information to the va. This form will be used by the united states department of veterans affairs. Sign, fax and printable from pc, ipad, tablet or mobile. Make them reusable by making templates, add and fill out fillable fields. It may be requested by the department for someone who is filing a va disability claim. Make them reusable by creating templates, include and complete fillable fields.
Complete and sign va form 21 4142, authorization to disclose information to the department of veterans affairs va and va form 21 4142a, general release for medical provider information to the department of veterans affairs va, identifying any private medical records you wish va. Video instructions and help with filling out and completing va form 21 4142. Home va commonly used forms va compensation and pension forms va form 21 0958 notice of disagreement. Veterans signature do not print supersedes va form 21 526b, may 2010, which will not be used. Fill out, securely sign, print or email your va form 21 4142 2012 instantly with signnow. The most secure digital platform to get legally binding, electronically signed. Fill out the authorization to disclose information to the department of veterans affairs online and print it out for free. This form is used by the united states department of veterans affairs. I am getting ready to file another claim but am not using the vso i had in jan. Approve documents using a legal digital signature and share them by way of email, fax or print. Records to be released to the department of veterans affairs va. The veterans benefits administration vba uses va form 21 4142, authorization to disclose information to the department of veterans affairs va, to request private medical records and information regarding the source of records in support of claims for compensation andor pension benefits.
Download fillable va form 21 686c in pdf the latest version applicable for 2020. Fill out forms electronically working with pdf or word format. Va form 21 4142 fill online, printable, fillable, blank pdffiller. This site provides public access to all va forms that are appropriate to be on the web.
A va form 21 4142 is a united states department of veteran affairs form used to authorize and provide consent for the release of medical information to the va. Sign, fax and printable from pc, ipad, tablet or mobile with pdffiller. Va form 21 4142 authorization for release of information. Home va commonly used forms va compensation and pension forms va form 21 4142 authorization for release of information. Fill out documents electronically working with pdf or word format. On part b of va form 21 526, veterans application for compensation and pension, tell us the name and address of the person, medical facility, company or agency that has these records. Download fillable va form 21 4192 in pdf the latest version applicable for 2020. The most secure digital platform to get legally binding. The va form 21 41401 is used by the department of veterans affairs and department of defense in the united states.
Existing stocks of the va form 214142, jan 2011, will be used. Va form 21686c download fillable pdf or fill online. This notice of disagreement is used to initiate an appeal from a va. Search va forms authorization to disclose information to the department of veterans affairsva fillable file type. Veterans signature do not print supersedes va form 21 526b, jul 2009, which will not be used. Apply for and manage the va benefits and services youve earned as a veteran. The most secure digital platform to get legally binding, electronically signed documents in just a few. Va form 214142 authorization for release of information. When the va grants you your tdiu benefits, you should verify that the effective date is correct. General release for medical provider information to the department of veterans affairs va fillable file type. When you have completed this form, mail it to the address in the letter on page 1, or fax it, or take it to your. General release for medical provider information to the. If you are unable to find your form here, you may want to visit.
Va form 21 4142 authorization and consent to release information to the department of veterans affairs va 450k va form 21 0958 notice of disagreement 3,308k va form 21 0845 authorization to disclose personal information to a third party 617k va form. If you would like to have va request your private treatment records, please attach a va form 21 4142. A va form 21 2690 is known as an examination for housebound status or permanent need for regular aid and assistance. Please print the information requested in ink, neatly and legibly to help process the form. Va form 214192 download fillable pdf or fill online. Va form 21 4142a, general release for medical provider information to the department of veterans affairs va, where appropriate. Fillable va form 2141401 free printable pdf sample. This form is commonly used by veterans to authorize your health care providers to disclose and release all medical records to the va. Approve forms using a lawful electronic signature and share them by way of email, fax or print.
At the end of the 21 526, you will find a va form 21 4142. Va form 21 4142, authorization to disclose information to the department of veterans affairs va, and. Get and sign va form 21 4142 2012 fill out and sign. Records to be released to the department of veterans affairs va veteran identification information. Benefit from a electronic solution to create, edit and sign documents in pdf or word format on the web. If you have filed a va form 21 8940 more than once, the va might incorrectly use a date of one of those va. Download fillable va form 21 48 in pdf the latest version applicable for 2020. Va form 214142 veterans benefits administration veterans affairs. Turn them into templates for numerous use, add fillable. Va form 214142 cant print it veterans benefits network. Fill out the request for employment information in connection with claim for disability benefits online and print it out for free.
Sf form 180 request pertaining to military records. Va form 21 4142 cant print it va form 21 4142 cant print it. Submit your claim on a signed and completed va form 21 527ez, application for pension attached. Please print the information required in ink, neatly, and legibly to help process the form.
Complete and sign va form 21 4142, authorization to disclose information to the department of veterans affairs va and va form 21 4142a, general release for medical provider information to the department of veterans affairs va, identifying any private medical records you wish va to request for you. Fill out, securely sign, print or email your va form 21 4140 20112019 instantly with signnow. I have read both pages of this form and agree to the disclosures above from the types of sources listed. Last name first name middle name of veteran type or print. And what is the difference between these two forms. Fill out blank fields, edit and save completed document.
Fdc criteria claims for veterans non serviceconnected pension benefits 1. Fill out, securely sign, print or email your va form 21 4142 example instantly with signnow. Fill out the statement in support of claim online and print it out for free. Fill out the declaration of status of dependents online and print it out for free.
Va 214142 2014 2019 printable and fillable, blank pdf. Va form 21 4140 fill out and sign printable pdf template. Authorization to disclose information to the department of veterans affairs va fillable file type. Apply for and manage the va benefits and services youve earned as a veteran, servicemember, or family memberlike health care, disability, education, and more. Form va 214142 authorization and consent to release. Va form 214142 download fillable pdf or fill online. Use va form 21526 to apply for compensation andor pension benefits.
569 1231 46 1121 1342 1152 1075 969 402 1522 199 1501 1392 118 113 884 611 350 1209 1377 1373 494 1016 1463 757 864 916 529 791 461 242