Get the up-to-date VA Form 21-4142-2025 now

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The document is a VA Form 21-4142, which serves as an authorization for veterans to disclose their medical information to the Department of Veterans Affairs (VA) for the purpose of processing claims. It includes sections for veteran identification, patient identification, sources of medical records, and specific records to be released. The form emphasizes the importance of providing accurate information and outlines the privacy regulations under which the VA operates. It also provides instructions for submission and contact information for assistance.

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Where do I send my VA Form 21a?

Step 3: Submit your VA Form 21a and any attachments to OGC (Please only choose 1 method of submission): Mail: Office of the General Counsel (022D), 810 Vermont Avenue, NW, Washington, DC20420.

Who must the VA form 21 4192 be sent to?

When to use this form. Use VA Form 21-4192 if youre a Veteran and you need your most recent employer to send us information so you can apply for Individual Unemployability disability benefits. Your most recent employer must complete and submit this form.

How to submit VA form 21 4142a?

After completing the form, mail to: Department of Veterans Affairs, Evidence Intake Center, P.O. Box 4444, Janesville, WI 53547-4444. NOTE: You may complete the form online or by hand.

What is the difference between 4142 and 4142a?

While the VA has direct access to medical records from VA facilities, it does not automatically retrieve records from private doctors, specialists, or hospitals. Thats where VA Forms 21-4142 (Authorization to Disclose Information) and 21-4142a (General Release for Medical Provider Information) come into play.

Where do I send my VA claim form?

Department of Veterans Affairs. Evidence Intake Center. PO Box 4444. Janesville, WI 53547-4444.

What is the VA form 21-4142 used for?

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.

What is the difference between 21-4142 and 21 4142a?

Complete 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); submit completed forms with your claim and VA will attempt to obtain your records through our

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