Valid OMB control numbers can be located on the OMB Internet Page at www 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out Section I, which requires your identification details. Enter the veteran's last name, first name, and middle name, followed by their VA file number and social security number.
3. In Section II, provide the source of information. List the name and address of the physician or hospital along with treatment dates and conditions being treated.
4. Proceed to Section III. Carefully read through the consent paragraphs before signing. Ensure you check the appropriate statement regarding authorization for information release.
5. Finally, sign and date the form in Section III. Make sure to include your mailing address and telephone number for any follow-up communication.

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