Who needs a VA Form 21-4142?
A VA Form 21-4142 is known as an Authorization and Consent to Release Information to the US Department of Veteran Affairs. It is filled out by the citizens who are going to claim a disability. The form VA 21-4142 will be used by the Department of Veteran Affairs for processing and reviewing disability or medical claims filed by US Army veterans.
What is VA Form 21-4142 for?
The completion of the Authorization and Consent to Release Information form provides permission to obtain medical records from the claimant physician or healthcare provider to the Veteran’s Administration.
Is VA Form 21-4142 accompanied by other forms?
This fillable VA 21-4142 form is used as a supplement itself, preceding submission of a claim for VA benefits.
When is VA Form 21-4142 due?
The Authorization form is in effect for 12 months. However, the Authorization and Consent can be revoked by the claimant when considered necessary. If the revocation doesn’t happen, the authorization will automatically expire in 12 months after the date indicated in the form.
How do I fill out VA Form 21-4142?
The information to provide on the VA Form 21-4142 must clearly indicate:
- Veteran/Claimant Identification (name, date of birth, SSN)
- Source of Pertinent Information (identification of the medical treatment provider and its contact information, dates of treatment, disabilities)
- Consent to Release Information (signature, mailing address, date, etc.)
Where do I send VA Form 21-4142?
The properly filled out VA 21-4142 Form must be submitted to the local VA office.