21-4142
Authorization to Disclose Information to VA
Use this when
- Authorizes a non-VA source to disclose your private health information to VA
- Covers the consent VA needs before requesting the records
VA Form 21-4142
Authorization to Disclose Information to VA
Authorizes non-VA sources to disclose relevant records or information to VA.
21-4142
Supporting Your Claim
What this form does
Authorizes non-VA sources to disclose relevant records or information to VA.
Authorizes VA to request personal information from non-VA sources in support of a benefit claim.
Official VA title: Authorization to Disclose Information to the Department of Veterans Affairs (VA)
VA revision August 18, 2024 · Links verified against VA.gov August 10, 2026
Use it when: When relevant records are held by a non-VA provider or other source and you want VA to request them. Do not submit it for records you have already provided or plan to obtain yourself, because an unnecessary request may add time.
Preparation route
How to use 21-4142
Every preparation step stays open so you can scan the whole job before starting.
Do now · 01
Before you start
- Estimated time
- 15-20 minutes
Use this form when: When relevant records are held by a non-VA provider or other source and you want VA to request them. Do not submit it for records you have already provided or plan to obtain yourself, because an unnecessary request may add time.
Waypoint · 02
Complete the form
- Your signature authorizing the release
- The person or organization allowed to disclose information
- The information VA may request
Waypoint · 03
Avoid common mistakes
- Submitting without signing — the authorization requires your signature
- Submitting it for records already sent to VA
- Omitting the paired provider information VA requests on Form 21-4142a
Go next · 04
Submit the form
Available methods
- Online
- Mail to
- Department of Veterans Affairs, Claims Intake Center, PO Box 4444, Janesville, WI 53547-4444
- Submission note
- Submit with your 21-526EZ or as additional evidence for a pending claim.
Field note
VA cannot pay fees a provider charges to release records. The combined online flow covers both the authorization and the provider details.
Which form fits?
21-4142 and 21-4142a — how do they work together?
21-4142a
Medical Provider Information
Use this when
- Identifies each non-VA provider or facility that has your records
- Lists provider addresses, treatment conditions, and treatment dates so VA can request the right records
Our recommendation
When you want VA to request private medical records, complete both roles: 21-4142 provides authorization and 21-4142a provides the medical-provider details. VA's online authorization flow collects the same information.
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