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Appointment of Representative and Authorization to Disclose Information

Provide authorization to an individual to release information protected under the Federal Privacy Act. This form is not valid to designate a representative for the Appeals process (there is a separate form in the forms list for the appeals process).

The information that you are asked to provide on the form is as follows. You must have this information available to complete the form properly.

  • Your name, signature and date
  • The name of the person that you are authorizing to receive information on your behalf
  • The date that you would like the consent to expire
  • Your sponsor number (the social security number of the family member who served)

 

Authorization+to+Disclose+Information.pdf | 71 KB

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