Va Form 3288 PDF Details

When individuals or their authorized representatives need to request the release of personal information from the records held by the Department of Veterans Affairs (VA), they turn to the VA Form 3288. This form plays a critical role in ensuring that such requests are handled in a manner compliant with the law, particularly under the aegis of privacy and data protection norms established by the Privacy Act of 1974 and relevant VA confidentiality statutes. Notably, the form explicitly clarifies that its execution is strictly limited to the information detailed in the request, underscoring a commitment to privacy and consent. Prospective respondents are reminded of the voluntary nature of this disclosure, though failure to furnish requested details may impede the VA's ability to fulfill the request. With an average completion time of just 7.5 minutes, the form respects the user's time while still upholding rigorous standards for data handling and privacy. Beyond its immediate function, the form also serves as a touchpoint for broader discussions on privacy, consent, and the ethical stewardship of veterans' information. This careful balance reflects a nuanced understanding of the importance of both serving veterans' needs and safeguarding their personal information against unauthorized disclosure, a principle clearly articulated in the various sections of the form from the initial consent through to the detailed directions for submitting comments to the VA Clearance Officer, thereby ensuring both efficacy and compliance in the handling of sensitive information.

QuestionAnswer
Form NameVa Form 3288
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesva form 3288, request consent, printable va form 3288, va form 21 3288

Form Preview Example

Form Approved: OMB No. 2900-0028

Respondent Burden: 7.5 minutes

REQUEST FOR AND CONSENT TO RELEASE OF INFORMATION FROM INDIVIDUAL'S RECORDS

PRIVACY ACT STATEMENT: The execution of this form does not authorize the release of information other than that specifically described below. The information requested on this form is solicited under Title 38, United States Code, and will authorize release of the information you specify. The information may also be disclosed outside VA as permitted by law to include disclosure as stated in the "Notices of Systems of VA Reocrds" published in the Federal Register in accordance with the Privacy Act of 1974.

RESPONDENT BURDEN: VA may not conduct or sponsor, and the respondent is not required to respond, to this collection of information unless it displays a valid OMB Control Number. The Privacy Act of 1974 (5 U.S.C. 552a) and VA's confidentiality statute (38 U.S.C. 5701) as implemented by 38 CFR 1.526(a) and 38 CFR 1.576(b) require individuals to provide written consent before documents or information can be disclosed to third parties not allowed to receive reocrds or information under any other provision of law. The information requested is approved under OMB Control Number 2900-0025 and is necessary to ensure that the statutory requirements of the Privacy Act and VA's confidentiality statute are met.

Responding to this collection of information is voluntary. However, if the information is not furnished, we may not be able to comply with your request. Public reporting burden for this collection is estimated to average 7.5 minutes per respondent, including the time for reviewing instructiions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspects of this collection of Information, including suggestions for reducing this burden, to the VA Clearance Officer (005E3), 810 Vermont Avenue, NW, Washington, DC 20420. Send comments only. Do not send this form or requests for benefits to this address.

TO

Department of Veterans Affairs

NAME OF INDIVIDUAL (Type or print)

VA FILE NO. (Include prefix)

SOCIAL SECURITY NUMBER

 

 

NAME AND ADDRESS OF ORGANIZATION OR INDIVIDUAL TO WHOM INFORMATION IS TO BE RELEASED

VETERAN'S REQUEST

I hereby request and authorize the Department of Veterans Affairs to release the following information from the records identified above to the organization, agency, or individual named hereon:

NAME

INFORMATION REQUESTED (Number each item requested and give the dates or approximate dates - period from and to - covered by each.)

PURPOSE(S) FOR WHICH THE INFORMATION IS TO BE USED.

NOTE: Additional information may be listed on the reverse side of this form.

SIGNATURE OF INDIVIDUAL OR PERSON AUTHORIZED TO SIGN FOR INDIVIDUAL (Attach authority to sign, e.g., POA)

DATE

VA FORM

3288

AdobeFormsDesigner

OCT 1995(R)

 

 

Form Approved: OMB No. 2900-0028

Respondent Burden: 7.5 minutes

REVERSE OF VA FORM 3288, OCT 1995 (R)

AdobeFormsDesigner

 

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