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2021 3.5 Satisfied (30 Votes)
2019 4.8 Satisfied (253 Votes)
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When to use this form. Use VA Form 21-4192 if youre a Veteran and you need your most recent employer to send us information so you can apply for Individual Unemployability disability benefits. Your most recent employer must complete and submit this form.
Supplemental Information Forms VA Form 21-8049 - Request for Details of Expenses. VA Form 21P-8416 - Medical Expense Report. VA Form 21P-8416b - Report of Medical, Legal, and Other Expenses Incident to Recovery for Injury or Death. VA Form 21-0516 - EVR Veteran with No Children. VA Form 21-0517 - EVR Veteran with Children.
Complete VA Form 21-4142, Authorization to Disclose Information to the Department of Veterans Affairs (VA) and VA Form 21-4142a, General Release for Medical Provider Information to the Department of Veterans Affairs (VA); submit completed forms with your claim and VA will attempt to obtain your records through our
The VA Form 21-4142 is valid for 12 months from the date signed. It is permissible to authorize release of, and disclose, information created after the consent is signed.
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