Va form 21 4192 1994-2025

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The document is a VA Form 21-4192, titled 'Request for Employment Information in Connection with Claim for Disability Benefits.' It is used to collect employment information from an employer regarding a veteran who has filed a claim for disability benefits. The form requires details about the veteran's employment history, earnings, time lost due to disability, and any benefits received. It emphasizes the importance of providing accurate information to assist in determining the veteran's benefit entitlement.

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Click ‘Get Form’ to open VA Form 21-4192 in the editor.
Begin by completing Section I, which includes the employer's name and address, as well as the veteran's full name, social security number, and VA file number.
Move to Section II. Here, the employer should provide employment details such as the beginning and ending dates of employment, total earnings in the last 12 months before deductions, and any time lost due to disability.
Fill in the type of work performed and specify the number of hours worked daily and weekly. If applicable, note any concessions made for age or disability.
In Section III, indicate if the veteran is receiving any benefits related to their employment. If yes, complete details about the type of benefit and its gross monthly amount.
Finally, ensure that Items 21A and 21B are signed and dated by the employer or supervisor before submitting.

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Versions	Form popularity	Fillable & printable
2021	4.8 Satisfied (147 Votes)
2017	4.3 Satisfied (198 Votes)
2015	4.3 Satisfied (64 Votes)
2010	4.2 Satisfied (54 Votes)
2004	4.3 Satisfied (67 Votes)
1994	4 Satisfied (47 Votes)

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Who can help me fill out VA forms?

An accredited attorney, claims agent, or Veterans Service Organization (VSO) representative can help you file a claim or request a decision review. Learn how to find and appoint one of these types of accredited representatives to help you.

What is the VA form 21-4192 used for?

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.

Does the VA contact previous employers Tdiu?

If you decide to file a TDIU claim, youll need to submit a VA Form 21-8940. Based on the information you provide in Form 21-8940, the VA will automatically generate and send a VA Form 21-4192 to your most recent employer. The VA will send you a copy as well.

Do you have to file for TDIU?

To receive TDIU benefits, the veteran must apply for disability compensation and fill out two additional forms: Veterans Application for Increased Compensation Based on Unemployability (Form 21-8940) Request for Employment Information in Connection with Claim for Disability Benefits (Form 21-4192)

Do I need to fill out VA form 21-4192?

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.

21 4192

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What if my employer wont fill out the VA form 21-4192?

The VA cant deny your unemployability claim if your former employer fails to complete VA Form 21-4192. The form is not absolutely necessary to receive a favorable decision on your TDIU claim. Many veterans have succeeded with their TDIU claim without a 21-4192. However, without the form, the process could be delayed.

Va form 21 4192 1994-2025

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What if my employer wont fill out the VA form 21-4192?

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