About VA Form 21-4140
- Form name: Employment Questionnaire
- Related to: Disability
- Form last updated: June 2022
When to use this form
Use VA Form 21-4140 if we asked you to verify your employment status because you currently receive Individual Unemployability disability benefits for a service-connected condition.
Downloadable PDF
Download VA Form 21-4140 (PDF)Helpful links related to VA Form 21-4140
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Find out if you qualify for compensation for a presumptive disability or other service-connected conditions.
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Find out how to file a claim for disability compensation or increased disability compensation.
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Find out if you need to complete additional forms for your disability claim.
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Find out how to file for VA Individual Unemployability compensation if you're an unemployed Veteran who can't work due to a service-connected disability.