Skip to Content
Your browser is out of date. To use this website, please update your browser or use a different device.
U.S. flag

An official website of the United States government

About VA Form 21-4140

Form name: Employment Questionnaire
Related to: Disability
Form last updated: August 31, 2021

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)
Last updated: