About VA Form 21-4140
- Form name: Employment Questionnaire
- Form revision date: August 2024
- Related to: Disability
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.
Download form
Download this PDF form and fill it out. Then submit your completed form on this page. Or you can print the form and mail it to the address listed on the form.
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.