About VA Form 21-4192
- Form name: Request for Employment Information in Connection with Claim for Disability Benefits
- Related to: Disability
- Form last updated: June 2022
When to use this form
Use VA Form 21-4192 if you’re 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.
Downloadable PDFDownload VA Form 21-4192 (PDF)
Related forms and instructions
VA Form 21-8940
Form name: Veteran's Application for Increased Compensation Based on Unemployability
Use VA Form 21-8940 if you want to apply for Individual Unemployability disability benefits for a service-connected condition that prevents you from keeping a steady job.Download VA Form 21-8940 (PDF)
Helpful links related to VA Form 21-4192
Eligibility for VA disability benefits
Find out if you qualify for compensation for a presumptive disability or other service-connected conditions.
How to file a VA disability claim
Find out how to file a claim for disability compensation or increased disability compensation.
File additional forms for your disability claim
Find out if you need to complete additional forms for your disability claim.
VA Individual Unemployability if you can't work
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.