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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.

Downloadable PDF

Online tool

You can fill out this form online instead of filling out and sending us the paper form.

Helpful links related to VA Form 21-4140

  • Find out if you qualify for compensation for a presumptive disability or other service-connected conditions.

  • Find out how to file a claim for disability compensation or increased disability compensation.

  • Find out if you need to complete additional forms for your disability claim.

  • 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.

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