Who needs a VA Form 21-4140-1?
Veterans receiving the Department of Veteran Affairs (VA) compensation at the 100% rate based on being unable to secure or follow a substantially gainful occupation as a result of their service-connected disabilities should complete this form.
To file this form, the applicant must have at least one service-connected disability that led to the inability to maintain gainful employment.
What is VA Form 21-4140-1 for?
The VA administration needs this information from this employment questionnaire to determine continued eligibility to compensation at the 100 percent rate based on individual employability. Information provided on this form is used as the applicant’s certification of their employment or unemployment status. There are severe penalties for providing false statements on this form.
Is the VA 21-4140-1 form accompanied by other forms?
An applicant must attach all evidence they have to certify their disability and its sufficiency for the 100% compensation rate. Also evidence regarding the veteran’s work history should be provided as well including references from hospitals and medical reports indicating the (dis)abilities of the claimant, their treatment and medication, and the time spent not being able to work because of disabilities.
How do I fill out VA Form 21-4140-1?
This one-page form must be filed out with the following information:
-
Station address;
-
Name and address of veteran;
-
List of all the employments for the past twelve months (if applicable);
-
Unemployment certification (if the person did not work during the past 12 months);
After completing the VA Employment form, it should be dated and signed. The telephone number (including the area code) should be provided as well.
Where do I send VA Form 21-4140-1?
Once completed and signed, this form should be directed to the appropriate VA regional office. It can also be submitted with the help of an accredited representative or agent.
