Search results
Use this form to submit a statement to support a claim for VA benefits. The form has sections for veteran/beneficiary identification, remarks, declaration of intent, and signature.
30 sie 2024 · Download and use VA Form 21-4138 to provide additional information to support your VA claim. Find out how to apply for VA health care, disability compensation, or other benefits.
Download and print the official form to submit a statement to support a claim for VA benefits. The form has instructions, sections, and privacy act information for completing and mailing the form.
EXISTING STOCKS OF VA FORM 21-4138, JAN 2015, WILL BE USED. Page 1. INSTRUCTIONS: Read the Privacy Act and Respondent Burden on Page 2 before completing the form. Complete as much of Section I as possible. The information requested will help process your claim for benefits. If you need any additional room, use the second page. VA DATE STAMP
The following statement is made in connection with a claim for benefits in the case of the above-named veteran: VA FORM 21-4138, JAN 2015.
VA Form 21-4138, officially the Statement in Support of Claim, is a document used by veterans to support a claim for benefits. The Department of Veterans Affairs will use this information in this form to determine if the claim is legitimate and should be approved.
VA Form 21-4138 is used to provide self-certified statements in support of various types of claims processed by VA. Statements submitted by or on behalf of a claimant should contain certification by the respondent that the information provided is true and correct.
