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The veteran named in Item 3 has filed a claim for veterans disability benefits and has stated that he/she was recently employed by you. In order to arrive at a fair decision in this case, we need the information requested below.
20 wrz 2024 · 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.
13 kwi 2023 · The VA Form 21-4192 is a VA request for employment information from your most recent employer. It’s typically submitted alongside a few other forms when a veteran wants to file a VA unemployability claim, also known as Total Disability Individual Unemployability (TDIU).
2 kwi 2021 · VA Form 21-4192: Request for Employment Information In Connection With Claim For Disability Benefits. Whenever a veteran decides to apply for a Total Disability Rating Based on Individual Unemployability (TDIU), they will need to complete a VA Form 21-8940.
30 cze 2023 · The Department of Veterans Affairs (VA) uses VA Form 21-4192, Request for Employment Information in Connection with Claim for Disability Benefits, to obtain information on a veteran’s employment history. The form is intended to get basic employment information, such as dates of employment.
Please be sure to sign and date this form in Items 23A and 23B. For free help in completing this form, call VA toll-free at 1-800-827-1000. If you use a Telecommunications Device for the Deaf (TDD), the Federal number is 711. NOTE: You can either complete the form online or by hand.
VA Form 21-4192 is used to gather necessary employment information from veterans’ employers so VA can determine eligibility to increased disability benefits based on unemployability. Without this information, determination of entitlement would not be possible.
