VA Form 21-4140 Employment Questionnaire

How to Fill Out VA Form 21-4140?

The VA 21-4140 must be completed annually by all IU recipients under the age of 60. The VA requires Veterans who receive IU benefits to regularly certify that they are still unemployed or marginally employed. Step-by-step VA Form 21-4140 instructions can be found below.

1. Section I ("Veteran's Identification Information") requires the Veteran to provide their full name, Social Security number, VA file number, date of birth, current mailing address, and contact information.
2. Section II ("Employment Certification") requires the Veteran to list all employment over the previous year. The required information includes the names and addresses of all employers, the type of work done, the dates of employment, monthly earnings, and the time lost from illness.
3. Section III ("Unemployment Certification") is signed by Veterans who were unemployed for the previous 12 months to certify that the provided information is correct and true.

Where to Mail VA Form 21-4140?

The VA has implemented centralized mail processing for all compensation claims. The mailing address for VA Form 21-4140 is the Department of Veterans Affairs, Claims Intake Center, PO Box 4444, Janesville, Wisconsin 53547-4444. Forms can be faxed to the VA toll-free at +1 (844) 531-7818 or (248) 524-4260 (for Foreign Claimants).