Va 21-4140 Form 2021-2025

Va 21-4140 Form: What You Should Know

The data collected on this questionnaire may be used to determine the beneficiary's eligibility for additional VA benefits, to determine the beneficiary's dependency status, and to determine the eligibility and status of a dependent. To use this form, your employment information must be verified. If you do not believe the information in this questionnaire is accurate, you must file a statement with this questionnaire. The statement must be completed and signed by an employee who is a member of the following groups: Army Federal employees, including civilians as well as non-civilian members of the military, including National Guard and Reserves; Army, Navy, or Air Force civilians, including civilians on active duty who are not on military and are engaged in an activity not in the interest of the United States Government; Air Force civilians; Department of Defense civilians; and National Guard or Reserve personnel, including civilians on active duty.  Note: If a civilian employee does not belong to a group listed above, the Form 21-4140-1 is used to verify the employee's employment. Your answers to questions in this questionnaire will be confidential and will be used for only one purpose: determining if you have continued entitlement to individual employability. Questions you must answer include; Are you a person receiving VA benefits, such as a disability compensation, survivor benefits, disability compensation or other benefits? Are you employed for compensation, including from federal, public, or private sectors, and paid for the work your employer provides, for more than 3 months in the last 5 years? Are you employed for compensation, including from federal, public, or private sectors, and paid for the work your employer provides, for more than 12 months in the last 5 years? If your employment continues after you have filed the information, you may report it on an Application for Benefit of Claim, Form 21-7802, for purposes of claiming benefits. Are you receiving disability compensation under TBI, TAR, or TBI/PTSD through the Department of Veterans Affairs? NOTE: Do not select a question that requires you to provide an answer; simply read the question and answer as written, and you must fill in the appropriate boxes. If your employer provides you with transportation from your place of work to your home, to and from your place of work, or to and from school or to and from work-related activities as well as travel expenses, you must report your transportation expenses using the Form 21-4102 and the date you received this document.

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