Get Va Form 21 4193 Fillable Form

The VA Form 21 4193 is used to notify the Department of Veterans Affairs about a veteran or beneficiary who is incarcerated in a penal institution. Filling out this form accurately is important to ensure proper handling of benefits during incarceration. This guide provides clear and concise instructions to assist you in completing the form online.

Follow the steps to fill out the VA Form 21 4193 online

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter the VA file number in the first field if known. If not, you can leave it blank. This number helps associate your submission with existing records.
3. Provide the full name of the veteran, including first name, middle name, and last name, in the designated fields.
4. Input the service number and social security number of the veteran in steps 3A and 3B respectively.
5. If the person incarcerated is not the veteran, provide their name in field 4.
6. Indicate the relationship of the person incarcerated to the veteran in field 5.
7. Fill in the date of the offense committed in field 6, using the format MM/DD/YYYY.
8. Specify the type of offense in field 7 as either felony or misdemeanor.
9. Record the length of the sentence in field 9, stating the total duration.
10. Provide the scheduled release date in field 10, again following the MM/DD/YYYY format.
11. If applicable, indicate whether the individual is in a work release or halfway house program in field 11A by selecting 'yes' or 'no'.
12. Fill in the institutional telephone number, including the area code, in field 12.
13. Use field 13 for any additional remarks or information that may be relevant.
14. Sign and date the form in fields 14 and 16. Ensure all entries are completed accurately before moving on.
15. Finally, after reviewing all entries, save your changes, download the form, or print it for submission.

Complete your VA Form 21 4193 online today to ensure timely processing of your benefits.