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Get VA Form 21-4192 - Veterans Benefits Network

Whitehouse. gov/omb/library/OMBINV. html VA. If desired you can call 1-800-827-1000 to get information on where to send comments or suggestions about this form. VA FORM JUL 2004 21-4192 SUPERSEDES VA FORM 21-4192 DEC 1994 WHICH WILL NOT BE USED. U.S. DOD Form dod-va-21-4192 OMB Approved No. 2900-0065 Respondent Burden 15 minutes REQUEST FOR EMPLOYMENT INFORMATION IN CONNECTION WITH CLAIM FOR DISABILITY BENEFITS SECTION I - IDENTIFICATION INFORMAT.

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