Get Va 21-4192 2021-2025

Filling out the VA 21-4192 form is an important step for veterans seeking disability benefits. This guide will provide you with a comprehensive, step-by-step approach to completing the form online, ensuring you provide all necessary information accurately.

Follow the steps to complete the VA 21-4192 form online.

1. Click ‘Get Form’ button to access the form and view it in the editor.
2. In Section I, provide the identification information. Enter the veteran or beneficiary's name, social security number, date of birth, and VA file number if applicable.
3. Proceed to Section II to complete employment information. The employer should fill out the beginning and ending dates of employment, the type of work performed, and the amount earned during the last 12 months before employment ended.
4. Also in Section II, indicate the number of hours worked daily and weekly, any time lost due to disability in the previous 12 months, and if any concessions were made to the employee due to age or disability.
5. Complete the details relating to termination of employment if the veteran is not currently working, including reasons for termination and details about the last payment received.
6. Section III must be filled out if the veteran is currently serving in the Reserve or National Guard. Indicate their current duty status and any disabilities that may affect military duties.
7. In Section IV, the employer should confirm if the veteran is receiving or entitled to any benefits as a result of their employment and complete the relevant fields regarding the type of benefit, the gross monthly amount, and dates of benefit payments.
8. Finally, ensure that the employer or supervisor signs and dates the form in Items 23A and 23B to validate it.
9. Review the completed form for accuracy, save any changes made, and then download, print, or share the form as needed.

Start completing the VA 21-4192 form online today to submit your request for employment information.