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DATE PAID YES VA FORM JUL 2015 NO If Yes complete Items 15B and 15C 21-4192 SUPERSEDES VA FORM 21-4192 DEC 2010 WHICH WILL NOT BE USED. Reginfo. gov/public/do/PRAMain. If desired you can call 1-800-827-1000 to get information on where to send comments or suggestions about this form. VA FORM 21-4192 JUL 2015. OMB Control No* 2900-0065 Respondent Burden 15 minutes Expiration Date 11/30/2017 REQUEST FOR EMPLOYMENT INFORMATION IN CONNECTION WITH CLAIM FOR DISABILITY BENEFITS SECTION I - IDENTIFICATION INFORMATION To be completed by VA. 1. NAME AND ADDRESS OF EMPLOYER OF VETERAN Complete 2. ADDRESS Complete RETURN TO INSTRUCTIONS The veteran named in Item 3 has filed a claim for veterans disability benefits and has stated that he/she was recently employed by you. In order to arrive at a fair decision in this case we need the information requested below. Please complete Sections II III and IV and return to this office at the above address. Please be sure to sign and date this form in Items 2....

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Related content

VA Form 21-4192 - Veterans Affairs
This site provides public access to all VA forms that are appropriate to be on the web.
Learn more
VA Form 21-4192 - Request for Employment...
INSTRUCTIONS: The veteran named in Item 3 has filed a claim for veterans disability...
Learn more
21 4192 VBA ARE - UserManual.wiki
13. CONCESSIONS (if any) MADE TO EMPLOYEE BY REASON OF AGE OR DISABILITY. $. VA FORM. SEP...
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Related links form

ATF Form 1 (5320.1) 2022 ATF 6 (5330.3A) Part 1 2023 MN HOU101 2017 ATF 4 (5320.4) 2022

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232