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About VA Form 21-4192

Form name: Request for Employment Information in Connection with Claim for Disability Benefits
Related to: Disability
Form revision date: August 2024

When to use this form

Use VA Form 21-4192 if you’re a Veteran and you need your most recent employer to send us information so you can apply for Individual Unemployability disability benefits. Your most recent employer must complete and submit this form.

Downloadable PDF

VA Form 21-8940

Form name: Veteran's Application for Increased Compensation Based on Unemployability

Use VA Form 21-8940 if you want to apply for Individual Unemployability disability benefits for a service-connected condition that prevents you from keeping a steady job.

Helpful links related to VA Form 21-4192

  • Find out if you qualify for compensation for a presumptive disability or other service-connected conditions.

  • Find out how to file a claim for disability compensation or increased disability compensation.

  • Find out if you need to complete additional forms for your disability claim.

  • Find out how to file for VA Individual Unemployability compensation if you're an unemployed Veteran who can't work due to a service-connected disability.

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