Form VA Form Letter 29- VA Form Letter 29- Request for Employment Information in Connection with a

In Reply Refer To:
Ins. File No.
Name:
Soc. Sec. No.:

The above-named veteran has filed a claim for disability insurance benefits.
Before a claim can be processed, the employment information requested on the reverse of this letter
must be obtained. Your cooperation in completing this form will permit us to expedite the veteran’s
claim.
We have the veteran’s permission to request this report.
Sincerely yours,

Enclosure:

(Over)

FL 29-459
AUG 2007(R)

OMB Approved No. 2900-0066
Respondent Burden: 10 minutes

REQUEST FOR EMPLOYMENT INFORMATION IN CONNECTION WITH
A CLAIM FOR DISABILITY BENEFITS
PRIVACY ACT INFORMATION - The VA will not disclose information collected on this form to any source other than what has been authorized under the Privacy
Act of 1974 or Title 5 Code of Federal Regulations 1.526 for routime uses indentified in the VA system of records, 36VA00, Veterans and Armed Forces Personnel
U.S. Government Life Insurance Records - VA, published in the Federal Register. Your obligation to respond is voluntary, but your failure to provide us the
information could impede processing.
RESPONDENT BURDEN - We need this information to help us make a decision on the claim for disability insurance benefits under consideration (38 U.S.C. 1912,
1915, 1942 and 1948). We estimate that you will need an average of 10 minutes per response to review the instructions, find the information and complete this form.
VA cannot conduct or sponsor a collection of information unless a valid OMB control number is displayed. You are not required to respond to a collection of
information if this number is not displayed. Valid OMB control numbers can be located on the OMB Internet page at
www.whitehouse.gov/omb/library/OMBINV.VA.EPA.html#VA. If desired, you can call 1-800-827-1000 to get information on where to send comments or
suggestions about this form.
1. DATES OF EMPLOYMENT
FROM

TO

2. INSURED WORKED
FULL-TIME

3. AVERAGE NO. OF HOURS WORKED
DAILEY

4. AVERAGE WAGES

WEEKLY

PART-TIME
5. LAST DAY INSURED WORKED

6. REASON

7. TYPE OF DUTIES PERFORMED

8. DATES INSURED DID NOT WORK BECAUSE OF ILLNESS

9. NATURE OF ILLNESS

10. REMARKS

11A. SIGNATURE AND TITLE

11B. DATE SIGNED

FL 29-459
AUG 2007(R)