Statement in Support of Claim (VA Form 21-4138)

OMB 2900-0075

OMB 2900-0075

VA Form 21-4138 is used to provide self-certified statements in support of various types of claims processed by VA. Statements submitted by or on behalf of a claimant should contain certification by the respondent that the information provided is true and correct. This form facilitates claims processing by providing a uniform format for the certification statement. VA Form 21-4138 is being revised to include new standardization data points; to include optical character recognition boxes. This is a non-substantive change.

The latest form for Statement in Support of Claim (VA Form 21-4138) expires 2020-12-31 and can be found here.

All Historical Document Collections
Revision of a currently approved collection 2024-05-31
Approved without change
Reinstatement with change of a previously approved collection 2021-05-11
Approved without change
Extension without change of a currently approved collection 2017-09-28
Approved without change
Revision of a currently approved collection 2014-10-29
Approved without change
Extension without change of a currently approved collection 2011-08-25
Approved without change
Extension without change of a currently approved collection 2008-07-08
Approved with change
Extension without change of a currently approved collection 2005-06-07
Approved with change
Extension without change of a currently approved collection 2002-04-26
Approved without change
Reinstatement without change of a previously approved collection 1999-04-12
Withdrawn and continue
Extension without change of a currently approved collection 1995-08-28
Approved without change
Extension without change of a currently approved collection 1993-07-01
Approved without change
Extension without change of a currently approved collection 1990-09-26
Approved without change
Extension without change of a currently approved collection 1987-09-22
Approved without change
Extension without change of a currently approved collection 1984-09-10
Approved without change
Reinstatement with change of a previously approved collection 1982-08-03
Approved with change
No material or nonsubstantive change to a currently approved collection 1981-02-22
Approved with change
No material or nonsubstantive change to a currently approved collection 1977-09-16
Approved without change
Revision of a currently approved collection 1977-07-19

© 2024 OMB.report | Privacy Policy