OMB control number
Statement in Support of Claim (VA Form 21-4138)
OMB 2900-0075 ยท VA.
OMB 2900-0075
The respondent population for VA Form 21-4138 is composed of individuals providing self-certified statements in support of various types of claims processed by the agency. As such, 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.
The latest form for Statement in Support of Claim (VA Form 21-4138) expires 2027-07-31 and is listed under ICR 202403-2900-002.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form VA Form 21-4138 Statement in Support of Claim (VA Form 21-4138) | Form |
| 2024-11840, 30-Day FRN (2900-0075, VAF21-4138).pdf | Supplementary Document |
| 2024-06019, 60-Day FRN (2900-0075, VAF21-4138).pdf | Supplementary Document |
| 2900-0075, Supporting Statement (VAF21-4138).docx | Supporting Statement A |
 Statement in Support of Claim (VA Form 21-4138) |
Form |