OMB control number
Employment Questionnaire (VA Form 21-4140)
OMB 2900-0079 · VA.
OMB 2900-0079
VA Form 21-4140 is used to gather the necessary information to determine continued entitlement to individual unemployability. Recipients are required to certify, when requested, that the eligibility factors which established entitlement to the benefit being paid continue to exist. Individual unemployability is awarded based on a veteran’s inability to be gainfully employed due to service-connected disabilities, and entitlement may be terminated if a veteran begins working. Without information about recipients’ employment, VA would not be able to determine continued entitlement to individual unemployability, and overpayments would result.
The latest form for Employment Questionnaire (VA Form 21-4140) expires 2027-08-31 and is listed under ICR 202404-2900-003.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form VA Form 21-4140 Employment Questionnaire (VA Form 21-4140) | Form |
| 2024-14839, 30-Day FRN (2900-0079, VAF21-4140).pdf | Supplementary Document |
| 2024-09583, 60-Day FRN (VAF21-4140).pdf | Supplementary Document |
 2900-0079, Supporting Statement (VAF21-4140).docx | Supporting Statement A |
 Employment Questionnaire (VA Form 21-4140) |
Form |