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VA Form 21-4192Individual Unemployability
Request for Employment Information in Connection with Claim for Disability Benefits
Provide employer information for a Veteran seeking Individual Unemployability benefits.
Current official form · August 2024 · forms-library-2026.07.23 · record 579f529f47da
When this form is commonly used
The Veteran’s most recent employer completes and submits this form in connection with an Individual Unemployability claim.
Who completes it
Employer—not the Veteran
What it helps document
- Confirms employment dates and earnings
- Describes concessions or time lost
- States the reason employment ended
- Supports the related 21-8940 application
Common mistakes to avoid
- Veteran completing the employer certification
- Employer omitting signature or contact details
- Dates or earnings conflicting with 21-8940 without explanation
- Waiting without documenting attempts to obtain the form
Official VA form information
Use a fresh official copy
Review the current VA instructions before completing the form. The direct action opens the official government PDF or, for DBQs, the official download directory.
Download destination verified July 18, 2026