Employment Questionnaire (VA Form 21-4140)

OMB 2900-0079

VA Forms 21-4140 and 21-4140-1 are to be used to gather information that is necessary to determine a recipient's continued entitlement to individual unemployability benefits. Without information about recipients' employment, VA would not be able to determine continued entitlement, and overpayments would result.

The latest form for Employment Questionnaire (VA Form 21-4140) expires 2020-10-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
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

All Historical Document Collections

202404-2900-003 Approved without change	Revision of a currently approved collection	2024-07-09
202009-2900-012 Approved without change	Reinstatement without change of a previously approved collection	2021-05-24
201702-2900-003 Approved without change	Revision of a currently approved collection	2017-07-28
201404-2900-016 Approved without change	Revision of a currently approved collection	2014-10-03
201104-2900-025 Approved without change	Extension without change of a currently approved collection	2011-08-26
200803-2900-005 Approved without change	Extension without change of a currently approved collection	2008-06-18
200505-2900-004 Approved without change	Reinstatement with change of a previously approved collection	2005-05-11
200210-2900-013 Approved without change	No material or nonsubstantive change to a currently approved collection	2002-10-31
200004-2900-003 Approved without change	Reinstatement without change of a previously approved collection	2000-04-28
199508-2900-051 Withdrawn and continue	Extension without change of a currently approved collection	1995-08-28
199305-2900-003 Approved without change	Extension without change of a currently approved collection	1993-05-19
199006-2900-004 Approved without change	Extension without change of a currently approved collection	1990-06-21
198707-2900-010 Approved without change	Extension without change of a currently approved collection	1987-07-27
198406-2900-029 Approved without change	Revision of a currently approved collection	1984-06-19
198106-2900-001 Approved without change	Revision of a currently approved collection	1981-06-02
198101-2900-025 Approved with change	No material or nonsubstantive change to a currently approved collection	1981-01-26
197704-2900-001 Approved without change	Revision of a currently approved collection	1977-04-11