Get the free va form 4939

OMB Number: 2900-0160 Estimated Burden: 5 minutes STATEMENT OF ASSURANCE OF COMPLIANCE WITH SECTION 504 OF THE REHABILITATION ACT OF 1973 The Paperwork Reduction Act of 1995 requires us to notify

How to fill out va form 4939

How to fill out VA Form 4939:

1. Begin by downloading VA Form 4939 from the official Department of Veterans Affairs website or obtain a physical copy from a VA office.
2. Familiarize yourself with the purpose of VA Form 4939, which is the Veteran's Application for Increased Compensation Based on Unemployability. This form is used to apply for additional monetary benefits for disabled veterans who are unable to work due to service-connected disabilities.
3. Provide your personal information in Section I of the form. This includes your full name, Social Security number, VA file number, current mailing address, and contact information.
4. In Section II, indicate your marital status, as well as information about any dependents you have, including their names, birth dates, and relationship to you.
5. Proceed to Section III, where you will be required to list all the disabilities that prevent you from working. Include the name of each disability, diagnostic code, and whether it is service-connected or non-service-connected.
6. Complete Section IV by providing details about your education and employment history. List any schools attended, degrees earned, and employment information, including job titles and dates of employment.
7. If you are currently receiving treatment for your disabilities or if you have a VA-appointed fiduciary, indicate it in Section V.
8. In Section VI, sign and date the form. If you are on active duty or a patient in a VA facility, a representative authorized to sign on your behalf should indicate their name, title, and relationship to you.
9. Make sure to gather any necessary supporting documents before submitting your completed form. This may include medical records, employment records, or other evidence that supports your claim for increased compensation based on unemployability.

Who needs VA Form 4939?

Veterans who have service-connected disabilities that prevent them from working and wish to apply for increased compensation based on unemployability need to complete VA Form 4939. This form is specifically for those who are seeking additional monetary benefits due to their inability to maintain substantial gainful employment as a result of their disabilities. It is important to consult with a VA representative or a disability claims expert to determine if you are eligible before filling out and submitting this form.

For pdfFiller’s FAQs

What is va form 4939?

VA Form 4939 is the Application for Extended Care Services.

Who is required to file va form 4939?

Veterans who are seeking extended care services from the VA are required to file VA Form 4939.

How to fill out va form 4939?

VA Form 4939 can be filled out online on the VA website or through a VA representative.

What is the purpose of va form 4939?

The purpose of VA Form 4939 is to apply for extended care services provided by the VA.

What information must be reported on va form 4939?

VA Form 4939 requires information such as personal details, medical history, and details of the care services needed.

When is the deadline to file va form 4939 in 2023?

The deadline to file VA Form 4939 in 2023 is typically December 31st.

What is the penalty for the late filing of va form 4939?

The penalty for late filing of VA Form 4939 may result in delayed approval of extended care services from the VA.

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