Get the free VA Form 21-4192 - U.S. Department of Veterans Affairs
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ARIZONA DEPARTMENT OF ECONOMIC SECURITY
Rehabilitation Services AdministrationRSA1298A FOR FF (419)Page 1 of 2REFERRAL FORM
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What is va form 21-4192?
VA Form 21-4192 is a Request for Employment Information in Connection with Claim for Disability Benefits.
Who is required to file va form 21-4192?
Veterans who are claiming disability benefits and have worked in the past are required to file VA Form 21-4192.
How to fill out va form 21-4192?
VA Form 21-4192 must be completed by providing detailed employment information, including employer details, dates of employment, job duties, and supervisor information.
What is the purpose of va form 21-4192?
The purpose of VA Form 21-4192 is to gather employment information to assist in evaluating the veteran's disability claim.
What information must be reported on va form 21-4192?
Information such as employer details, dates of employment, job duties performed, and supervisor contact information must be reported on VA Form 21-4192.
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