Get the free VA Form 21-0960A-4

HYPERTENSION DISABILITY BENEFITS QUESTIONNAIRE. 2E. CURRENT ... SUPERSEDES VA FORM 21-0960A-3, OCT 2012, WHICH WILL NOT BE USED.

How to fill out va form 21-0960a-4

How to fill out VA form 21-0960A-4:

1. Begin by obtaining a copy of the VA form 21-0960A-4, which is the Veterans Affairs (VA) Application for Increased Compensation Based on Individual Unemployability. This form is used by veterans who are seeking increased compensation due to their inability to maintain substantially gainful employment.
2. Start with filling out the basic information at the top of the form. This includes your name, social security number, VA file number, address, and other contact details. Ensure that all information is accurate and up to date.
3. Next, move on to Section I of the form, which requires you to provide information about your current employment status. Indicate whether you are currently employed or self-employed, and provide details such as your job title and employer's information. If you are not currently employed, explain the reasons for your unemployment.
4. In Section II, you will need to provide a detailed history of your employment for the past five years. List all the jobs you have held during this period, including part-time or temporary positions. For each job, provide the name of the employer, job title, dates of employment, and reasons for leaving if applicable.
5. Proceed to Section III, where you will need to describe any education or vocational training you have received. Include details such as the name of the institution, the course or program you completed, and any relevant certifications or degrees obtained.
6. In Section IV, you will need to disclose any business or professional activities you are currently engaged in. This includes ownership or co-ownership of a business, self-employment, or any consulting work you may be involved in. Provide accurate information about the nature of your business or professional activities.
7. Moving on to Section V, you will need to provide information about any periods of hospitalization, treatment, or observation for medical conditions. Include the dates of these periods and the reasons for seeking medical care.
8. Section VI requires you to list any VA or non-VA appointments relating to your claimed conditions. This includes appointments with doctors, therapists, or specialists. Provide the date, type of appointment, and the name of the doctor or facility attended.
9. In Section VII, you will need to provide a brief summary of the employment difficulties you are facing due to your claimed conditions. Explain how your disabilities impact your ability to work and maintain substantially gainful employment.
10. Finally, sign and date the form at the bottom, certifying that the information provided is true and accurate to the best of your knowledge.

Who needs VA form 21-0960A-4:

1. Veterans who are seeking increased compensation due to their inability to maintain substantially gainful employment may need to fill out VA form 21-0960A-4.
2. This form is relevant for veterans who believe that their service-connected disabilities prevent them from working and require additional compensation.
3. It is also necessary for veterans who want to apply for Individual Unemployability (IU) benefits provided by the VA.

For pdfFiller’s FAQs

What is va form 21-0960a-4?

The VA Form 21-0960A-4 is the application for increased compensation based on unemployability.

Who is required to file va form 21-0960a-4?

Veterans who are seeking increased compensation based on unemployability are required to file VA Form 21-0960A-4.

How to fill out va form 21-0960a-4?

VA Form 21-0960A-4 should be filled out completely and accurately, providing all necessary information about the veteran's work history and medical conditions.

What is the purpose of va form 21-0960a-4?

The purpose of VA Form 21-0960A-4 is to assess a veteran's eligibility for increased compensation based on unemployability due to service-connected disabilities.

What information must be reported on va form 21-0960a-4?

VA Form 21-0960A-4 requires information about the veteran's work history, medical conditions, and how those conditions impact their ability to work.

How do I execute va form 21-0960a-4 online?

Completing and signing va form 21-0960a-4 online is easy with pdfFiller. It enables you to edit original PDF content, highlight, blackout, erase and type text anywhere on a page, legally eSign your form, and much more. Create your free account and manage professional documents on the web.

How do I complete va form 21-0960a-4 on an iOS device?

pdfFiller has an iOS app that lets you fill out documents on your phone. A subscription to the service means you can make an account or log in to one you already have. As soon as the registration process is done, upload your va form 21-0960a-4. You can now use pdfFiller's more advanced features, like adding fillable fields and eSigning documents, as well as accessing them from any device, no matter where you are in the world.

How do I fill out va form 21-0960a-4 on an Android device?

On Android, use the pdfFiller mobile app to finish your va form 21-0960a-4. Adding, editing, deleting text, signing, annotating, and more are all available with the app. All you need is a smartphone and internet.