VA Form 21-4140

Employment Questionnaire

Unemployability (TDIU)Official VA form on VA.gov

Who fills it

veteran

Journey phase

Keeping Your Award Current

Estimated time

15-20 minutes.

When to file

By the deadline printed on the form VA sends (typically 60 days from mailing).

VA mailed you this form as part of annual TDIU certification. You must respond even if you had no employment or income.

Gather before you start

—VA Form 21-4140 mailed to you by VA (information pre-printed)

—Records of any employment or self-employment during the prior year

—Gross earnings from any work (not VA compensation, SSA, or other benefits)

—Number of hours worked and employer information if applicable

Attach with the form

—W-2 or 1099 if you had any reportable employment income

Section I - Veteran Identification

1 field

Blocks 1-3 (pre-printed)Name, SSN, VA File Number (typically pre-printed by VA)PII

These fields are usually pre-printed by VA. Verify they are correct. If anything is wrong, note it and contact VA - a wrong VA File Number means the response goes to the wrong award.

Example

(pre-printed; verify accuracy)

Common mistakes

Not verifying pre-printed data before signing - address errors or SSN errors are common.

Section II - Employment During Prior Year

1 field · 1 citation

Blocks 4-10Did you work or earn income from employment during the prior year?

Report ALL work for pay during the prior calendar year: full-time, part-time, temporary, seasonal, contract, gig work, self-employment, or any other compensated activity. Do NOT include: VA disability compensation, Social Security benefits, pension, investment income, gifts, rental income from property (unless you managed it as a business). If you worked even one day, report it.

Example

e.g., NO employment in calendar year 2025. OR: Worked part-time at ABC Grocery 03/2025-05/2025, 12 hours/week, $1,800 total gross earnings.

Common mistakes

Not reporting "marginal" work (very low hours or below poverty-level income) - any work for pay must be reported even if it is below the TDIU threshold.
Confusing "income" with "employment" - VA asks specifically about work performed, not passive income like rental or investment income.
Leaving this blank and signing - if you had no employment, write "None" or "No employment" explicitly.

Authority

38 CFR 4.16 - Schedular TDIU: 1 disability ≥60% OR multiple disabilities w/ combined ≥70% incl. one ≥40%; extra-schedular under 4.16(b).

Section III - Employer Details (if applicable)

1 field · 1 citation

Blocks 11-16Employer name, address, dates, wages, hours per weekRepeatable

If you had any employment, provide complete employer information for each job. This allows VA to evaluate whether the work constitutes "substantially gainful employment" (which could affect your TDIU). Work below the federal poverty threshold is considered "marginal" and generally does not terminate TDIU.

Example

Employer: ABC Grocery, 123 Main St, Phoenix AZ; 03/01/2025-05/31/2025; 12 hours/week; $1,800 gross earnings for the period.

Common mistakes

Reporting annual salary when VA asks for earnings during the period worked - report actual gross earnings for the time period.
Not reporting self-employment income - any business activity with income counts.

Authority

38 CFR 4.16 - Schedular TDIU: 1 disability ≥60% OR multiple disabilities w/ combined ≥70% incl. one ≥40%; extra-schedular under 4.16(b).

Section IV - Certification and Signature

1 field

Blocks 17-18Veteran signature and datePII

Sign and date. By signing, you certify under penalty of perjury that the information is accurate. VA cross-references with IRS and SSA records annually.

Example

(signature/date by deadline on form)

Common mistakes

Missing the response deadline - TDIU benefits are suspended pending response. If you miss the deadline, contact VA immediately.
Not signing - VA cannot process unsigned questionnaires.
Underreporting income that appears on IRS/SSA records - VA cross-references; discrepancies are flagged as potential fraud.

Statutory & regulatory authority

38 CFR 4.16 - Schedular TDIU: 1 disability ≥60% OR multiple disabilities w/ combined ≥70% incl. one ≥40%; extra-schedular under 4.16(b).

38 CFR 3.500 - When VA reduces or discontinues benefits.

38 USC 1110 - Service-connected compensation for wartime veterans.

VA Form 21-4140

Employment Questionnaire

Unemployability (TDIU)Official VA form on VA.gov

Who fills it

veteran

Journey phase

Keeping Your Award Current

Estimated time

15-20 minutes.

When to file

By the deadline printed on the form VA sends (typically 60 days from mailing).

VA mailed you this form as part of annual TDIU certification. You must respond even if you had no employment or income.

Gather before you start

—VA Form 21-4140 mailed to you by VA (information pre-printed)

—Records of any employment or self-employment during the prior year

—Gross earnings from any work (not VA compensation, SSA, or other benefits)

—Number of hours worked and employer information if applicable

Attach with the form

—W-2 or 1099 if you had any reportable employment income

Section I - Veteran Identification

1 field

Blocks 1-3 (pre-printed)Name, SSN, VA File Number (typically pre-printed by VA)PII

These fields are usually pre-printed by VA. Verify they are correct. If anything is wrong, note it and contact VA - a wrong VA File Number means the response goes to the wrong award.

Example

(pre-printed; verify accuracy)

Common mistakes

Not verifying pre-printed data before signing - address errors or SSN errors are common.

Section II - Employment During Prior Year

1 field · 1 citation

Blocks 4-10Did you work or earn income from employment during the prior year?

Example

e.g., NO employment in calendar year 2025. OR: Worked part-time at ABC Grocery 03/2025-05/2025, 12 hours/week, $1,800 total gross earnings.

Common mistakes

Not reporting "marginal" work (very low hours or below poverty-level income) - any work for pay must be reported even if it is below the TDIU threshold.
Confusing "income" with "employment" - VA asks specifically about work performed, not passive income like rental or investment income.
Leaving this blank and signing - if you had no employment, write "None" or "No employment" explicitly.

Authority

38 CFR 4.16 - Schedular TDIU: 1 disability ≥60% OR multiple disabilities w/ combined ≥70% incl. one ≥40%; extra-schedular under 4.16(b).

Section III - Employer Details (if applicable)

1 field · 1 citation

Blocks 11-16Employer name, address, dates, wages, hours per weekRepeatable

Example

Employer: ABC Grocery, 123 Main St, Phoenix AZ; 03/01/2025-05/31/2025; 12 hours/week; $1,800 gross earnings for the period.

Common mistakes

Reporting annual salary when VA asks for earnings during the period worked - report actual gross earnings for the time period.
Not reporting self-employment income - any business activity with income counts.

Authority

38 CFR 4.16 - Schedular TDIU: 1 disability ≥60% OR multiple disabilities w/ combined ≥70% incl. one ≥40%; extra-schedular under 4.16(b).

Section IV - Certification and Signature

1 field

Blocks 17-18Veteran signature and datePII

Sign and date. By signing, you certify under penalty of perjury that the information is accurate. VA cross-references with IRS and SSA records annually.

Example

(signature/date by deadline on form)

Common mistakes

Missing the response deadline - TDIU benefits are suspended pending response. If you miss the deadline, contact VA immediately.
Not signing - VA cannot process unsigned questionnaires.
Underreporting income that appears on IRS/SSA records - VA cross-references; discrepancies are flagged as potential fraud.

Statutory & regulatory authority

38 CFR 4.16 - Schedular TDIU: 1 disability ≥60% OR multiple disabilities w/ combined ≥70% incl. one ≥40%; extra-schedular under 4.16(b).

38 CFR 3.500 - When VA reduces or discontinues benefits.

38 USC 1110 - Service-connected compensation for wartime veterans.

VA Form 21-4140

Employment Questionnaire

Unemployability (TDIU)Official VA form on VA.gov

Who fills it

veteran

Journey phase

Keeping Your Award Current

Estimated time

15-20 minutes.

When to file

By the deadline printed on the form VA sends (typically 60 days from mailing).

VA mailed you this form as part of annual TDIU certification. You must respond even if you had no employment or income.

Gather before you start

—VA Form 21-4140 mailed to you by VA (information pre-printed)

—Records of any employment or self-employment during the prior year

—Gross earnings from any work (not VA compensation, SSA, or other benefits)

—Number of hours worked and employer information if applicable

Attach with the form

—W-2 or 1099 if you had any reportable employment income

Section I - Veteran Identification

1 field

Blocks 1-3 (pre-printed)Name, SSN, VA File Number (typically pre-printed by VA)PII

These fields are usually pre-printed by VA. Verify they are correct. If anything is wrong, note it and contact VA - a wrong VA File Number means the response goes to the wrong award.

Example

(pre-printed; verify accuracy)

Common mistakes

Not verifying pre-printed data before signing - address errors or SSN errors are common.

Section II - Employment During Prior Year

1 field · 1 citation

Blocks 4-10Did you work or earn income from employment during the prior year?

Example

e.g., NO employment in calendar year 2025. OR: Worked part-time at ABC Grocery 03/2025-05/2025, 12 hours/week, $1,800 total gross earnings.

Common mistakes

Not reporting "marginal" work (very low hours or below poverty-level income) - any work for pay must be reported even if it is below the TDIU threshold.
Confusing "income" with "employment" - VA asks specifically about work performed, not passive income like rental or investment income.
Leaving this blank and signing - if you had no employment, write "None" or "No employment" explicitly.

Authority

38 CFR 4.16 - Schedular TDIU: 1 disability ≥60% OR multiple disabilities w/ combined ≥70% incl. one ≥40%; extra-schedular under 4.16(b).

Section III - Employer Details (if applicable)

1 field · 1 citation

Blocks 11-16Employer name, address, dates, wages, hours per weekRepeatable

Example

Employer: ABC Grocery, 123 Main St, Phoenix AZ; 03/01/2025-05/31/2025; 12 hours/week; $1,800 gross earnings for the period.

Common mistakes

Reporting annual salary when VA asks for earnings during the period worked - report actual gross earnings for the time period.
Not reporting self-employment income - any business activity with income counts.

Authority

38 CFR 4.16 - Schedular TDIU: 1 disability ≥60% OR multiple disabilities w/ combined ≥70% incl. one ≥40%; extra-schedular under 4.16(b).

Section IV - Certification and Signature

1 field

Blocks 17-18Veteran signature and datePII

Sign and date. By signing, you certify under penalty of perjury that the information is accurate. VA cross-references with IRS and SSA records annually.

Example

(signature/date by deadline on form)

Common mistakes

Missing the response deadline - TDIU benefits are suspended pending response. If you miss the deadline, contact VA immediately.
Not signing - VA cannot process unsigned questionnaires.
Underreporting income that appears on IRS/SSA records - VA cross-references; discrepancies are flagged as potential fraud.

Statutory & regulatory authority

38 CFR 4.16 - Schedular TDIU: 1 disability ≥60% OR multiple disabilities w/ combined ≥70% incl. one ≥40%; extra-schedular under 4.16(b).

38 CFR 3.500 - When VA reduces or discontinues benefits.

38 USC 1110 - Service-connected compensation for wartime veterans.

VA Form 21-4140

Employment Questionnaire

Unemployability (TDIU)Official VA form on VA.gov

Who fills it

veteran

Journey phase

Keeping Your Award Current

Estimated time

15-20 minutes.

When to file

By the deadline printed on the form VA sends (typically 60 days from mailing).

VA mailed you this form as part of annual TDIU certification. You must respond even if you had no employment or income.

Gather before you start

—VA Form 21-4140 mailed to you by VA (information pre-printed)

—Records of any employment or self-employment during the prior year

—Gross earnings from any work (not VA compensation, SSA, or other benefits)

—Number of hours worked and employer information if applicable

Attach with the form

—W-2 or 1099 if you had any reportable employment income

Section I - Veteran Identification

1 field

Blocks 1-3 (pre-printed)Name, SSN, VA File Number (typically pre-printed by VA)PII

These fields are usually pre-printed by VA. Verify they are correct. If anything is wrong, note it and contact VA - a wrong VA File Number means the response goes to the wrong award.

Example

(pre-printed; verify accuracy)

Common mistakes

Not verifying pre-printed data before signing - address errors or SSN errors are common.

Section II - Employment During Prior Year

1 field · 1 citation

Blocks 4-10Did you work or earn income from employment during the prior year?

Example

e.g., NO employment in calendar year 2025. OR: Worked part-time at ABC Grocery 03/2025-05/2025, 12 hours/week, $1,800 total gross earnings.

Common mistakes

Not reporting "marginal" work (very low hours or below poverty-level income) - any work for pay must be reported even if it is below the TDIU threshold.
Confusing "income" with "employment" - VA asks specifically about work performed, not passive income like rental or investment income.
Leaving this blank and signing - if you had no employment, write "None" or "No employment" explicitly.

Authority

38 CFR 4.16 - Schedular TDIU: 1 disability ≥60% OR multiple disabilities w/ combined ≥70% incl. one ≥40%; extra-schedular under 4.16(b).

Section III - Employer Details (if applicable)

1 field · 1 citation

Blocks 11-16Employer name, address, dates, wages, hours per weekRepeatable

Example

Employer: ABC Grocery, 123 Main St, Phoenix AZ; 03/01/2025-05/31/2025; 12 hours/week; $1,800 gross earnings for the period.

Common mistakes

Reporting annual salary when VA asks for earnings during the period worked - report actual gross earnings for the time period.
Not reporting self-employment income - any business activity with income counts.

Authority

38 CFR 4.16 - Schedular TDIU: 1 disability ≥60% OR multiple disabilities w/ combined ≥70% incl. one ≥40%; extra-schedular under 4.16(b).

Section IV - Certification and Signature

1 field

Blocks 17-18Veteran signature and datePII

Sign and date. By signing, you certify under penalty of perjury that the information is accurate. VA cross-references with IRS and SSA records annually.

Example

(signature/date by deadline on form)

Common mistakes

Missing the response deadline - TDIU benefits are suspended pending response. If you miss the deadline, contact VA immediately.
Not signing - VA cannot process unsigned questionnaires.
Underreporting income that appears on IRS/SSA records - VA cross-references; discrepancies are flagged as potential fraud.

Statutory & regulatory authority

38 CFR 4.16 - Schedular TDIU: 1 disability ≥60% OR multiple disabilities w/ combined ≥70% incl. one ≥40%; extra-schedular under 4.16(b).

38 CFR 3.500 - When VA reduces or discontinues benefits.

38 USC 1110 - Service-connected compensation for wartime veterans.