VA Form 21-4140
Employment Questionnaire
VA mailed you this form as part of annual TDIU certification. You must respond even if you had no employment or income.
- 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).
Official VA form page: https://www.va.gov/find-forms/about-form-21-4140/
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
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.
(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
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.
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)
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.
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
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.
(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 and 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.