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Content Overview

The VBA VA 21 4138 form plays a crucial role in the process of veterans seeking assistance from the Department of Veterans Affairs. This form is primarily used to request a change in the status of a veteran’s benefits, allowing individuals to communicate their needs effectively to the VA. It serves as a formal means for veterans to provide updated information regarding their circumstances, such as changes in income, employment, or family status. By submitting this form, veterans can ensure that their benefits accurately reflect their current situation, which is essential for receiving the appropriate level of support. Furthermore, the form is designed to streamline communication between veterans and the VA, making it easier for both parties to address any issues that may arise. Understanding how to properly fill out and submit the VBA VA 21 4138 form can significantly impact a veteran’s access to benefits and services, highlighting its importance in the overall framework of veteran assistance.

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SECTION I: VETERAN/BENEFICIARY'S IDENTIFICATION INFORMATION
SECTION II: REMARKS
(The following statement is made in connection with a claim for benefits in the case of the above-named veteran/beneficiary)
STATEMENT IN SUPPORT OF CLAIM
VA FORM
JUL 2024
21-4138
OMB Control No. 2900-0075
Respondent Burden: 15 minutes
Expiration Date: 07/31/2027
SUPERSEDES VA FORM 21-4138, JUN 2021.
Page 1
Before completing this form, read the Privacy Act and Respondent Burden on page 2. Use this form to
submit a statement to support a claim. For more information you can contact us through Ask VA: https://ask.va.gov/, or call us
toll-free at 1-800-827-1000 (TTY:711). VA forms are available at www.va.gov/vaforms. After completing the form, mail to:
Department of Veterans Affairs, Evidence Intake Center, P.O. Box 4444, Janesville, WI 53547-4444.
VA DATE STAMP
(DO NOT WRITE IN THIS SPACE)
4. VETERAN'S DATE OF BIRTH (MM/DD/YYYY)2. VETERAN'S SOCIAL SECURITY NUMBER
3. VA FILE NUMBER (If applicable)
1. VETERAN/BENEFICIARY'S NAME (First, Middle Initial, Last)
5. VETERAN'S SERVICE NUMBER (If applicable)
No. &
Street
8. MAILING ADDRESS (Number and street or rural route, P.O. Box, City, State, ZIP Code and Country)
Apt./Unit Number City
ZIP Code/Postal Code
State/Province
Country
6. TELEPHONE NUMBER (Include Area Code)
7. E-MAIL ADDRESS
(Optional)
You may complete the form online or by hand. If completed by hand, print the information requested in ink, neatly and legibly, and insert one letter per box to help
expedite processing of the form.
Enter International Phone Number
(If applicable)
INSTRUCTIONS:
NOTE:
SECTION II: REMARKS (Continued)
(The following statement is made in connection with a claim for benefits in the case of the above-named veteran/beneficiary)
SECTION III: DECLARATION OF INTENT
VA FORM 21-4138, JUL 2024
The VA will not disclose information collected on this form to any source other than what has been authorized under the Privacy Act of 1974 or Title 38,
Code of Federal Regulations 1.576 for routine uses (i.e., civil or criminal law enforcement, congressional communications, epidemiological or research studies, the collection of money owed to the
United States, litigation in which the United States is a party or has an interest, the administration of VA Programs and delivery of VA benefits, verification of identity and status, and personnel
administration) as identified in the VA system of records, 58VA21/22/28, Compensation, Pension, Education, and Veteran Readiness and Employment Records - VA, published in the Federal
Register. Your obligation to respond is required to obtain or retain benefits. VA uses your SSN to identify your claim file. Providing your SSN will help ensure that your records are properly
associated with your claim file. Giving us your SSN account information is voluntary. Refusal to provide your SSN by itself will not result in the denial of benefits. The VA will not deny an
individual benefits for refusing to provide his or her SSN unless the disclosure of the SSN is required by Federal Statute of law in effect prior to January 1, 1975, and still in effect. The requested
information is considered relevant and necessary to determine maximum benefits under the law. The responses you submit are considered confidential (38 U.S.C. 5701). Information submitted is
subject to verification through computer matching programs with other agencies.
Page 2
VETERAN'S SOCIAL SECURITY NO.
I CERTIFY THAT the statements on this form are true and correct to the best of my knowledge and belief.
9. SIGNATURE OF VETERAN/BENEFICIARY (Required)
10. DATE SIGNED (MM/DD/YYYY)
The law provides severe penalties which include fine or imprisonment, or both, for the willful submission of any statement or evidence of a material fact,
knowing it to be false.
PENALTY:
PRIVACY ACT INFORMATION:
RESPONDENT BURDEN: An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control
Number. The OMB control number for this project is 2900-0075, and it expires 07/31/2027. Public reporting burden for this collection of information is estimated to average 15 minutes per
respondent, per year, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. Send comments regarding this burden estimate and any other aspect of this collection of information, including suggestions for reducing the burden to VA Reports Clearance
Officer at [email protected]. Please refer to OMB Control No. 2900-0075 in any correspondence. Do not send your completed VA Form 21-4138 to this email address.

Form Specifications

Fact Name Details
Form Title VBA VA 21-4138
Purpose This form is used to provide information about a claim for benefits or services.
Who Uses It Veterans, service members, and their beneficiaries may use this form.
Submission Method The form can be submitted online, by mail, or in person at a regional office.
Governing Law Federal law under Title 38 of the United States Code governs the use of this form.
Processing Time Processing times may vary based on the complexity of the claim.
Required Information Claimants must provide personal information, details about the claim, and supporting documentation.
Where to Find It The form is available on the U.S. Department of Veterans Affairs website.
Assistance Veterans Service Organizations can assist with completing and submitting the form.

VBA VA 21 4138: Usage Guidelines

Completing the VBA VA 21 4138 form is essential for your upcoming process. Follow these steps carefully to ensure accurate submission.

  1. Begin by downloading the VBA VA 21 4138 form from the official website or obtain a physical copy.
  2. Read the instructions provided on the first page of the form thoroughly.
  3. Fill in your personal information in the designated fields, including your name, address, and contact details.
  4. Provide your Social Security number and any relevant identification numbers as requested.
  5. Complete the sections regarding your service history, ensuring all dates and details are accurate.
  6. Answer all questions honestly and to the best of your ability. If a question does not apply to you, mark it as “N/A.”
  7. Review the form for any errors or omissions. Double-check all entries for accuracy.
  8. Sign and date the form at the bottom as required.
  9. Make a copy of the completed form for your records before submission.
  10. Submit the form according to the instructions provided, either by mail or electronically, as specified.

After submission, keep an eye on your mail or email for any updates regarding your application. It’s important to respond promptly to any requests for additional information.

Your Questions, Answered

What is the VBA VA 21 4138 form?

The VBA VA 21 4138 form is used by veterans to request a waiver of overpayment. It allows individuals to explain their circumstances and request a reconsideration of the debt owed to the Department of Veterans Affairs (VA). This form is crucial for those who believe that the overpayment was not their fault or that repaying the debt would cause undue financial hardship.

Who should fill out the VBA VA 21 4138 form?

Any veteran who has received a notice of overpayment from the VA should consider filling out this form. It is particularly relevant for individuals who have experienced changes in their financial situation or who feel the overpayment was made in error. Family members or representatives acting on behalf of the veteran may also complete the form with proper authorization.

How do I obtain the VBA VA 21 4138 form?

The form can be downloaded directly from the VA’s official website. Alternatively, veterans can request a hard copy by contacting their local VA office or calling the VA's toll-free number. It’s essential to ensure that you are using the most current version of the form to avoid processing delays.

What information do I need to provide on the form?

When completing the VBA VA 21 4138 form, you will need to provide personal information such as your name, Social Security number, and contact details. Additionally, you should include details about the overpayment, your financial situation, and any supporting documentation that substantiates your claim. Clear and concise explanations will aid in the review process.

Is there a deadline for submitting the VBA VA 21 4138 form?

Yes, there is typically a deadline for submitting the form after receiving the overpayment notice. It is important to check the notice for specific dates. Generally, it is advisable to submit the form as soon as possible to avoid further complications or additional interest on the debt.

What happens after I submit the VBA VA 21 4138 form?

Once submitted, the VA will review your request and the information provided. They may contact you for additional information or clarification. You will receive a decision regarding your waiver request, which may take several weeks. If your request is denied, you have the right to appeal the decision.

Can I appeal a decision made on my VBA VA 21 4138 form?

Yes, if the VA denies your request for a waiver, you have the option to appeal the decision. Instructions for the appeals process will be included with the decision letter. It is crucial to adhere to the timelines and procedures outlined in the letter to ensure your appeal is considered.

Where can I find additional assistance with the VBA VA 21 4138 form?

Veterans can seek assistance from various resources, including local veterans' service organizations, legal aid offices, or the VA’s own representatives. Many organizations offer free help in completing the form and navigating the process, ensuring that veterans receive the support they need.

Common mistakes

  1. Failing to provide accurate personal information. This includes incorrect names, addresses, or Social Security numbers.

  2. Not signing the form. A signature is essential for the form to be considered valid.

  3. Leaving out important details about the claim. Omitting relevant information can lead to delays in processing.

  4. Using unclear or illegible handwriting. Ensure that all entries are clear to avoid misunderstandings.

  5. Not providing supporting documentation. Attach all necessary documents to substantiate your claim.

  6. Failing to follow the instructions provided with the form. Each section has specific requirements that must be met.

  7. Submitting the form without reviewing it for errors. Double-checking can prevent mistakes that could delay your claim.

  8. Not keeping a copy of the submitted form. Retaining a copy can be helpful for future reference or follow-up.

Documents used along the form

The VBA VA 21 4138 form is an important document used by veterans to report their income and net worth for various benefits. However, several other forms and documents often accompany this submission to ensure that the application process is comprehensive and accurate. Below is a list of these essential documents, each serving a specific purpose in the evaluation of a veteran's benefits.

  • VA Form 21-526EZ: This form is used to apply for disability compensation and related benefits. It gathers information about the veteran’s service and medical history.
  • VA Form 21-4142: This document is a release form that allows the VA to obtain medical records from healthcare providers. It is crucial for supporting claims for benefits.
  • VA Form 21-22: This form designates an individual or organization to represent the veteran in their claims process. It ensures that the veteran receives proper advocacy.
  • VA Form 21-534EZ: This form is used by surviving spouses or dependents to apply for Dependency and Indemnity Compensation (DIC) or other benefits after a veteran’s death.
  • VA Form 21-0958: This is the Notice of Disagreement form, which veterans use to contest a decision made by the VA regarding their benefits. It is an essential step in the appeals process.
  • VA Form 21-8940: This form is used to apply for a Total Disability based on Individual Unemployability (TDIU). It helps determine if a veteran is unable to secure or follow substantially gainful employment due to service-connected disabilities.
  • VA Form 21-2680: This document is a request for an examination for housebound status or permanent need for regular aid and attendance. It is necessary for veterans seeking additional benefits due to their health conditions.

Each of these forms plays a critical role in the benefits application process. Ensuring that all necessary documents are submitted can significantly impact the outcome of a veteran’s claim. It is vital to approach this process with care and attention to detail, as the right documentation can facilitate a smoother and more efficient review by the VA.

Similar forms

The VBA VA 21 4138 form is used for reporting statements in support of claims for veterans' benefits. Several other documents serve similar purposes in helping veterans navigate the benefits system. Here are four documents that are comparable to the VBA VA 21 4138 form:

  • VA Form 21-4138, Statement in Support of Claim: This form is also used to provide additional evidence or statements to support a claim. It allows veterans to explain their situation in detail, similar to the VBA VA 21 4138.
  • VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits: This form is used to apply for disability compensation. While it serves a broader purpose, it often requires statements similar to those submitted on the VBA VA 21 4138 to support the claim.
  • VA Form 21-534EZ, Application for DIC, Death Pension, and Accrued Benefits: This document is for surviving spouses and dependents. It allows them to submit statements that support their claims, paralleling the VBA VA 21 4138 in terms of providing necessary information.
  • VA Form 21-0958, Notice of Disagreement: This form is used when a veteran disagrees with a decision made by the VA. It requires a detailed explanation of the disagreement, similar to the VBA VA 21 4138, where veterans articulate their circumstances and reasons for appeal.

Dos and Don'ts

When filling out the VBA VA 21 4138 form, it's essential to approach the process carefully. Here’s a list of things to do and avoid to ensure your application is completed correctly.

  • Do read the instructions thoroughly before starting.
  • Do fill out the form completely, providing all requested information.
  • Do use black or blue ink for legibility.
  • Do double-check your contact information for accuracy.
  • Do sign and date the form at the end.
  • Don't leave any required fields blank.
  • Don't use abbreviations unless specified in the instructions.
  • Don't submit the form without making copies for your records.
  • Don't rush through the process; take your time to ensure accuracy.
  • Don't forget to check for any additional documents that may be required.

By following these guidelines, you can help ensure that your form is processed smoothly and efficiently.

Misconceptions

When dealing with the VBA VA 21 4138 form, which is used for requesting a waiver of overpayment, several misconceptions can arise. Understanding these can help ensure that you navigate the process more effectively. Here are some common misunderstandings:

  • It is only for veterans with financial difficulties. Many believe that this form is solely for veterans facing financial hardships. In reality, it can be used by any veteran who has received an overpayment, regardless of their financial situation.
  • Submitting the form guarantees a waiver. Some may think that completing and submitting the form automatically results in a waiver of the overpayment. However, the decision ultimately depends on the review process and the specific circumstances surrounding the overpayment.
  • There is no deadline for submission. It is a common misconception that there are no time limits for submitting the form. In fact, there are specific deadlines that must be adhered to, and failing to submit the form on time can result in the denial of the waiver request.
  • Only the veteran can submit the form. While it is true that the veteran typically submits the form, authorized representatives or family members can also assist in the process. This can be particularly helpful for those who may have difficulty completing the form on their own.
  • All overpayments are eligible for a waiver. Some individuals assume that any overpayment can be waived. However, certain types of overpayments may not qualify, depending on the circumstances of the overpayment and the applicable laws.
  • The form requires extensive documentation. Many believe that a lengthy amount of documentation is necessary to submit the form. While some supporting information may be needed, the form itself is straightforward and does not require excessive paperwork.

By addressing these misconceptions, you can approach the VBA VA 21 4138 form with greater clarity and confidence. It’s important to gather accurate information and seek assistance if needed to ensure a smooth process.

Key takeaways

Filling out the VBA VA 21 4138 form can be a crucial step for veterans seeking benefits. Here are some key takeaways to keep in mind:

  • The form is used to report a change in income or employment status.
  • Accurate information is essential. Double-check all entries before submission.
  • Use clear and concise language to describe your situation.
  • Ensure that you sign and date the form. An unsigned form may delay processing.
  • Keep a copy of the completed form for your records.
  • Submit the form to the correct address, as indicated in the instructions.
  • Consider seeking assistance from a veteran service organization if needed.
  • Be mindful of deadlines. Timely submission can affect your benefits.
  • Follow up with the VA after submission to confirm receipt and processing status.
  • Stay informed about your rights and the benefits you may be entitled to.

Completing the VBA VA 21 4138 form accurately and promptly can significantly impact your benefits. Take the time to ensure all information is correct and complete.