U.S. Department of Veterans Affairs · Federal form
Fill out Form 21-4138
Statement in Support of Claim JUL 2024
VA says: “Use VA Form 21-4138 to share more information as instructed by another VA form or process.” Source
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Facts from the official source
Quoted or closely restated from the U.S. Department of Veterans Affairs' own pages and PDFs, checked .
| Fact | What the source says | Source |
|---|---|---|
| Issued by | U.S. Department of Veterans Affairs | About VA Form 21-4138, Statement in Support of Claim (VA) |
| Edition | JUL 2024 | VA Form 21-4138 (JUL 2024), official PDF VA Form 21-4138, page 2 footer (page 1 footer: "VA FORM JUL 2024 21-4138"). |
| Current revision | VA lists July 2024 as the form revision date of the VA Form 21-4138 it publishes. | About VA Form 21-4138, Statement in Support of Claim (VA) About VA Form 21-4138, form details, "Form revision date". |
| Where to mail it | After completing the form, mail it to: Department of Veterans Affairs, Evidence Intake Center, P.O. Box 4444, Janesville, WI 53547-4444. | VA Form 21-4138 (JUL 2024), official PDF VA Form 21-4138 (JUL 2024), page 1, Instructions. |
| How to complete it | The form may be completed online or by hand. If completed by hand, print in ink, neatly and legibly, one letter per box. | VA Form 21-4138 (JUL 2024), official PDF VA Form 21-4138 (JUL 2024), page 1, Section I. |
| Signature | The signature of the veteran/beneficiary (item 9) is required, with the date signed (item 10), under the certification that the statements are true and correct. | VA Form 21-4138 (JUL 2024), official PDF VA Form 21-4138 (JUL 2024), page 2, Section III: Declaration of Intent. |
| Not by e-mail to VA Reports Clearance | Do not send the completed VA Form 21-4138 to the VA Reports Clearance Officer email address printed for burden comments. | VA Form 21-4138 (JUL 2024), official PDF VA Form 21-4138 (JUL 2024), page 2, Respondent Burden. |
| Official instructions | The instructions are printed at the top of page 1; VA asks you to read the Privacy Act and Respondent Burden on page 2 before completing the form. | VA Form 21-4138 (JUL 2024), official PDF VA Form 21-4138 (JUL 2024), page 1, Instructions. |
| Prior edition | This edition supersedes VA Form 21-4138, JUN 2021. | VA Form 21-4138 (JUL 2024), official PDF VA Form 21-4138 (JUL 2024), page 1 footer. |
What is on the form
- Section I: Veteran/Beneficiary's Identification Information
- Name, Social Security number, VA file number, date of birth, service number, telephone, e-mail and mailing address (items 1 to 8). VA Form 21-4138, page 1
- Section II: Remarks
- Free-text statement made in connection with a claim for benefits, continued on page 2. VA Form 21-4138, pages 1 and 2
- Section III: Declaration of Intent
- Certification, signature of veteran/beneficiary (item 9) and date signed (item 10). VA Form 21-4138, page 2
Checked by PDF Tower: the official PDF has 2 pages and 33 fillable fields (32 text, 0 checkbox or radio, 1 signature), 861 KB. SHA-256 f534b7c43aa774ed…, computed .
Edition and revisions
- Edition on this page: JUL 2024.
Sources
- About VA Form 21-4138, Statement in Support of Claim (VA) Retrieved .
- VA Form 21-4138 (JUL 2024), official PDF Retrieved .
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