21-4192 Form - Specifically, the form may require the following information: Your most recent employer must complete and submit this form. If you’re filing a claim for disability compensation online, you don’t need to submit this pdf form. Request for employment information in connection with claim for disability benefits. Learn more about special claims based on individual unemployability.
If you’re filing a claim for disability compensation online, you don’t need to submit this pdf form. Learn more about special claims based on individual unemployability. Your most recent employer must complete and submit this form. Specifically, the form may require the following information: Request for employment information in connection with claim for disability benefits.