Va 21-4142 Form 2021-2024

Va 21-4142 Form: What You Should Know

REQUESTED FOR: For the following information, please click on the “Add Additional Information” button below: VA-2416-6 — Disability Rating and Disability Payment. To search for disability rating information, please use the  VA Form 21-4314. If you did not submit a claim or have additional questions after reading this form, please call the VBA at  or TDD, (for hearing impaired). Section III — SUBMISSION FOR REVIEW. To request review of your request for eligibility or disability review information, please provide the following information in the  order provided (“Form 21-4142.pdf”) : Your name, date of birth, and Social Security number. Contact information for the person responsible for reviewing your request; A description of the information that is being requested; Verification of eligibility for benefits and eligibility for your particular disability; Documentation supporting the reasons you want the information requested. Please provide any additional information that may be needed. Please enclose any supporting documentation. The VBA will review your request upon receipt of this information. If the VBA agrees to the request, a letter will be sent notifying such person of your eligibility for benefits and the status of your request. If the VBA does not agree to your request, your claim may be denied and your information disclosed as part of the investigation. In certain circumstances, you may also be issued a request (form 21-4142.pdf) to provide the following information: Your name, date of birth and Social Security number. All correspondence with the VBA will be held in strict confidence. VBA-21-4142-REQUEST.pdf VBA-21-4142-REQUEST.pdf Section IV — REVIEW. VBA will review the information in your request and will not initiate a claim or release your information until we approve the request. VA will work with the VBA regarding your request for review only if the VBA agrees and receives a copy of your signed Authorization to Disclose Form 21-4142 (if you are not required to provide an Authorization to Disclose Form 21-4142). If you fail to give us the Authorization, we will respond that the information requested is exempt.

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