Agency Information Collection Activity (Employment Questionnaire (VA Form 21-4140 and VA Form 21-4140-1))

The Veterans Benefits Administration (VBA), Department of Veterans Affairs (VA), is announcing an opportunity for public comment on the proposed collection of certain information by the agency. Under the Paperwork Reduction Act (PRA) of 1995, Federal agencies are required to publish notice in the Federal Register concerning each proposed collection of information, including each proposed revision of a currently approved collection, and allow 60 days for public comment in response to the notice. VA Forms 21-4140 and 21-4140-1 are to be used to gather the necessary information to determine continued entitlement to individual unemployability for veterans who are unable to secure or follow a substantially gainful occupation as a result of his or her service- connected disabilities. Additionally, per 38 CFR 3.901, veterans must knowingly submit false information in order for it to be considered fraud. Therefore, VA requires veterans who are receiving individual unemployability benefits to certify that they are still unemployed or are marginally employed. The form will be completed annually by all recipients of individual unemployability who are under age 60.