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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 ...
Get VA Form 21-4138, Statement in Support of Claim. Use this VA form to submit a VA buddy statement or other statement you believe will help support your request for VA benefits.
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 800-827-1000 (TTY:711). VA forms are available at www.va.gov/vaforms.
The following statement is made in connection with a claim for benefits in the case of the above-named veteran: VA FORM 21-4138, JAN 2015.
Use this form to submit a formal statement to support your VA claim—or the claim of another Veteran or eligible family member. People also sometimes call this statement a “buddy statement.” How to submit this form. You can submit this form online or by mail. Submit a lay or witness statement online to support a claim.
VA Form 21-4138 can be completed online or printed and filled out by hand. Veterans may also ask for assistance with filling out the form, such as from an accredited veterans’ representative. First, you should provide identifying information in Section I, such as: Full name. Social security number.
EXISTING STOCKS OF VA FORM 21-4138, JAN 2015, WILL BE USED. Page 1 INSTRUCTIONS: Read the Privacy Act and Respondent Burden on Page 2 before completing the form. Complete as much of Section I as possible. The information requested will help process your claim for benefits. If you need any additional room, use the second page. VA DATE STAMP