Statement in Support of Claim (VA Form 21-4138)

The respondent population for VA Form 21-4138 is composed of individuals providing self-certified statements in support of various types of claims processed by the agency. As such, VA Form 21-4138 is used to provide self-certified statements in support of various types of claims processed by VA. Statements submitted by or on behalf of a claimant should contain certification by the respondent that the information provided is true and correct. This form facilitates claims processing by providing a uniform format for the certification statement.

The latest form for Statement in Support of Claim (VA Form 21-4138) expires 2027-07-31 and can be found here.