Official VA Form

VA Form 21-4193

Notice to Department of Veterans Affairs of Veteran or Beneficiary Incarcerated in Penal Institution

VA Form 21-4193 — Notice to Department of Veterans Affairs of Veteran or Beneficiary Incarcerated in Penal Institution is an official U.S. Department of Veterans Affairs form. The current version was last revised 2022-10-27. It is 3 pages long. Download the up-to-date PDF below — BaseNeed syncs form data directly from VA.gov so you always get the current edition.

Download the official PDF (VA.gov) →

Last revised: 2022-10-27
First issued: 2023-10-26
Pages: 3
Administered by: VBA

Frequently asked questions

What is VA Form 21-4193 used for?

Notice to Department of Veterans Affairs of Veteran or Beneficiary Incarcerated in Penal Institution. It is an official VA form, administered by VBA.

Where can I download the current VA Form 21-4193?

Download the official PDF from VA.gov here: https://www.vba.va.gov/pubs/forms/VBA-21-4193-ARE.pdf (last revised 2022-10-27).

How long is VA Form 21-4193?

VA Form 21-4193 is 3 pages long, last revised 2022-10-27.

Always the current version — synced from VA.gov. BaseNeed is not affiliated with the U.S. Department of Veterans Affairs.

You are not the first person to deal with this

BaseNeed is a members-only community for service members, veterans, spouses and their families. Nothing posted inside is public — not on Google, not on Facebook. That is the point: people talk about moves, money and paperwork there, and that only works behind a door.

Nearby form numbers

VA Form 21-4142a — General Release for Medical Provider Information to the Department of Veterans Affairs

VA Form 21-4170 — Statement of Marital Relationship

VA Form 21-4192 — Request for Employment Information in Connection with Claim for Disability Benefits

VA Form 21-4502 — Application for Automobile or Other Conveyance and Adaptive Equipment (UNDER 38 U.S.C. 3901-3904)

VA Form 21-526EZ — Application for Disability Compensation and Related Compensation Benefits

VA Form 21-651 — Election of Compensation in Lieu of Retired Pay or Waiver of Retired Pay to Secure Compensation from Department of Veterans Affairs (38 U.S.C. 5304(a)-5305)