Claimants Details

Va Form 22 1995 is a document that all veterans should have in their possession. This form is used to apply for Veterans Affairs (VA) benefits, and it is important to understand how to complete it correctly in order to receive the benefits you deserve. In this blog post, we will provide an overview of Va Form 22 1995 and explain how to fill out each section correctly. Completing this form can be difficult, so if you need assistance, please contact a VA representative for help.

The listing has got information regarding the va form 22 1995. It's advisable that you read through this information before you start editing the form.

QuestionAnswer
Form NameVa Form 22 1995
Form Length4 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min
Other names

Form Preview Example

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OMB Control No. 2900-0074

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Respondent Burden: 20 Minutes

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Expiration Date: 10/31/2021

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

REQUEST FOR CHANGE OF PROGRAM OR PLACE OF TRAINING

 

 

 

 

PART I - IDENTIFICATION AND PERSONAL INFORMATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1A. NAME OF APPLICANT (Last, First, Middle)

 

 

 

 

 

 

 

 

 

 

 

 

VA DATE STAMP

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DO NOT WRITE IN THIS SPACE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1B. MAILING ADDRESS (Complete street address, City, State, and 9-digit ZIP Code)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1C. APPLICANT'S TELEPHONE NUMBER (Including Area Code)

 

1D. VA FILE NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

HOME (include area code)

 

MOBILE (include area code)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1F. SOCIAL SECURITY OF APPLICANT (For transferability cases,

1E. APPLICANT'S E-MAIL ADDRESS (if applicable)

 

 

 

 

 

 

 

enter the veteran's social security number)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PART II - YOUR PROGRAM INFORMATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2. EDUCATION BENEFIT YOU WANT TO RECEIVE (Only Select One)

 

 

 

 

 

 

 

CHAPTER 33 (Post-9/11 GI BILL)

C.

 

 

 

 

CHAPTER 32 (Veterans Educational Assistance

E.

 

 

TRANSFER OF ENTITLEMENT PROGRAM

A.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Program including section 903)

 

 

 

 

 

CHAPTER 30 (Montgomery GI Bill -

 

 

 

 

 

CHAPTER 1606 (Montgomery GI Bill-

 

 

 

 

B.

 

 

D.

 

 

 

 

 

 

 

 

 

Active Duty)

 

 

 

 

 

Selected Reserve)

 

 

 

 

 

 

3. HOW WILL YOU TAKE TRAINING?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SCHOOL ATTENDANCE

 

 

 

 

 

 

G.

 

LICENSING & CERTIFICATION TEST

A.

 

 

D.

 

 

 

 

COOPERATIVE TRAINING

 

 

 

 

 

 

 

 

 

 

 

 

NATIONAL ADMISSIONS EXAMS OR

B.

 

 

CORRESPONDENCE

E.

 

 

 

 

TUITION ASSISTANCE TOP-UP

H.

 

 

 

 

 

 

 

 

 

 

 

(Active Duty Only)

 

 

 

NATIONAL EXAMS FOR CREDIT

 

APPRENTICESHIP OR ON-THE-JOB

 

 

 

 

 

 

 

 

 

 

 

 

 

C.

 

 

F.

 

 

 

 

FLIGHT TRAINING

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TRAINING

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4A. WHAT EDUCATIONAL, PROFESSIONAL OR VOCATIONAL GOAL ARE

 

4B. WHAT IS THE NAME OF THE PROGRAM YOU ARE REQUESTING?

YOU WORKING TOWARD?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4C. IF CHANGING SCHOOLS, PROVIDE NAME AND COMPLETE ADDRESS

 

4D. PROVIDE NAME AND COMPLETE ADDRESS OF PREVIOUS SCHOOL OR

OF NEW SCHOOL OR TRAINING ESTABLISHMENT YOU ARE PLANNING

 

TRAINING ESTABLISHMENT (If only changing schools, list current school.)

TO ATTEND (If applicable)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4E. TELL US WHEN AND WHY YOU STOPPED TRAINING AT YOUR PRIOR SCHOOL OR ESTABLISHMENT. CONTINUE IN REMARKS, ITEM 10, OR ON A SEPARATE

SHEET IF NECESSARY. (If applicable)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VA FORM

22-1995

 

 

 

 

SUPERSEDES VA FORM 22-1995, FEB 2020,

 

 

 

Page 1

JUL 2020

 

 

 

 

WHICH WILL NOT BE USED.

 

 

 

 

PART III - DIRECT DEPOSIT INFORMATION

5.DIRECT DEPOSIT (Complete this item only if you wish to start, change or stop direct deposit.) (See Instructions and Information, Page 3, Item number 5 for additional information regarding direct deposit.)

NOTE: To prevent possible delays in payment, claimants are highly encouraged to use Direct Deposit and set up an Electronic Fund Transfer (EFT.) Direct Deposit is not available for the Post-Vietnam Era Educational Assistance Program (VEAP - Chapter 32) nor for Section 903.

 

 

 

 

START OR CHANGE EFT (Please attach a voided personal check or provide the information in items 5A through 5D below.)

 

STOP EFT

5A. TYPE OF ACCOUNT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CHECKING

 

SAVINGS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5B. NAME OF FINANCIAL INSTITUTION

5C. 9 DIGIT ROUTING OR TRANSIT NUMBER

5D. ACCOUNT NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

PART IV - MISCELLANEOUS INFORMATION

6.INFORMATION ON DEPENDENTS (COMPLETE THIS ITEM ONLY IF YOU SERVED BEFORE JANUARY 1, 1977 (or had a delayed entry before January 2, 1978) AND YOU CURRENTLY HAVE DEPENDENTS.)

QUESTIONS

YES

NO

6A. ARE YOU CURRENTLY MARRIED?

6B. DO YOU HAVE ANY CHILDREN WHO ARE:

(1) UNDER AGE 18 OR

(2) OVER 18 BUT UNDER AGE 23, NOT MARRIED AND ATTENDING SCHOOL? OR

(3) OF ANY AGE PERMANENTLY HELPLESS FOR MENTAL OR PHYSICAL REASONS?

6C. IS EITHER YOUR FATHER OR MOTHER DEPENDENT UPON YOU FOR FINANCIAL SUPPORT?

7.RECENT PERIODS OF SERVICE (PERIODS OF ACTIVE DUTY SINCE YOUR INITIAL PERIOD OF ACTIVE DUTY.) Please complete this section for each period of your active duty since your initial period of active duty if you have not previously reported this information. It will help VA process your claim if you attach a certified copy of "Member 4 Copy" of your DD Form 214 for each period of active service. (Don't report Active Duty for Training.)

7A. BRANCH OF SERVICE AND RESERVE OR GUARD COMPONENT SERVED IN DURING ACTIVE DUTY

7B. BEGINNING AND ENDING

DATES OF ACTIVE DUTY

7C. WERE YOU

INVOLUNTARILY CALLED TO

ACTIVE DUTY FOR THIS PERIOD? (If yes send in

copies of your orders)

YES

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7D. WHAT WAS THE CHARACTER

OF YOUR DISCHARGE?

7E. IF THIS ACTIVE DUTY IS

NATIONAL GUARD DUTY, INDICATE

IF AUTHORITY IS TITLE 10

(FEDERAL) OR TITLE 32 (STATE).

(ATTACH COPIES OF ANY ORDERS)

NOTE: DO NOT INCLUDE FULL TIME ASSIGNMENT BY A SERVICE DEPARTMENT TO A CIVILIAN SCHOOL FOR A COURSE OF EDUCATION; ATTENDANCE AT A SERVICE ACADEMY; OR NON-CREDITABLE TIME (TIME LOST BECAUSE OF INDUSTRIAL OR AGRICULTURAL FURLOUGH, ARREST WITHOUT ACQUITTAL, BEING AWOL, DESERTION, SENTENCE OF COURT-MARTIAL, ETC.)

8.DO YOU EXPECT TO RECEIVE EDUCATIONAL BENEFITS UNDER THE GOVERNMENT EMPLOYEE'S TRAINING ACT (GETA) FOR THE SAME COURSE(S) YOU WILL RECEIVE VA EDUCATION BENEFITS? (Answer only if you are a Federal Government employee)

YES

NO

9.ARE YOU RECEIVING OR DO YOU ANTICIPATE RECEIVING ANY MONEY (including but not limited to Federal Tuition Assistance) FROM THE ARMED FORCES OR PUBLIC HEALTH SERVICE FOR THE COURSE FOR WHICH YOU HAVE APPLIED TO VA FOR EDUCATION BENEFITS? IF YOU WILL RECEIVE SUCH BENEFITS, CHECK "YES." SHOW COMPLETE DETAILS IN THE REMARKS SECTION TO INCLUDE THE SOURCE OF THE FUNDS. NOTE: IF YOU ARE APPLYING FOR THE TUITION ASSISTANCE TOP-UP BENEFIT, CHECK "NO." (Answer only if you are on Active Duty)

YES

NO

10. REMARKS

PART V - CERTIFICATION AND SIGNATURE OF APPLICANT

I CERTIFY THAT all statements in my application are true and correct to the best of my knowledge and belief. If on active duty, I also certify that I have consulted with an Education Service Officer (ESO) regarding my education program.

PENALTY - Willful false statements as to a material fact in a claim for education benefits is a punishable offense and may result in the forfeiture of these or other benefits and in criminal penalties.

11A. SIGNATURE OF APPLICANT (DO NOT PRINT)

SIGN HERE IN INK

11B. DATE SIGNED

VA FORM 22-1995, JUL 2020

Page 2

 

INSTRUCTIONS & INFORMATION

When Should You Use This Form?

Use this form when:

you're changing schools,

you're changing your educational, professional, vocational goal,

you left your program due to unsatisfactory attendance, progress, or conduct; and you're now reentering the same program,

you were receiving VA education benefits as a veteran and now wish to receive benefits while on active military duty.

INSTRUCTIONS FOR SPECIFIC ITEMS ON THE FORM

Most items on this form are self-explanatory. Here is additional information on certain items.

Item #4A: Here are some examples of what we mean by "goals":

Educational goal: GED certificate, high school diploma, bachelor's degree, master's degree, Ph.D

Professional goal: lawyer, physician, teacher, physical therapist, medical technologist, medical records librarian, stenographer, machinist, electronic technician, X-ray technician, radio and

Vocational goal: TV service technician, automobile mechanic, practical nurse.

Item #5: The Department of the Treasury requires all Federal benefit payments be made by electronic funds transfer (EFT), also called direct deposit (Direct Deposit is not available for Chapter 32 recipients). To enroll in direct deposit, please attach a voided personal check, deposit slip, or provide the information requested in Item 5. If you do not have a bank account, please visit https://www.benefits.va.gov/benefits/banking.asp. This website provides information about the Veterans Benefits Banking Program (VBBP), and a link to banks and credit unions that may fit your needs. You may also call 1-800-827-1000. If you elect not to enroll, you must contact representatives handling waiver requests for the Department of the Treasury at 1-888-224-2950. They will encourage your participation in EFT and address any questions or concerns you may have.

Item #6: Provide your dependents' information only if you have military service before January 1, 1977 (or delayed entry before January 2, 1978).

Item #6A: IMPORTANT: If you are certifying that you are married for the purpose of VA benefits, your marriage must be recognized by the place where you and/or your spouse resided at the time of marriage, or where you and/or your spouse resided when you filed your claim (or a later date when you become eligible for benefits) (38 U.S.C. § 103(c)). Additional guidance on when VA recognizes marriages is available at http://www.va. gov/opa/marriage/.

If You Need Help

If you need help in completing this form, you can contact us through our home page on the Internet. Our website is: www.benefits.va.gov/gibill. Click on the "Contact Us" tab and then the "Ask a Question" tab. Or you may call us toll free at 1-888-GI-BILL-1 (1-888-442-4551.) If you use the Telecommunications Device for the Deaf (TDD), the Federal Relay number is 711. Please call 1-800-827-1000 if you want a VA counselor to help you in planning your program.

TO FILE THIS FORM:

(A) If you have selected a school or training establishment,

Step1: Mail the completed form to the VA Regional Processing Office in the region of that school's or establishment's physical address. Determine the correct office from the list on page 4.

Step 2: Notify the veterans certifying official at your school or training establishment that you have applied for VA education benefits. Ask him or her to submit your enrollment information using VA Form 22-1999, Enrollment Certification, or its electronic version.

Step 3: Wait for VA to process your application and notify you of our decision concerning your continued eligibility for educational assistance.

(B)If you have not selected a school or training establishment,

Step 1: Mail the completed form to the VA Regional Processing Office in the region of your home address. Determine the correct office from the list on page 4.

Step 2: Wait for VA to process your application and notify you of our decision concerning your continued eligibility for educational assistance.

VA FORM 22-1995, JUL 2020

Page 3

 

Eastern Region:

VA Regional Office

P. O. Box 4616

Buffalo, NY 14240-4616

SERVES THE FOLLOWING STATES

 

CO

CT

DC

 

DE

 

IA

IL

IN

KS

KY

MA

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MD

ME

MI

 

MN

 

MO

MT

NC

ND

NE

NH

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NJ

NY

OH

 

PA

 

RI

SD

TN

VA

VT

WI

 

 

 

 

 

 

 

 

 

 

 

 

 

 

WV

WY

 

APO/FPO AA

 

FOREIGN

U.S. VIRGIN ISLANDS

 

 

 

 

 

 

SCHOOLS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Western Region:

VA Regional Office

P.O. Box 8888

Muskogee, OK 74402-8888

SERVES THE FOLLOWING STATES

AK

AL

AR

AZ

CA

 

FL

GA

HI

ID

LA

 

 

 

 

 

 

 

 

 

 

 

MS

NM

NV

OK

OR

 

PR

SC

TX

UT

WA

 

 

 

 

 

 

 

 

 

 

 

 

APO/FPO AP

 

 

GUAM

 

PHILIPPINES

 

 

 

 

 

 

 

 

 

 

 

 

REQUEST TO OPT OUT OF INFORMATION SHARING WITH EDUCATIONAL INSTITUTIONS:

The Harry W. Colmery Veterans Educational Assistance Act of 2017 (Public Law 115-48), also known as the "Forever GI Bill," requires the Department of Veterans Affairs (VA) to make available to educational institutions information about the amount of educational assistance to which a Veteran or other eligible individual is entitled. If you're eligible for the Post-9/11 GI Bill (Chapter 33), Montgomery GI Bill - Active Duty (Chapter 30), Montgomery GI Bill -Selected Reserve, (Chapter 1606), or the Survivors' and Dependents' Educational Assistance Program (DEA) (Chapter 35), you may elect to “opt-out” of these disclosures and have VA withhold this information instead. To request an opt-out, or for information about how to opt- out, please refer to our website at va.gov, or click https://www.va.gov/find-forms/, to complete the Request to Opt-Out of Information Sharing with Educational Institutions, VA Form 22-0993.

PRIVACY ACT NOTICE: The VA will not disclose information collected on this form to any source other than what has been authorized under the Privacy Act of 1974 or title 38, Code of Federal Regulations, section 1.526 for routine uses (e.g. VA sends educational forms or letters with a veteran's identifying information to the veteran's school or training establishment to (1) assist the veteran in the completion of claims forms or (2) for the VA to obtain further information as may be necessary from the school for the VA to properly process the veteran's education claim or to monitor his or her progress during training) as identified in the VA system of records, 58VA21/22/28, Compensation, Pension, Education and Veteran Readiness and Employment Services - VA, published in the Federal Register. Your obligation to respond is required to obtain or retain education benefits. The requested information is considered relevant and necessary to determine the maximum benefits under the law. While you do not have to respond, VA cannot process your claim for education assistance unless the information is furnished as required by existing law (38 U.S.C. 3471). The responses you submit are considered confidential (38 U.S.C. 5701). Any information provided by applicants, recipients, and others may be subject to verification through computer matching programs with other agencies.

RESPONDENT BURDEN: We need this information to determine your continued eligibility to VA education benefits (38 U.S.C. 3471). Title 38, United States Code, allows us to ask for this information. We estimate that you will need an average of 20 minutes to review the instructions, find the information, and complete this form. VA cannot conduct or sponsor a collection of information unless a valid OMB control number is displayed. You are not required to respond to a collection of information if this number is not displayed. Valid OMB control numbers can be located on the OMB Internet Page at http://www.reginfo.gov/public/do/PRAMain. If desired, you can call 1-888-GI-BILL-1 (1-888-442-4551) to get information on where to send comments or suggestions about this form.

VA FORM 22-1995, JUL 2020

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