Va Form 22 8794A PDF Details

The VA Form 22-8794A serves a crucial purpose in facilitating financial transactions for beneficiaries of Chapter 33 benefits, under Public Law 110-252, through the convenience and security of Electronic Funds Transfer (EFT). This form stands as a testament to the commitment of the Department of Veterans Affairs (VA) to enhance the efficacy of benefit delivery systems, safeguarding the personal and financial information of applicants in alignment with the Privacy Act of 1974 and related provisions in Title 38, Code of Federal Regulations 1.576. By mandating the collection of specific identifier information including educational and financial institution details, the VA ensures that benefits are accurately and securely disbursed to the rightful recipients. The procedure, designed to supersede any prior financial information provided, requires an average commitment of just 10 minutes to complete, emphasizing the VA's effort to minimize respondent burden while maintaining a robust verification process through potential computer matching with other agencies. Importantly, the form's submission is voluntary, yet integral for those looking to avail themselves of EFT for their benefit payments, illustrating a balance between operational efficiency and user convenience.

QuestionAnswer
Form NameVa Form 22 8794A
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesdva_form22 8794a eft va form 22 8794a

Form Preview Example

OMB Control No. 2900-0262

Respondent Burden: 10 Minutes

ELECTRONIC FUNDS TRANSFER (EFT) INFORMATION

PRIVACY ACT NOTICE: 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 1.576 for routine uses as identified in the VA system of records 58VA21/22/28, Compensation, Pension, Education and Vocational Rehabilitation and Employment Records - VA, and published in the Federal Register. Your obligation to respond is voluntary. This form is provided to help ease the cost and increase the security for financial transactions that may occur due to chapter 33 (Public Law 110-252) by using electronic fund transfers. The responses you submit are considered confidential (38 U.S.C. 5701). Any information provided by applicants, recipients, and others is subject to verification through computer matching programs with other agencies.

RESPONDENT BURDEN: We need this information to identify that your school or job training establishment requests electronic fund transfer for chapter 33 benefits paid on behalf of an individual. We estimate that you will need an average of 10 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 www.whitehouse.gov/library/omb/OMBINV.VA.EPA.html#VA. 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.

GENERAL INSTRUCTIONS

This form must be completed whenever there is a change in the financial institution information (Part II). The information contained in this form will supersede any information provided on previously submitted forms.

PART I - EDUCATIONAL INSTITUTION INFORMATION

1. NAME OF EDUCATIONAL INSTITUTION

2.ADDRESS OF INSTITUTION Number and Street

Unit/Bldg. Number

City, State, Zip

3A. TAX IDENTIFICATION NUMBER

3B. FACILITY CODE

PART I I - FINANCIAL INSTITUTION INFORMATION

4.NAME OF FINANCIAL INSTITUTION

5.ADDRESS OF INSTITUTION Number and Street

Unit/Bldg. Number

City, State, Zip

6. FINANCIAL ACCOUNT INFORMATION

Nine Digit Routing

Transit Number

Type of Account

(Check appropriate box)

Checking

Savings

Depositor Account Number

 

 

PART I I I - CONTACT INFORMATION

 

7. CONTACT PERSON

 

 

 

 

 

 

 

8. TELEPHONE NUMBER (Include Area Code)

 

 

 

 

 

PENALTY - The law provides that whoever makes any statement of a material fact knowing it to be false shall be punished by fine or imprisonment or both.

 

 

 

 

SIGNATURE

 

TITLE

DATE

 

 

 

 

 

VA FORM

22-8794A

SUPERSEDES VA FORM 22-8794A, FEB 2009,

 

SEP 2009

WHICH WILL NOT BE USED.

 

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Completing part 1 in Va Form 22 8794A

2. Soon after performing the previous step, go on to the subsequent stage and complete the necessary details in all these fields - FINANCIAL ACCOUNT INFORMATION, Nine Digit Routing Transit Number, Depositor Account Number, CONTACT PERSON, TELEPHONE NUMBER Include Area Code, Type of Account Check appropriate, Checking, Savings, PART I I I CONTACT INFORMATION, PENALTY The law provides that, SIGNATURE, TITLE, DATE, VA FORM SEP, and SUPERSEDES VA FORM A FEB WHICH.

TELEPHONE NUMBER Include Area Code, TITLE, and FINANCIAL ACCOUNT INFORMATION of Va Form 22 8794A

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