Va Form 24 5281 – Fill Out and Use This PDF

Form Approved: OMB No. 2900-0261

Respondent Burden: 10 minutes

APPLICATION FOR REFUND OF EDUCATIONAL CONTRIBUTIONS

(VEAP, Chapter 32, Title 38, U.S.C.)

PRIVACY ACT INFORMATION: The information requested on this form is solicited under 38 U.S.C. 3223 (PL 94-502). This information is necessary to properly identify and refund the amount currently being held in the Post-Vietnam Era Veterans Education Account. Disclosure of the information requested is voluntary. However failure to provide this information may delay your refund payment. Your answers on the form may be given outside VA only if authorized under the Privacy Act, including the routine uses identified in the VA system of records, 58VA21/22, Compensation, Pension, Education and Rehabilitation Records - VA, published in the Federal Register.

RESPONDENT BURDEN: VA may not conduct or sponsor, and respondent is not required to respond to this collection of information unless it displays a valid OMB Control Number. Public reporting burden for this collection of information is estimated to average 10 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. If you have comments regarding this burden estimate or any other aspect of this collection of information, call 1-800-827-1000 for mailing information on where to send your comments.

IMPORTANT INSTRUCTIONS - Before you complete this form, you should understand that you may be eligible to receive educational benefits. By receiving a refund of your contributions you will forfeit entitlement to any educational benefits you may have earned under this program. If you have any questions

concerning your eligibility for benefits or need assistance with completing this form, you should contact your nearest VA regional office before submitting this form.

You may reach the VA by dialing toll-free 1-888-442-4551. However if you wish a refund, you must complete this form and forward it to the closest VA office.

PART I - IDENTIFICATION DATA

5. MAILING ADDRESS OF APPLICANT

PART II - NOTICE OF DISENROLLMENT AND APPLICATION FOR REFUND

I request to be disenrolled from the POST-VIETNAM ERA VETERANS EDUCATIONAL ASSISTANCE PROGRAM. I further request a refund of my remaining contributions . I realize that a refund of my contributions will result in forfeiture of my entitlement to receive educational benefits under this program. However while on active duty, I may enroll again in this program by establishing a payroll deduction and/or making a lump sum contribution(s) not to exceed a total of $2700, thereby reestablishing entitlement to educational benefits.

6. REASON FOR DISENROLLMENT

NOTE: The following signature block is to be completed only by applicants on active duty. Signature of Service Approving Official is required only upon disenrollment prior to completion of at least 12 monthly contributions to this program.

	FOR
		7. SIGNATURE OF APPLICANT	8. DATE SIGNED	9. SIGNATURE AND TITLE OF SERVICE APPROVING OFFICIAL	10. DATE SIGNED
	APPLICANTS
	ON
	ACTIVE
		11. LAST ALLOTMENT (Month, year)	12. SIGNATURE OF INSTALLATION FINANCE OFFICER		13. DATE SIGNED
	DUTY

NOTE: The following signature block is to be completed only by applicants not on active duty, and must either be notarized by a Notary Public or certified by a VA official upon the applicants personal appearance and presentation of valid identification at any VA regional office.

14.SIGNATURE OF APPLICANT

15. DATE SIGNED

16. SIGNATURE AND TITLE OF VA CERTIFYING OFFICIAL

17. DATE SIGNED

FOR
	18. DATE OF DISCHARGE (AS SHOWN ON YOUR DD FORM 214)
APPLICANTS
NOT
ON	Sworn to and subscribed before me this		day of		,
ACTIVE
DUTY
	[SEAL]		Notary Public

My commission expires

PART III - CERTIFICATION (FOR VA USE ONLY)

I CERTIFY that I have reviewed this document and that payment of refund is proper.

VA FORM	24-5281	SUPERSEDES VA FORM 24-5281, AUG 1998, WHICH
MAY 2001		WILL NOT BE USED.