Form 28-1905m at a glance
What it is: VA Form 28-1905m, Request and Authorization for Supplies and Direct Reimbursement (Chapter 31, Veteran Readiness and Employment), requests assistance with supplies and equipment and/or direct reimbursement.
Who signs: The claimant signs in box 12A, CLAIMANT SIGNATURE (REQUIRED).
Where to get it: VA forms are available at www.va.gov/vaforms.
Use this form to submit a request for assistance with obtaining supplies and equipment and/or direct reimbursement needed or required to complete your Chapter 31 program.
VA will furnish goods and/or services to the claimant who is participating in a rehabilitation plan of services if one of the following criteria applies. The goods and/or services are required for one of the following reasons: to be used by all individuals in the claimant's program, to compensate for the effects of the claimant's disabilities, or to allow the claimant to function more independently and lessen his or her dependence on others (38 CFR 21.212(b)).
Or the VA case manager has determined that the goods and/or services are needed and both of the following criteria are met: the items are generally owned and used by students or employees pursuing the training, independent living, or employment objective, and individuals who do not have the items would be placed at a distinct disadvantage (38 CFR 21.212(d)).
The information requested on this form is required under the provisions of 31 U.S.C. 3325, for the purpose of disbursing Federal money.
A filled-in Form 28-1905m example: a claimant asks for a drafting table
How to fill out Form 28-1905m, box by box
Section I: Claimant's identification information
Enter the claimant's name (First, Middle Initial, Last) in box 1.
Enter the rehabilitation plan goal in box 3 and the VA file number (if applicable) in box 2.
In box 4, enter the address where supplies will be delivered to the claimant (Number and street or rural route, P.O. Box, City, State, ZIP Code and Country), with the Apt./Unit Number and State/Province.
In box 5, enter the telephone number, including the area code. Enter the international phone number if applicable.
Box 6, the email address, is optional. To agree to receive electronic correspondence from VA in regards to your claim, mark the "I agree" box.
Section II: Request for purchase or direct reimbursement
Claimants are required to complete Section II and provide the supportive information for the request of purchase or direct reimbursement.
In box 7, enter the Name of Item/Services and Description.
In box 8, enter the quantity. In box 9, enter the estimated cost (Government Purchase Card).
Section II is continued on the next page.
Section III: Certification and signature of claimant
Mark the box for I CERTIFY THAT I have filled in this form completely and that it is true and correct to the best of my knowledge and belief.
Sign on the line in 12A, the claimant signature (required), and enter the date signed in 12B (MM/DD/YYYY).
The claimant's signature in Section III verifies that the requested items are needed or required based on the conditions listed in Section II and will be used during his or her rehabilitation plan of services.
Section IV: Training facility or employer (if applicable)
If the training facility or employer requires the claimant to personally possess the goods and/or services, the training facility representative or employer must specify the goods and/or services in Section II and sign in Section IV.
If the VA case manager determines that the goods and/or services are needed or required, signature from the training facility or employer representative is not necessary.
Section IV prints this certification: I CERTIFY THAT the items listed in Section II, Item 7 are required of all students or all employees.
In 13A, enter the name and address of the training facility or employer (Number and Street or rural route, P.O. Box, City, State/Province, ZIP Code and Country).
The training facility or employer representative signs in 13B with a title, and enters the date signed in 13C (MM/DD/YYYY).
Section IV: Case manager, boxes 14A to 14C
The case manager must review the requested goods and/or services in Section II and sign in Section IV and VI (if applicable).
In 14A, enter the name of the case manager (First, Middle Initial, Last); the case manager signs in 14B and enters the date signed in 14C (MM/DD/YYYY).
More rules for Form 28-1905m
Do not send your completed VA Form 28-1905m to the VA Reports Clearance Officer email address, VACOPaperworkReduAct@VA.gov, which is for comments regarding the burden estimate.
If your situation is different
Direct Reimbursement
In box 10, enter the actual cost (Direct Reimbursement).
In box 11, enter the date the item or service was received (Direct Reimbursement).
For Direct Reimbursement, the claimant's signature also verifies the item(s) or service(s) were received on the dates listed in Item 11.
Before you go
Before completing this form, read the Privacy Act and Respondent Burden on page 3.
You may complete the form online or by hand. If completing by hand, print neatly and legibly in ink, and completely fill in each applicable box to help expedite the processing of the form.
Common questions about Form 28-1905m
What is VA form 28 1905M?
VA Form 28-1905m, Request and Authorization for Supplies and Direct Reimbursement (Chapter 31, Veteran Readiness and Employment), requests assistance with supplies and equipment and/or direct reimbursement. This form supersedes VA Form 28-1905M, JUL 2021, which will not be used.
Where do I file it?
If returning by mail, mail to: Veteran Readiness and Employment (VR&E) Intake Center, Department of Veterans Affairs, P.O. Box 5210, Janesville, WI 53547-5210.
Is there a penalty?
The law provides severe penalties (including fine and/or imprisonment) for willfully submitting any statement or evidence of a material fact you know to be false, or for fraudulent receipt of any document you are not entitled to.
Where to get help with Form 28-1905m
For more information, contact VA at https://ask.va.gov or call toll-free at 1-800-827-1000. If you use a Telecommunications Device for the Deaf (TDD), the Federal relay number is 711.
Sources
[1] VA Form 28-1905m (MAY 2024; the file's edition line also names the superseded JUL 2021), Request and Authorization for Supplies and Direct Reimbursement, Department of Veterans Affairs (the Official source link on this page).
