1910 Application Voucher Form Details

Va Form 28 1910 is a required form for all veterans seeking medical benefits through the Department of Veterans Affairs. The form is used to determine eligibility and calculate benefits. Completed correctly, the form can help ensure that veterans receive the health care they deserve. In this blog post, we'll provide an overview of Va Form 28 1910 and explain how to complete it.

You will discover information about the type of form you need to fill out in the table. It will tell you the time you will need to finish va form 28 1910, exactly what fields you will have to fill in and several further specific details.

QuestionAnswer
Form NameVa Form 28 1910
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other names281910, 28 1910 fillable, va 1910 form, 28 1910 online

Form Preview Example

Department of Veterans

Affairs

APPLICATION AND PUBLIC VOUCHER FOR ADVANCEMENT

FROM THE VOCATIONAL REHABILITATION REVOLVING FUND

 

D.O. VOUCHER NUMBER

 

BUREAU VOUCHER NUMBER

FILE NUMBER

 

 

 

 

<CLAIM NUMBER>

 

 

 

 

 

 

 

 

 

PAID BY

 

 

THE UNITED STATES

 

 

 

<VETERAN NAME>

 

 

 

<ADDRESS>

 

 

 

<CITY, STATE, ZIPCODE>

 

 

 

 

 

(FOR USE OF PAYING OFFICE)

 

 

 

 

 

 

 

 

APPLICATION FOR ADVANCE

 

 

I request an advance of

from the Vocational Rehabilitation Revolving Fund. If the advance is made, I consent to collection of the

amount advanced by deductions from my compensation, pension, subsistence allowance, educational assistance allowance, retirement or military retired or retainer pay, or by other means necessary to make full recovery. I understand that if my training is discontinued or completed, or I reach my program eligibility termination date before I have repaid the advance, VA will withhold any monies due me until the advance is paid in full.

SIGNATURE OF VETERAN

ADDRESS

DATE

 

 

 

CERTIFICATE OF DESIGNATED OFFICER IN VOCATIONAL REHABILITATION AND COUNSELING DIVISION

I CERTIFY THAT the applicant is receiving vocational rehabilitation services and I approve an advance in the amount of

. Recovery

of the funds will be made at the rate of

per month from future payment of subsistence allowance, compensation, pension,

educational assistance allowance, retirement, military retired or retainer pay to which he or she is lawfully entitled.

 

 

 

 

 

 

 

SIGNATURE AND TITLE

 

STATION

 

DATE

 

 

 

 

343/

 

 

 

 

 

 

 

 

CERTIFICATE OF DESIGNATED OFFICER IN FINANCE ACTIVITY

I CERTIFY THAT the applicant will begin to receive or is receiving vocational rehabilitation services under chapter 31, Title 38, U.S. code. This voucher has been examined and found true and correct.

SIGNATURE OF AUTHORIZED CERTIFYING OFFICER

AMOUNT CERTIFIED

DATE

 

 

 

ACCOUNTING CLASSIFICATION

(For completion by administrative officer)

APPROPRIATION

 

SYMBOL

TITLE

 

AMOUNT

 

 

36X4114

VOCATIONAL REHABILITATION DEPARTMENT

 

 

 

 

OF VETERANS AFFAIRS REVOLVING FUND

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PAID BY (Check one)

 

BUREAU SCHEDULE OR ADP BATCH

 

DATE

 

CHECK

(Third Party Check)

CONTROL NO. AMOUNT

 

 

 

 

 

 

 

 

 

CASH

 

 

 

 

 

 

 

 

 

 

 

 

SIGNATURE OF PAYEE (Cash payment only)

 

 

DATE

 

 

 

 

 

 

 

 

VA FORM

28-1910

EXISTING STOCKS OF VA FORM 28-1910, JUN 1986, WILL BE

 

*U.S. GPO:

 

USED

1982-343-134/3489

 

MAR-90