Va Form 28 8739A PDF Details

Securing the benefits and support veterans deserve after serving requires navigating various procedures and documentation. Among these, the VA Form 28-8739A stands out as a pivotal document designed to uphold veterans' privacy while ensuring they receive the maximal benefits from rehabilitation programs. Crafted by the Department of Veterans Affairs, this form serves as a Protection of Privacy Information Statement, pivotal for counselees and participants of rehabilitation courses. It's underpinned by Title 38 of the United States Code of Federal Regulations 1.576, which aims to streamline the process of vocational and educational planning, authorize rehabilitation services, and monitor vocational progress. By completing this form, veterans willingly contribute vital information, understanding it will be strictly used to further their rehabilitation and educational goals. The safeguards of the Privacy Act of 1974 are meticulously observed, ensuring that disclosed information remains protected unless sharing is authorized under specific circumstances defined within the Act. The form makes it clear that while providing information is voluntary, withholding information can impact the extent of benefits received, potentially affecting veterans' educational or rehabilitation opportunities. Nevertheless, it reassures veterans that non-disclosure will not negatively affect their eligibility for other benefits. Emphasizing transparency and consent, the form concludes with a certification by the veteran, affirming the truthfulness of the provided information, thereby laying a foundation for trust and clarity in the rehabilitation process.

QuestionAnswer
Form NameVa Form 28 8739A
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other names28-8739a, vocational, counselees, disclosures

Form Preview Example

Department of Veterans Affairs

PROTECTION OF PRIVACY INFORMATION STATEMENT

(For use by counselees and rehabilitation program participants)

I have been informed and understand that the information requested in this and any later interviews is requested under the authorization of Title 38, United States Code of Federal Regulations 1.576, Veterans Benefits. This information is needed to assist in vocational and educational planning, to authorize my receipt of rehabilitation services, to develop a record of my vocational progress, and to assure I obtain the best results from my rehabilitation program. I understand that the information I provide will not be used for any other purpose and that my responses may be disclosed outside the VA only if the disclosure is authorized under the Privacy Act of 1974, including the routine uses identified in VA system of records, 58VA21/22, Compensation, Pension, Education and Rehabilitation Records published in the Federal Register. Generally, disclosures under the authority of a routine use will be made to develop my claim for vocational rehabilitation benefits under Title 38, United States Code.

My giving the requested information is voluntary. I understand that the following results might occur if I do not give this information:

(1)I may not receive the maximum benefit either from counseling or from my education or rehabilitation program.

(2)If certain information is required before I may enter a VA program, my failure to give the information may result in my not receiving the education or rehabilitation benefit for which I have applied.

(3)If I am in a program in which information on my progress is required, my failure to give this information may result in my not receiving further benefits or services.

My failure to give this information will not have a negative effect on any other benefit to which I may be entitled.

I HEREBY CERTIFY THAT the information I have given is true and correct to the best of my knowledge and belief.

____________________________________________________

__________________________

Veteran’s Signature

Today’s Date

VA FORM 28-8739A

OCTOBER 2004

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