Va Form 28 8739A PDF Details

Filing your VA Form 28-8739A is an important step in the process of receiving disability compensation from the Department of Veterans Affairs (VA). This form allows you to submit a claim for benefits, such as pension and compensation for service-connected disability. Filling out this form may seem intimidating at first, but understanding how it works can help take some of the stress out of submitting a claim. In this blog post we'll cover what details are requested on the VA Form 28-8739A, explain who needs to complete it, and provide instructions on how to file a completed form with the VA. With these tips, filing your claim can be much easier!

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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va form 28 8739a writing process outlined (step 1)

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