The Va Form 28 8872 is a document used to apply for disability compensation. This form can be tricky to fill out, so it is important to understand the instructions and how to complete it correctly. In this blog post, we will go over the basics of the Va Form 28 8872 and provide tips on how to submit a strong application.
This page has got information about va form 28 8872. It can be useful to know its size, the actual time to prepare the form, the fields you will need to fill in, and so on.
| Question | Answer |
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| Form Name | Va Form 28 8872 |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | 28 8872, va form 28 8872, 28 form va 8872, 8h 28 8872 form |
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REHABILITATION PLAN |
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1. DATE |
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2. FIRST - MIDDLE - LAST NAME OF VETERAN |
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3. CLAIM NUMBER |
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4. SOCIAL SECURITY NUMBER |
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C- |
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5. PROGRAM PLAN (Check one) |
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6A. TYPE OF PLAN |
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IEEP - INDIVIDUALIZED |
IWRP - INDIVIDUALIZED |
ORIGINAL |
AMENDMENT |
(If "Amendment," complete |
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Items 6B and 6C) |
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EXTENDED EVALUATION |
WRITTEN REHABILITATION |
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6B. AMENDMENT NO. TO IWRP |
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6C. DATE OF IWRP |
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IEAP - INDIVIDUALIZED |
IILP - INDIVIDUALIZED |
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EMPLOYMENT ASSISTANCE |
INDEPENDENT LIVING |
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7. PROGRAM GOAL |
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NOTE: INTERMEDIATE OBJECTIVES TO ACHIEVE PLANNED GOAL COVERED IN ITEMS 8 THRU 12. |
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8A. OBJECTIVE ONE (Description) |
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8B. ANTICIPATED COMPLETION DATE |
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8C. SERVICES PROVIDED |
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8D. DURATION OF SERVICES |
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FROM (Mo., Yr.) |
TO (No., Yr.) |
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8E. NAME & ADDRESS OF PERSON OR INSTITUTION PROVIDING SERVICES |
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8F. PERSON TO CONTACT (If institution) |
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8G. TELEPHONE NO. (Include Area Code) |
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8H. EVALUATION CRITERIA |
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8I. EVALUATION PROCEDURE |
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8J. EVALUATION SCHEDULE |
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8K. PROGRESS NOTES |
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9A. OBJECTIVE TWO (Description) |
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9B. ANTICIPATED COMPLETION DATE |
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9C. SERVICES PROVIDED |
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9D. DURATION OF SERVICES |
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FROM (Mo., Yr.) |
TO (No., Yr.) |
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9E. NAME & ADDRESS OF PERSON OR INSTITUTION PROVIDING SERVICES |
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9F. PERSON TO CONTACT (If institution) |
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9G. TELEPHONE NO. (Include Area Code) |
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9H. EVALUATION CRITERIA |
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SEP 1989 |
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WILL BE USED. |
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VA FORM |
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EXISTING STOCKS OF VA FORM |
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CONTINUED ON |
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ITEM 9, CONTINUED
9I. EVALUATION PROCEDURE
9J. EVALUATION SCHEDULE
9K. PROGRESS NOTES
10A. OBJECTIVE THREE (Description)
10C. SERVICES PROVIDED
10B. ANTICIPATED COMPLETION DATE
10D. DURATION OF SERVICES
FROM (Mo., Yr.) |
TO (No., Yr.) |
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10E. NAME & ADDRESS OF PERSON OR INSTITUTION PROVIDING SERVICES
10F. PERSON TO CONTACT (If institution)
10G. TELEPHONE NO. (Include Area Code)
10H. EVALUATION CRITERIA
10I. EVALUATION PROCEDURE
10J. EVALUATION SCHEDULE
10K. PROGRESS NOTES
11. CONTINUATION SHEET
CHECK BOX IF VA FORM
12. CLOSURE STATEMENT
I CERTIFY THAT I have participated in the development of this program plan. I understand it is my responsibility to cooperate in the program and make reasonable efforts on my behalf. There will be periodic and/or an annual review of the plan, at which time the VA staff members and I will have a chance to jointly redevelop it.
13. SIGNATURE OF VETERAN
14. SIGNATURE OF COUNSELING PSYCHOLOGIST
15. SIGNATURE OF VOCATIONAL REHABILITATION SPECIALIST
16. ANNUAL REVIEW DATE