VA Form 28-1900: Application for Veteran Readiness and Employment Benefits

Enter the claimant's name (First, Middle Initial, Last) in box 1.

Enter the Social Security Number in box 2, the VA File Number in box 3 (if different from Item 2) and the Date of Birth in box 4 (MM-DD-YYYY).

In box 5, enter the Mailing Address (Number and street or rural route, City, State and ZIP Code), OR write "None," if no mailing address.

If you have created your profile in VA.gov, the address you provided in your profile must match the address you provided on this form to avoid delays in processing your application.

You will not be denied Chapter 31 benefits if you do not have a mailing address as outlined in 38 U.S.C. 5126. However, if you do not have a mailing address, you need to write "NONE" on Question #5 and provide an alternative means of contact, either an address such as an address to a homeless shelter or P.O. Box or telephone number, so you can be scheduled for an initial evaluation appointment.

In box 6, enter the Main Telephone Number (include Area Code, or check "None" if no available telephone number).

Check "None" if there is no phone number. Enter an International Phone Number (if applicable).

In box 7, enter the Cell Phone Number (include Area Code, or check "None" if no available cell phone number).

In box 8, enter the E-Mail Address of Claimant. You can check the box to say: I agree to receive electronic correspondence from VA in regards to my claim.

In box 9, if you are moving within the next 30 days, provide your new address.

Enter the number of years of education in box 10.

It is important that you check the box on Section II: Protection of Privacy Information Statement, to ensure that you will be provided appropriate vocational rehabilitation services. If you do not check the box, you will be required to sign a separate VA Form 28-8739a, Protection of Privacy Information Statement.

The box reads: I acknowledge I have read the Protection of Privacy Information Statement.

By signing you certify that the information you have entered on this form is true and complete to the best of your knowledge and belief.

Making willful false claims and statements for Chapter 31 benefits is a punishable offense that may result in a fine or imprisonment, or both (Reference: 31 U.S.C. 3802(a)).

Sign in box 11A, Signature of Claimant, and enter the date in box 11B, Date Signed (MM-DD-YYYY).

Do not use this form to reapply for Chapter 31 benefits if you previously applied and received an entitlement decision for the Chapter 31 program. To request reactivation of your claim for Chapter 31 benefits, follow the information on requesting a review of the previous closure decision at www.va.gov/decision-reviews.

If you previously applied for Chapter 31 benefits, received an entitlement decision and your case was closed as discontinued or rehabilitated, you must request to reactivate your claim for Chapter 31 benefits by taking one of the following actions:

If you have already submitted a request for a Supplemental Claim, Higher-Level Review, or an Appeal to the Board, you do not need to take action at this time.

You must wait for the decision on the review you requested.

If your case was closed within one year from the date your case was discontinued or rehabilitated, you may complete and submit one of the following forms to request a decision review: VA Form 20-0995, Decision Review Request: Supplemental Claim; VA Form 20-0996, Decision Review Request: Higher Level Review; VA Form 10182, Decision Review Request: Board Appeal.

If your case was closed as discontinued or rehabilitated more than one year after VA provided notice of the decision, you must complete VA Form 20-0995, Decision Review Request: Supplemental Claim, and must submit new and relevant evidence.

To apply for Chapter 31 benefits, you may submit this completed application form to the Department of Veterans Affairs, Veteran Readiness and Employment (VR&E) Intake Center, P. O. Box 5210, Janesville, WI 53547-5210 or apply online at www.va.gov.