Form 22-5490 Application for Survivors' and Dependents' Educational A

OMB Control No. 2900-0098
Respondent Burden: 45 minutes

APPLICATION FOR SURVIVORS’ AND DEPENDENTS’ EDUCATIONAL ASSISTANCE
(Under Provisions of Chapter 35, Title 38, U.S.C.)
IMPORTANT: See attached Information and Instructions.
INTERNET VERSION AVAILABLE: You may complete and submit the application on-line at: www.gibill.va.gov

PART I - APPLICANT INFORMATION
1. SOCIAL SECURITY NUMBER OF APPLICANT

2. SEX OF APPLICANT

MALE

3. APPLICANT’S DATE OF BIRTH
Month
Day

Year

FEMALE

4. NAME (First, Middle Initial, Last)

5. APPLICANT’S ADDRESS
Number and Street

Apt./Unit Number
City, State, ZIP Code
6A. APPLICANT’S TELEPHONE NUMBERS (Include Area Code)
Primary:

Secondary:

6B. APPLICANT’S E-MAIL ADDRESS (If applicable)

7. RELATIONSHIP OF APPLICANT TO QUALIFYING INDIVIDUAL
SPOUSE

SURVIVING SPOUSE

CHILD

STEPCHILD

ADOPTED CHILD

PART II - INFORMATION CONCERNING DISABLED OR DECEASED VETERAN OR INDIVIDUAL ON ACTIVE DUTY
8. NAME OF INDIVIDUAL ON WHOSE ACCOUNT BENEFITS ARE CLAIMED (First, Middle Initial, Last)

9. SOCIAL SECURITY NUMBER

12. DATE OF BIRTH
Month
Day

10. VA FILE NUMBER (If known)

Year

11. BRANCH OF SERVICE

13. DATE OF DEATH OR DATE LISTED AS MISSING IN ACTION
OR POW
Month
Day
Year

14. IS THE INDIVIDUAL ON WHOSE ACCOUNT BENEFITS ARE BEING CLAIMED
ON ACTIVE DUTY? (PL-461)
YES

NO

PART III - TYPE AND PROGRAM OF EDUCATION OR TRAINING
15. EDUCATION OR TRAINING WILL BE BY: (Check more than one box, if necessary)
COLLEGE OR OTHER SCHOOL

APPRENTICESHIP OR OTHER ON-THE-JOB TRAINING

FARM COOPERATIVE

NATIONAL ADMISSION EXAMS OR NATIONAL EXAMS FOR CREDIT

LICENSING OR CERTIFICATION TEST

CORRESPONDENCE COURSE (SPOUSE OR SURVIVING SPOUSE ONLY)

16. PLEASE PROVIDE FULL NAME AND ADDRESS OF SCHOOL OR TRAINING FACILITY, IF KNOWN
Name

Number and Street

City, State, ZIP Code
17. PLEASE SPECIFY YOUR EDUCATION OR CAREER OBJECTIVE, IF KNOWN (E.G. Bachelor of Arts in Accounting, Welding
Certificate, Police Officer)

VA DATE STAMP
(Do Not Write In This Space)

18. DO YOU KNOW THE DATE YOU WILL BEGIN YOUR SCHOOL OR TRAINING?
Month

VA FORM
JAN 2009

Day

22-5490

Year

EXISTING STOCKS OF VA FORM 22-5490, NOV 2005,
WILL BE USED.

Page 1 of 7

SOCIAL SECURITY NUMBER OF APPLICANT

PART IV - SPECIAL INFORMATION CONCERNING APPLICANT
19. IF YOU ARE THE SPOUSE OF A DISABLED VETERAN, IS A DIVORCE OR ANNULMENT PENDING?
YES
NO
20. ARE YOU A HANDICAPPED CHILD, 14 YEARS OR OLDER, SPOUSE, OR SURVIVING
SPOUSE SEEKING SPECIAL RESTORATIVE TRAINING? (See Instructions)
YES

NO

YES
NO
23. SURVIVING SPOUSE’S AGE AT TIME OF REMARRIAGE

22. IF YOU ARE THE SURVIVING SPOUSE OF A DECEASED VETERAN, HAVE YOU
REMARRIED SINCE HIS OR HER DEATH?
YES

21. ARE YOU A HANDICAPPED CHILD, SPOUSE, OR SURVIVING SPOUSE
SEEKING SPECIALIZED VOCATIONAL TRAINING? (See Instructions)

NO

NOTE: Complete Item 24 only if you are a civilian employee of the U.S. Government.
24B. SOURCE OF EDUCATIONAL ASSISTANCE FROM GOVERNMENT
24A. DO YOU EXPECT TO RECEIVE FUNDS FROM YOUR AGENCY OR DEPARTMENT
EMPLOYMENT
FOR THE SAME COURSE FOR WHICH YOU EXPECT TO RECEIVE VA EDUCATIONAL
ASSISTANCE? (If you check "Yes," show the source of these funds in Item 24B)
YES

NO

25. PRIOR TO THIS APPLICATION, HAVE YOU EVER APPLIED FOR, OR RECEIVED, ANY OF THE FOLLOWING VA BENEFITS? (Check applicable box(es))
E.

SURVIVORS’ AND DEPENDENTS EDUCATIONAL
ASSISTANCE (Complete Items 26 and 27)

VOCATIONAL REHABILITATION BENEFITS

F.

NONE

VETERANS’ EDUCATION ASSISTANCE BASED ON
YOUR OWN SERVICE (Specify benefit)

G.

OTHER (Specify)

A.

DISABILITY COMPENSATION OR PENSION

B.

DEPENDENTS’ INDEMNITY COMPENSATION (DIC)

C.
D.

IMPORTANT: Complete Items 26 and 27 only if you check "E" in Item 25.
26. NAME OF VETERAN ON WHOSE ACCOUNT YOU PREVIOUSLY CLAIMED BENEFITS

27. VETERAN’S SOCIAL SECURITY OR FILE NUMBER

28. PLEASE PROVIDE THE NAME, ADDRESS, AND PHONE NUMBER OF SOMEONE WHO WILL ALWAYS
KNOW WHERE YOU CAN BE REACHED

29. DO YOU OR THE INDIVIDUAL ON WHOSE ACCOUNT
YOU ARE CLAIMING BENEFITS HAVE AN
OUTSTANDING WARRENT?
YES

NO

PART V - APPLICANT’S MILITARY SERVICE INFORMATION
(NOTE: Chapter 35 benefits are not payable while an eligible person is on active duty)
30. HAVE YOU EVER SERVED ON ACTIVE DUTY IN THE ARMED FORCES? (Including an initial period of active duty for training for a period of 3 months or more OR
subsequent periods of active duty for training of 6 months or more) (If "No," skip this part and continue to Part VI)
YES

NO

31. INFORMATION ABOUT YOUR PERIODS OF ACTIVE DUTY
(Please complete Items 31A through 31D for each period of your active duty)
A. DATE ENTERED
ACTIVE DUTY

B. DATE SEPARATED
FROM ACTIVE DUTY

Month

Day

Year

Month

Day

Year

Month

Day

Year

Month

Day

Year

C. BRANCH OF SERVICE OR RESERVE
OR GUARD COMPONENT

D. CHARACTER OF
DISCHARGE

PART VI - PREVIOUS EDUCATION, TRAINING, AND EMPLOYMENT
A. EDUCATION AND TRAINING
32A. CHECK THE APPROPRIATE BOX AND ENTER THE DATE IN ITEM 32B

32B. DATE

GRADUATED FROM HIGH SCHOOL

DISCONTINUED HIGH SCHOOL

EXPECT TO GRADUATE

GED

Month

Day

Year

NEVER ATTENDED HIGH SCHOOL

33. EDUCATION (Include all apprenticeships and on-the-job training)
TYPE OF
SCHOOL

NAME AND LOCATION
OF SCHOOL
(City and State)

DATES OF TRAINING
FROM

TO

NUMBER OF
SEMESTER, QUARTER,
OR CLOCK HOURS
COMPLETED

DEGREE, DIPLOMA,
OR CERTIFICATE
RECEIVED

MAJOR FIELD OR
COURSE OF STUDY

HIGH SCHOOL

COLLEGE
VA FORM 22-5490, JAN 2009

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SOCIAL SECURITY NUMBER OF APPLICANT

33. EDUCATION (Include all apprenticeships and on-the-job training) (Continued)
TYPE OF
SCHOOL

NAME AND LOCATION
OF SCHOOL
(City and State)

DATES OF TRAINING
FROM

TO

NUMBER OF
SEMESTER, QUARTER,
OR CLOCK HOURS
COMPLETED

DEGREE, DIPLOMA,
OR CERTIFICATE
RECEIVED

MAJOR FIELD OR
COURSE OF STUDY

VOCATIONAL
OR TRADE
OTHER

B. EMPLOYMENT
34. CURRENT AND PAST EMPLOYMENT
EMPLOYMENT

PRINCIPAL OCCUPATION

NUMBER OF MONTHS EMPLOYED

LICENSE OR RATING

PART VII - ELECTION (CHILD ONLY)
IMPORTANT: You may not receive payments for Dependency and Indemnity Compensation (DIC) or Pension and you may not be claimed as a
dependent in a compensation claim while receiving Survivors’ and Dependents’ educational assistance (DEA). CAREFULLY READ THE
INSTRUCTIONS BEFORE COMPLETING THIS ELECTION BLOCK. YOU ARE STRONGLY ENCOURAGED TO DISCUSS YOUR
ELECTION WITH A VA COUNSELOR.
35. DATE OF ELECTION

I CERTIFY THAT I understand the effects of an election to
receive DEA benefits and that I elect to receive such benefits
beginning on the following date:

Month

Day

Year

36. REMARKS (Use this space to provide information that does not fit elsewhere on this form or that will help VA process your claim. Refer to the item numbers on this form to help
us match your answers to the correct questions. If more space is needed, please attach separate sheets of paper. Be sure to include your name and Social Security Number on each
additional paper you include)

VA FORM 22-5490, JAN 2009

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SOCIAL SECURITY NUMBER OF APPLICANT

36. REMARKS (Continued)

APPLICATION SUBMISSION REMINDERS AND INFORMATION
Did you remember to:
Write your Social Security Number on each page?
Write your complete mailing address?
Attach all supporting documents (e.g. copy of birth certificate, marriage license, etc.)?
IF SO, PLEASE SIGN AND DATE THE APPLICATION IN ITEMS 42A AND 42B.

THE MOST CURRENT INFORMATION ON VA EDUCATION BENEFITS IS AVAILABLE ONLINE AT WWW.GIBILLL.VA.GOV .
37. IF YOU WOULD LIKE TO RECEIVE A PRINTED PAMPHLET, CHECK THIS BOX

PART VIII - CERTIFICATION AND SIGNATURE OF APPLICANT
I CERTIFY THAT all statements in my application are true and correct to the best of my knowledge and belief.
PENALTY: Willfully false statements as to a material fact in a claim for education benefits is a punishable offense and may result in the
forfeiture of these or other benefits and in criminal penalties.
38A. SIGNATURE OF APPLICANT (Do NOT Print)

38B. DATE SIGNED

SIGN HERE
IN INK

PART IX - SIGNATURE OF PARENT, GUARDIAN, OR CUSTODIAN
(This section must be completed by the parent, guardian, or custodian if the applicant is a minor)
39. NAME OF PARENT, GUARDIAN, OR CUSTODIAN (First, Middle Initial, Last) (Type or print)

40. MAILING ADDRESS OF PARENT, GUARDIAN OR CUSTODIAN
Number and Street

Apt./Unit Number
City, State, ZIP Code
41A. TELEPHONE NUMBERS OF PARENT, GUARDIAN, OR CUSTODIAN (Include Area Code)
Primary:

Secondary:

41B. E-MAIL ADDRESS OF PARENT, GUARDIAN, OR CUSTODIAN (If applicable)

42A. SIGNATURE OF: (Check one) (Do NOT Print)
PARENT

GUARDIAN

42B. DATE SIGNED

CUSTODIAN

SIGN HERE
IN INK
VA FORM 22-5490, JAN 2009

Page 4 of 7

(Please detach at perforation and retain this information for future reference)
INFORMATION AND INSTRUCTIONS FOR COMPLETING THE APPLICATION
FOR SURVIVORS’ AND DEPENDENTS’ EDUCATIONAL ASSISTANCE
This form is available on the Internet. We suggest that you file your application by going to www.gibill.va.gov and submitting your application
electronically. Select "Electronic Application Form."
If you submit your application electronically, VA will automatically transfer your application to the Regional Processing Office that handles your
claim. See HOW TO FILE YOUR CLAIM for additional information on sending any supporting documentation and where to mail your completed
paper application.

SPECIFIC INSTRUCTIONS
NOTE: The number on the instructions match the item numbers on
this application. Items not mentioned are self-explanatory.

Statement in Support of Claim, stating that they are requesting
reimbursement. The claimant should include:

DO NOT USE THIS FORM TO APPLY FOR VETERANS’
EDUCATION ASSISTANCE (chapters 30, 32, 33, 1606, or 1607) or
VOCATIONAL REHABILITATION BENEFITS (chapter 31).
These benefits require different application forms. Use VA Form
22-1990 to apply for Veterans’ Education Assistance. This form is
available at www.gibill.va.gov. Use VA Form 28-1900 to apply for
Vocational Rehabilitation benefits. See
http://va benefits.vba.va.gov/vonapp/main.asp for the Veterans
On-Line Application for this form. These forms are also available at
your nearest VA regional office and may be available where you
received this application.

(1) The name of the test taken

ITEM 7. To qualify for Survivors’ and Dependents’ Educational
Assistance you must be either:
(1) the spouse or child of a veteran who is permanently and totally
disabled as the result of a service-connected disability;
(2) the spouse or child of an individual on active duty who has been
listed for a total of more than 90 days as missing in action, captured
in line of duty by a hostile force, forcibly detained or interned in line
of duty by a hostile force, or forcibly detained or interned in line of
duty by a foreign government or power, or;
(3) the surviving spouse or child of a veteran who died of a
service-connected disability or who died while a service-connected
disability was rated permanent and total in nature.
(4) the spouse or child of an individual on active duty for which the
evidence shows that the individual is hospitalized or receiving
outpatient medical care services, or treatment; has a total disability
permanent in nature incurred or aggravated in the line of duty in the
active military, naval, or air service; and the serviceperson in likely
to be discharged or released from such service for such disability.
Eligibility for Survivors’ and Dependents’ Educational Assistance
will be terminated in the event that VA determines that the veteran
on whose account benefits are claimed is no longer totally disabled
or VA is notified that the individual is no longer listed as captured,
missing in action, or forcibly detained.
NOTE: "Child" includes adopted children and stepchildren who are
members of the veteran’s or individual’s household. Married
children are eligible for this benefit.
The period of eligibility for a child is generally between the ages of
18 and 26 years. In certain instances, it is possible to begin training
before age 18 and to continue after age 26.
ITEM 10. VA may have assigned the veteran or individual an
eight-digit file number. If you know this number, write it in the space
provided.
ITEM 15. Self-explanatory, except for the following items:
Check the "Licensing or certification test" block if you want
reimbursement for a licensing or certification test. A licensing test is
a test offered by a state, local, or federal agency which is required by
law to practice an occupation. A certification test is a test designed to
provide an affirmation of an individual’s qualification in a specific
occupation.
The best way to claim the benefit is for the individual to send VA a
copy of his or her test results with a note or a VA Form 21-4138,
VA FORM
JAN 2009

22-5490

(2) The name and address of the organization issuing the license or
certificate (not necessarily the organization that administered the
test)
(3) The date the test was taken
(4) The cost of the test
(5) The following (signed) statement: "I authorize release of my test
information to VA."
Check the "National admission exams or national exams for credit"
block if you want VA to reimburse you for the fee you paid for
taking one or more national tests. National tests for admission to
institutions of higher learning include the following: the Scholastic
Aptitude Test, Law School Admission Tests, Graduate Record Exam,
or the Graduate Management Admission Test. National tests
providing an opportunity for course credit at institutions of higher
learning include the following: The Advanced Placement Exam and
the College-level Examination Program.
NOTE ON CORRESPONDENCE TRAINING: Only spouses and
surviving spouses may receive benefits for correspondence training.
If you plan to enroll in a correspondence course or a combination
correspondence-residence course, be sure the field of study is
suitable to your abilities and interest before you sign a contract with
the school. Information on correspondence courses is available at the
nearest U.S. Veterans Assistance Center or VA Regional Office. The
correspondence school may require you to pay for all or the majority
of the course even though you complete only a portion of it. Unlike
other VA training programs, payments for correspondence courses
are made quarterly, after VA receives your certification showing the
number of lessons you completed during the previous quarter. You
must affirm a contract for enrollment in a correspondence course
after at least 10 days following the date you sign the contract. If you
decide not to enroll in a correspondence course after signing a
contract but before signing the affirmation, you are entitled to
receive a full refund from the school of any payment made for the
course.
ITEMS 20 and 21. Any eligible person may receive Special
Restorative Training or Specialized Vocational Training, if a VA
counselor determines that a specialized program is needed to
overcome the effects of a physical or mental handicap. To be
eligible, the disability must prevent you from pursuing an
educational program. Examples of Special Restorative Training
include speech and voice correction, language retraining, lip reading,
auditory training, Braille reading and writing, or other similar
training. Specialized Vocational Training consists of specialized
courses leading to a vocational objective. This objective must be
suitable for you and required because of a physical or mental
handicap.
NOTE: You will not be eligible to receive benefits for any period for
which you or the veteran or individual on whose account you are
claiming benefits has an outstanding felony warrant. Any benefits
paid to you for such a period will be an overpayment subject to
collection.
ITEM 22 and 23. A spouse may use educational benefits during the
10-year period after eligibility is found. A surviving spouse may use
these benefits during the 10-year period following the veteran’s

EXISTING STOCKS OF VA FORM 22-5490, NOV 2005,
WILL BE USED.

Page 5 of 7

SPECIFIC INSTRUCTIONS (Continued)
death or 10 years after VA determines the veteran’s death was
caused by a service-connected disability. The eligibility period is 20
years for a surviving spouse if the veteran’s death was in service.
Eligibility will terminate in the event a spouse is divorced from the
veteran or in the event a surviving spouse is remarried, unless the
remarriage is both after the surviving spouse’s 57th birthday and
after January 1, 2004.
NOTE: A surviving spouse who terminates a remarriage may
re-establish eligibility, but will not qualify for an extension of the
ten-year or twenty-year eligibility period.
ITEM 25. If you received education benefits under a law VA
administers, such as the Montgomery GI Bill Educational Assistance
Program, the Montgomery GI Bill Selected Reserve Educational
Assistance Program, the Reserve Educational Assistance Program, or
Post 9/11 GI Bill, specify which benefit in this block.
ITEM 25C. Check the "Vocational Rehabilitation Benefits" block if
you applied for VA education benefits as a disabled veteran.
ITEM 25E. Check the "Survivors’ and Dependents’ Educational
Assistance" block if you have previously applied for benefits as the
dependent of a veteran other than the veteran or individual on whose
account you are currently claiming benefits.
ITEM 25F. Check the "None" block if you have never previously
applied for VA education benefits.
ITEM 25G. Check the "Other" block if you previously applied for
VA benefits other than any of those specified in Items 25A through
25F.
ITEMS 26 and 27. If you previously applied for VA benefits as the
dependent child or spouse of an individual who is permanently and
totally disabled due to service-connected disabilities or who died on
active duty, provide the name of the individual (your parent or
spouse) and the Social Security Number or the VA file number for
this person in the space provided.
ITEM 30. Benefits under this program are not payable while an
eligible person is serving on active duty in the Armed Forces.
ITEM 32. A child who is under 18 and has not completed high
school must have his or her program of education or training
approved by a VA counselor before educational assistance benefits
can be authorized. An eligible person who has not received a high
school diploma or its equivalent can pursue approved
secondary-level programs. An eligible person can also pursue
refresher, remedial, or deficiency courses needed for admission into
an education program.
ITEM 34. If you have ever held a license to practice a profession or
journeyman rating to work at a trade, state the name of the license or
journeyman rating and the state in which the license was held in the
space marked "License or Rating." We only use this information if
you apply for benefits for a similar program. Examples of a license
include the following: electrician, CPA, teacher, lawyer, and
bricklayer. Use Item 36, "Remarks," if you need more space.
VA VOCATIONAL AND EDUCATIONAL COUNSELING HELP
IS AVAILABLE. If you need help planning your individual
educational and career goals, VA offers a wide range of counseling
services to help you. Services include educational and vocational
guidance and testing to help you to develop a greater understanding
of your skills, talents, and interests. For further information on VA
counseling, call VA Toll Free at:

1-800-827-1000 or TDD 1-800-829-4833
ITEM 35. Your election to receive Survivors’ and Dependents’
Educational Assistance is final and cannot be changed. This means
that payments of compensation, pension, or Dependents’ Indemnity
Compensation (DIC) based on school attendance after your 18th
birthday are prohibited once you cash your first benefit check under
this chapter. If you are planning to pursue a program of education for
longer than 45 months, you may find it to your advantage to
VA FORM 22-5490, JAN 2009

defer benefits and continue compensation, pension, or DIC payment
for the present. If it appears that a deferral of benefits might be to
your advantage, we strongly recommend that you discuss with a VA
counselor the various options open to you. However, if it does not
appear that a deferral would be to your advantage, indicate the date
from which you wish to receive Survivors’ and Dependents’
Educational Assistance.
ITEM 37. VA publishes Pamphlet 22-73-3, Summary of Educational
Benefits Under the Survivors’ and Dependents’ Educational
Assistance Program, Chapter 35 of Title 38, U.S.C., an information
pamphlet for this benefit. You should have received this pamphlet
with your application. If you check "Yes," VA will send you one.
You may also request a pamphlet from the person who furnished you
this application.

GENERAL INSTRUCTIONS
ADVANCE PAYMENT - Once you have enrolled in an approved
course, you may receive an advance payment for the first month (or
part of a month) and second month of enrollment if ALL the
following conditions are met:

.
.
.
.

You are enrolled on at least a half-time basis, and
Your school has agreed to receive and process
advance payment checks for delivery to it students, and
You request advance payment by signing a request block
on the enrollment certification your school sends to us, and
VA receives your enrollment certification at least 30 days
before classes start

NOTE: If we do not pay an advance payment, we will pay you after
each month you attend school. In some cases, VA will require you to
verify your enrollment each month before you receive payment.
IMPORTANT: Additional requirements set by law may prevent us
from making an advance payment.
HELP: If you need help in completing this application, call VA
TOLL FREE at 1-888-GI-BILL-1 (1-888-442-4551). If you are
hearing impaired, call us toll-free at 1-800-829-4833. Our education
Internet site (www.gibill.va.gov) is available to help you.
PRIVACY ACT INFORMATION: VA will not disclose information
collected on this form to any source other than what has been
authorized under the Privacy Act of 1974 or Title 38, Code of
Federal Regulations 1.576 for routine uses (i.e., awards of benefits)
as identified in the VA system of records, 58VA21/22/28,
Compensation, Pension, Education and Vocational Rehabilitation
Records - VA, and published in the Federal Register. Your obligation
to respond is required to obtain education benefits. Giving us your
SSN account information is voluntary. Refusal to provide your SSN
by itself will not result in the denial of benefits. VA will not deny an
individual benefits for refusing to provide his or her SSN unless the
disclosure of the SSN is required by a Federal Statute of law in effect
prior to January 1, 1975, and still in effect. The requested
information is considered relevant and necessary to determine the
maximum benefits allowable under the law. While you do not have
to respond, VA cannot process your claim for benefits unless the
information is furnished as required by existing law (38 U.S.C. 3513
and 5113). The responses you submit are considered confidential (38
U.S.C. 5701). Information submitted is subject to verification
through computer matching programs with other agencies.
RESPONDENT BURDEN: We need this information to determine
your eligibility for education benefits (38 U.S.C. 3513 and 5113).
Title 38 U.S.C. allows us to ask for this information. We estimate
that you will need an average of 45 minutes to review the
instructions, find the information, and complete this form. VA cannot
conduct or sponsor a collection of information unless a valid OMB
control number is displayed. You are not required to respond to a
collection of information if this number is not displayed. Valid OMB
control numbers can be located on the OMB Internet Page at
www.whitehouse.gov/omb/library/OMBINV.VA.EPA.html#VA. If
desired, you can call 1-888-GI-BILL-1 (1-888-442-4551) to get
information on where to send comments or suggestions about this
form.
Page 6 of 7

HOW TO FILE A COMPLETED PAPER APPLICATION
If you have:
(A) selected a school or training establishment,
Step 1: Mail the completed form to the VA Regional Processing Office in the region of that school’s physical address. Check
below for the post office box address for these offices.

.
.
.
.
.

Step 2: Notify the VA certifying official at your school or training establishment that you have applied for VA education benefits.
Ask him or her to submit your attendance information using VA Form 22-1999, Enrollment Certification, or its electronic
version.
Step 3: Wait for VA to process your application and notify you of our decision concerning your eligibility for education
assistance.
(B) not selected a school or training establishment,
Step 1: Mail the completed form to the VA Regional Processing Office in the region of your home address. Check below for the
post office box address for these offices.
Step 2: Wait for VA to process your application and notify you of our decision concerning your eligibility for education
assistance.
HOW TO FILE A COMPLETED ELECTRONIC APPLICATION
If you completed your application electronically, VA furnished you with the following: (1) a unique confirmation number for your
individual claim and (2) the address of the VA office (Education Regional Processing Office) that will process your claim. You need
to write this information down and keep it in a safe location.
If you have:
(A) selected a school or training establishment, follow the same action as shown in (A), step 2, above.
(B) not selected a school or training establishment, wait for VA to process your application and notify you of our decision concerning
your eligibility for educational assistance.

Eastern Region:
VA Regional Office
P. O. Box 4616
Buffalo, NY 14240-4616

Central Region:
VA Regional Office
P. O. Box 66830
St. Louis, MO 63166-6830

SERVES THE FOLLOWING STATES

SERVES THE FOLLOWING STATES

CT

DE

DC

ME

CO

IA

IL

IN

MD

MA

NH

NJ

KS

KY

MI

MN

NY

OH

PA

RI

MO

MT

NE

ND

VT

VA

WV

Foreign
Schools

SD

TN

WI

WY

Western Region:
VA Regional Office
P. O. Box 8888
Muskogee, OK 74402-8888

Southern Region:
VA Regional Office
P. O. Box 100022
Decatur, GA 30031-7022

SERVES THE FOLLOWING STATES

SERVES THE FOLLOWING STATES

AK

AR

AZ

CA

AL

FL

GA

MS

HI

ID

LA

NM

NC

PR

SC

US Virgin
Islands

NV

OK

OR

Philippines

TX

UT

WA

VA FORM 22-5490, JAN 2009

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