VA Form 22-1990R Application for Veterans Retraining assistance Program (

DRAFT
INFORMATION AND INSTRUCTIONS FOR COMPLETING THE APPLICATION FOR VETERANS
RETRAINING ASSISTANCE PROGRAM (VRAP)
(VA FORM 22-1990R)
Use this form to apply for the Veterans Retraining Assistance Program only. Other benefits require different application forms
that can be completed on-line and printed at www.va.gov/vaforms or can be obtained from the nearest VA regional office.
NOTE: The numbers on the instructions match the item numbers on the application. Items not mentioned are
self-explanatory.
Item 4. Please check "Yes," for currently unemployed if you do not have a job, have actively looked for work in the prior 4
weeks, and are currently available for work. If you are not working and were waiting to be recalled to a job from which you
had been temporarily laid off, you are also included as unemployed. Receiving benefits from the Unemployment Insurance
(UI) program has no bearing on whether you are classified as unemployed.
Item 14. Please check "Yes," if you have ever received educational assistance in any of the following
benefit programs:
• Montgomery GI Bill (MGIB) chapter 30 of title 38, U.S. Code
• Vocational Rehabilitation and Employment Program chapter 31 of title 38, U.S. Code
• Post - Vietnam Era Veterans' Educational Assistance Program (VEAP) chapter 32, U.S. Code, or
section 901 or section 903 of Public Law 96-342
• Post-9/11 GI Bill chapter 33 of title 38, U.S. Code
• Survivors' and Dependents' Educational Assistance chapter 35 of title 38, U.S. Code
• Montgomery GI Bill - Selected Reserve (MGIB - SR) chapter 1606 of title 10, U.S. Code
• Reserve Educational Assistance Program (REAP) chapter 1607 of title 10, U.S. Code
Item 16. Tell us the name of the school you would like to attend or are attending. To help processing, please spell out the full
name of the school. Do not use abbreviations. VRAP benefits can only be paid for approved programs offered by a
community college or technical school.
Note: The course you pursue must be approved for veterans and other eligible persons.
Item 17. Tell us the month your training will start or started. VRAP benefits cannot be paid for enrollments which begin prior
to July 1, 2012 or after March 31, 2014.
Item 18. Indicate the type of courses you will take to complete your study. If you are attending an institution of higher
learning, this is the degree you are pursuing, for example, "Accounting." If you are attending a trade school, this is the name
of your course, for example, "Carpentry."
Note: VRAP benefits can only be paid for Associate Degree or Certificate programs.
Item 19. Please identify the high demand occupation that your program will train you for. See Attachment A or visit
www.benefits.va.gov/VOW for a complete listing of high demand occupations.
ADDITIONAL HELP: If you need more help in completing this application, call VA Toll Free at 1-888-GI-BILL-1
(1-888-442-4551). If you use the Telecommunications Device for the Deaf (TDD), the Federal Relay number is 711. You can
also get education assistance after normal business hours at our education internet site at www.gibill.va.gov and
www.benefits.va.gov/VOW.

VA FORM
MAY 2012

22-1990R

PAGE 1

Eastern Region:
VA Regional Office
P.O. Box 4616
Buffalo, NY 14240-4616
Serves the following states:
CT
MD
NY
VT

DE
MA
OH
VA

DC
NH
PA
WV

ME
NJ
RI
Foreign Schools

Central Region:
VA Regional Office
P.O. Box 66830
St. Louis, MO 63166-6830
Serves the following states:
CO
KS
MO
SD

IL
MI
NE
WI

IA
KY
MT
TN

IN
MN
ND
WY

Western Region:
VA Regional Office
P.O. Box 8888
Muskogee, OK 74402-8888
Serves the following states:
AK
CA
MS
OR
Philippines

AL
HI
NM
TX
Guam

AR
ID
NV
UT

APO/FPO AP

AZ
LA
OK
WA

Southern Region:
VA Regional Office
P.O. Box 100022
Decatur, GA 30031-7022
Serves the following states:
FL
PR

GA
US Virgin Islands

NC

APO/FPO AA

SC

Privacy Act Notice: 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, section 1.576 for routine uses (e.g., VA sends educational forms or letters with a veteran's
identifying information to the veteran's school or training establishment to (1) assist the veteran in the completion of claims forms or (2) for the VA to
obtain further information as may be necessary from the school for the VA to properly process the veteran's education claim or to monitor his or her
progress during training) as identified in the VA system of records, 58VA21/22/28, Compensation, Pension, Education, and Vocational Rehabilitation
and Employment Records - VA, published in the Federal Register. Your obligation to respond is required to obtain or retain 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. The 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 enacted
before January 1, 1975, and still in effect. The requested information is considered relevant and necessary to determine the maximum benefits under
the law. While you do not have to respond, VA cannot process your claim for education assistance unless the information is furnished as required by
existing law (38 U.S.C. 3471). The responses you submit are considered confidential (38 U.S.C. 5701). Any information provided by applicants,
recipients, and others may be subject to verification through computer matching programs with other agencies.
Respondent Burden: We need this information to administer this benefit program. Public Law 112-56 allows us to ask for this information. We
estimate that you will need an average of 10 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 (Office of Management and Budget) 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 http://
www.reginfo.gov/public/do/PRAMain. If desired, you can call 1-800-827-1000 to get information on where to send comments or suggestions about this
form.
VA FORM 22-1990R, MAY 2012

PAGE 2

ATTACHMENT A
High Demand Occupational Objective and Occupation
Below is a listing of high demand occupations. Please identify and enter the high demand occupation that your program of education will
train you for in Part II, Item 19 of the form.
Healthcare Practitioner and Technical Occupations
Management Occupations
1. General and Operations Managers
2. Construction Managers
Business and Financial Occupations
3. Wholesale and Retail Buyers, except Farm Products
4. Purchasing Agents, except Wholesale, Retail, and
Farm Products
5. Claim Adjusters, Examiners, and Investigators
6. Business Operations Specialists, All Other
7. Appraisers and Assessors of Real Estate
8. Loan Officers
9. Tax Preparers
Computer and Mathematical Occupations
10. Computer Support Specialists
Architecture and Engineering Occupations
11. Architectural and Civil Drafters
12. Mechanical Drafters
13. Civil Engineering Technicians
14. Electrical and Electronics Engineering Technicians
15. Environmental Engineering Technicians
16. Industrial Engineering Technicians
17. Mechanical Engineering Technicians
18. Engineering Technicians, except Drafters, All Other
19. Surveying and Mapping Technicians
Life, Physical, and Social Science Occupations
20. Chemical Technicians
21. Geological and Petroleum Technicians
22. Social Science Research Assistants
23. Environmental Science and Protection Technicians,
including Health
24. Forest and Conservation Technicians
25. Life, Physical, and Social Science Technicians, All Other
Community and Social Services Occupations
26. Substance Abuse and Behavioral Disorder Counselors
Legal Occupations
27. Paralegals and Legal Assistants
Education, Training, and Library Occupations
28. Preschool Teachers, except Special Education
29. Library Technicians
Arts, Design, Entertainment, Sports, and Media Occupations
30. Merchandise Display and Window Trimmers
31. Actors
32. Athletes and Sports Competitors
33. Coaches and Scouts
34. Umpires, Referees, and Other Sports Officials
35. Choreographers
36. Musicians and Singers
37. Audio and Video Equipment Technicians
38. Broadcast Technicians
39. Photographers
VA FORM 22-1990R, MAY 2012

40. Registered Nurses
41. Radiation Therapists
42. Respiratory Therapists
43. Medical and Clinical Laboratory Technicians
44. Dental Hygienists
45. Cardiovascular Technologists and Technicians
46. Diagnostic Medical Sonographers
47. Nuclear Medicine Technologists
48. Radiologic Technologists and Technicians
49. Emergency Medical Technicians and Paramedics
50. Dietetic Technicians
51. Pharmacy Technicians
52. Psychiatric Technicians
53. Surgical Technologists
54. Veterinary Technologists and Technicians
55. Licensed Practical and Licensed Vocational Nurses
56. Medical Records and Health Information Technicians
57. Opticians, Dispensing
58. Health Technologists and Technicians, All Other
Healthcare Support Occupations
59. Nursing Aides, Orderlies, and Attendants
60. Occupational Therapy Assistants
61. Physical Therapist Assistants
62. Physical Therapist Aides
63. Massage Therapists
64. Dental Assistants
65. Medical Assistants
66. Medical Equipment Preparers
67. Medical Transcriptionists
Protective Service Occupations
68. First-Line Supervisors of Correctional Officers
69. First-Line Supervisors of Police and Detectives
70. First-Line Supervisors of Fire Fighting and Prevention
Workers
71. Firefighters
72. Correctional Officers and Jailers
73. Detectives and Criminal Investigators
74. Police and Sheriff's Patrol Officers
75. Private Detectives and Investigators
76. Transportation Security Screeners (Federal Only)
Food Preparation and Serving Related Occupations
77. Cooks, Private Household
Building and Grounds Cleaning and
Maintenance Occupations
78. Pest Control Workers
Personal Care and Service Occupations
79. Gaming Dealers
80. Funeral Service Managers, Directors, Morticians, and
Undertakers
81. Barbers
82. Hairdressers, Hairstylists, and Cosmetologists
83. Manicurists and Pedicurists
84. Skincare Specialists
85. Tour Guides and Escorts
86. Travel Guides
87. Residential Advisors
PAGE 3

ATTACHMENT A (Continued)
High Demand Occupational Objective and Occupation
Below is a listing of high demand occupations. Please identify and enter the high demand occupation that your program of education will
train you for in Part II, Item 19 of the form.
Sales and Related Occupations

Installation, Maintenance, and Repair Occupations (Cont.)

88. Advertising Sales Agents
89. Insurance Sales Agents
90. Travel Agents
91. Sales Representatives, Wholesale and Manufacturing, except
Technical and Scientific Products
92. Real Estate Sales Agents
93. Sales and Related Workers, All Other

135. Security and Fire Alarm System Installers
136. Aircraft Mechanics and Service Technicians
137. Automotive Body and Related Repairers
138. Automotive Glass Installers and Repairers
139. Automotive Service Technicians and Mechanics
140. Bus and Truck Mechanics and Diesel Engine Specialists
141. Farm Equipment Mechanics and Service Technicians
142. Mobile Heavy Equipment Mechanics, except Engines
143. Rail Car Repairers
144. Motorboat Mechanics and Service Technicians
145. Motorcycle Mechanics
146. Outdoor Power Equipment and Other Small
Engine Mechanics
147. Bicycle Repairers
148. Recreational Vehicle Service Technicians
149. Tire Repairers and Changers
150. Mechanical Door Repairers
151. Heating, Air Conditioning, and Refrigeration Mechanics
and Installers
152. Home Appliance Repairers
153. Industrial Machinery Mechanics
154. Maintenance Workers, Machinery
155. Electrical Power-Line Installers and Repairers
156. Telecommunications Line Installers and Repairers
157. Medical Equipment Repairers
158. Maintenance and Repair Workers, General
159. Commercial Divers
160. Locksmiths and Safe Repairers
161. Helpers - Installation, Maintenance, and Repair Workers
162. Installation, Maintenance, and Repair Workers, All Other

Office and Administrative Support Occupations
94. Bill and Account Collectors
95. Bookkeeping, Accounting, and Auditing Clerks
96. Payroll and Timekeeping Clerks
97. Procurement Clerks
98. Brokerage Clerks
99. Court, Municipal, and License Clerks
100. Eligibility Interviewers, Government Programs
101. Police, Fire, and Ambulance Dispatchers
102. Dispatchers, except Police, Fire and Ambulance
103. Production, Planning, and Expediting Clerks
104. Legal Secretaries
105. Medical Secretaries
106. Data Entry Keyers
107. Insurance Claims and Policy Processing Clerks
Construction and Extraction Occupations
108. Boilermakers
109. Brickmasons and Blockmasons
110. Stonemasons
111. Carpenters
112. Floor Sanders and Finishers
113. Terrazzo Workers and Finishers
114. Paving, Surfacing, and Tamping Equipment Operators
115. Pile-Driver Operators
116. Operating Engineers
117. Electricians
118. Glaziers
119. Insulation Workers, Mechanical
120. Plumbers, Pipefitters, and Steamfitters
121. Reinforcing Iron and Rebar Workers
122. Sheet Metal Workers
123. Structural Iron and Steel Workers
124. Construction and Building Inspectors
125. Fence Erectors
126. Hazardous Materials Removal Workers
127. Highway Maintenance Workers
128. Segmental Pavers
129. Construction and Related Workers, All Other
Installation, Maintenance, and Repair Occupations
130. Computer, Automated Teller, and Office Machine Repairers
131. Radio, Cellular, and Tower Equipment Installers and Repairs
132. Telecommunications Equipment Installers and Repairers,
except Line Installers
133. Electrical and Electronics Repairers, Commercial and
Industrial Equipment
134. Electronic Home Entertainment Equipment Installers and
Repairers

VA FORM 22-1990R, MAY 2012

Production Occupations
163. First-Line Supervisors of Production and Operating Workers
164. Aircraft structure, Surfaces, Rigging, and Systems
Assemblers
165. Structural Metal Fabricators and Fitters
166. Team Assemblers
167. Assemblers and Fabricators, All Other
168. Computer-Controlled Machine Tool Operators, Metal and
Plastic
169. Extruding and Drawing Machine Setters, Operators, and
Tenders, Metal and Plastic
170. Cutting, Punching, and Press Machine Setters, Operators,
and Tenders, Metal and Plastic
171. Grinding, Lapping, Polishing, and Buffing Machine Tool
Setters, Operators, and Tenders, Metal and Plastic
172. Lathe and Turning Machine Tool Setters, Operators, and
Tenders, Metal and Plastic
173. Machinists
174. Metal-Refining Furnace Operators and Tenders
175. Molding, Coremaking, and Casting Machine Setters,
Operators, and Tenders, Metal and Plastic
176. Multiple Machine Tool Setters, Operators, and Tenders,
Metal and Plastic
177. Welders, Cutters, Solderers, and Brazers
178. Welding, Soldering, and Brazing Machine Setters,
Operators, and Tenders
179. Heat treating Equipment Setters, Operators, and Tenders
Metal and Plastic

PAGE 4

ATTACHMENT A (Continued)
High Demand Occupational Objective and Occupation
Below is a listing of high demand occupations. Please identify and enter the high demand occupation that your program of education will
train you for in Part II, Item 19 of the form.
Production Occupations (Continued)

Transportation and Material Moving Occupations

180. Prepress Technicians and Workers
181. Printing Press Operators
182. Upholsterers
183. Cabinetmakers and Bench Carpenters
184. Power Plant Operators
185. Stationary Engineers and Boiler Operators
186. Water and Wastewater Treatment Plan and System Operators
187. Chemical Plant and System Operators
188. Petroleum Pump System Operators, Refinery Operators,
and Gaugers
189. Crushing, Grinding, and Polishing Machine Setters,
Operators, and Tenders
190. Mixing and Blending Machine Setters, Operators, and
Tenders
191. Extruding, Forming, Pressing, and Compacting Machine
Setters, Operators, and Tenders
192. Inspectors, Testers, Sorters, Samplers, and Weighers
193. Dental Laboratory Technicians
194. Ophthalmic Laboratory Technicians
195. Packaging and Filling Machine Operators and Tenders
196. Coating, Painting, and Spraying Machine Setters, Operators,
and Tenders
197. Painters, Transportation Equipment
198. Painting, Coating, and Decorating Workers
199. Molders, Shapers, and Casters, except Metal and Plastic
200. Production Workers, All Other

201. Airline Pilots, Copilots, and Flight Engineers
202. Commercial Pilots
203. Air Traffic Controllers
204. Flight Attendants
205. Ambulance Drivers and Attendants, except Emergency
Medical Technical Technicians
206. Bus Drivers, Transit and Intercity
207. Bus Drivers, School and Special Client
208. Locomotive Engineers
209. Railroad Conductors and Yardmasters
210. Transportation Inspectors

VA FORM 22-1990R, MAY 2012

PAGE 5

DRAFT

APPLICATION FOR VETERANS RETRAINING
ASSISTANCE PROGRAM (VRAP)
(See attached Information and Instructions)

PART I - APPLICANT INFORMATION (Department of Labor)
NOTE: THE FOLLOWING INFORMATION IS TO BE COLLECTED BY THE DEPARTMENT OF LABOR (Items 1-6).
1. DATE OF APPLICATION

OMB Control No. 1205-0491
Respondent Burden: 5 minutes

2. NAME OF APPLICANT (LAST, FIRST, MIDDLE INITIAL)

3. DATE OF BIRTH

DEPARTMENT OF LABOR ELIGIBILITY INFORMATION
4. ARE YOU CURRENTLY UNEMPLOYED? (Check applicable box)
YES

NO

5. HAVE YOU BEEN ENROLLED IN A FEDERAL OR STATE JOB TRAINING PROGRAM IN THE PAST 180 DAYS? (Check applicable box)

(Examples of these programs include any training funded by a local career center, a One-Stop Career Center, or any state or local employment office)
YES

NO

6. THE INFORMATION PROVIDED ON THIS APPLICATION WILL BE USED FOR THE PURPOSES OF DETERMINING YOUR ELIGIBILITY TO
RECEIVE RETRAINING ASSISTANCE BENEFITS FROM THE DEPARTMENT OF VETERANS AFFAIRS. THE INFORMATION MAY BE AUDITED FOR
ACCURACY. BY SIGNING BELOW, YOU AGREE TO THE FOLLOWING STATEMENT:
"I swear or affirm that the statements on this application, to the best of my knowledge are true and correct. I understand that by submitting this
application, I am making a statement to the government for the purposes of obtaining federal benefits. Section 1001 of Title 18 of the U.S. Code makes it
a criminal offense for any person to knowingly and willfully make false or fraudulent statements to any department or agency of the United States
Government. Additionally, I understand that if the information I have provided on this application is found to be false or incorrect, I will immediately be
unable to receive benefits under this program, and I may be required to reimburse the federal government for any benefits I have already received."
Signature of Applicant____________________________________________

Date Signed_____________________

RESPONDENT BURDEN: According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless
such collection displays a valid OMB control number. Public reporting burden for this collection of information is estimated to average 5 minutes per
response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and
reviewing the collection of information. The obligation to respond to this collection of information is required to obtain or retain the benefit (VOW to
Hire Heroes Act of 2011, Pub. L. 112-56 Sec. 211). Send comments regarding the burden estimate or any other aspect of this collection of information,
including suggestions for reducing this burden, to the U.S. Department of Labor, Employment and Training Administration, 200 Constitution Avenue, N.
W., Room S-4209, Washington, DC 20210 (OMB Control Number 1205-0491).

PART II - APPLICANT INFORMATION (Department of Veterans Affairs)
NOTE: THE FOLLOWING INFORMATION IS TO BE COLLECTED BY THE DEPARTMENT OF VETERANS AFFAIRS
(Items 7-24).

OMB Control No. 2900-XXXX
Respondent Burden: 10 minutes

8. SOCIAL SECURITY NUMBER

7. SEX OF APPLICANT
FEMALE

MALE

9. ADDRESS OF APPLICANT (Provide number and street or rural route, city or P.O., State, ZIP Code and Country)

11. SECONDARY TELEPHONE NUMBER (Include Area Code)

10. PRIMARY TELEPHONE NUMBER (Include Area Code)

12. E-MAIL ADDRESS (If applicable)
13. DIRECT DEPOSIT INFORMATION:

The Department of Treasury requires all Federal benefit payments be made by electronic funds transfer (EFT), also called direct deposit. Please attach a voided personal
check or deposit slip or provide the information requested below to enroll in direct deposit. If you do not have a bank account, you must receive your payment through
Direct Express Debit MasterCard. To request a Direct Express Debit MasterCard you must apply at www.usdirectexpress.com or by telephone at 1-800-333-1795. If
you elect not to enroll, you must contact representatives handling waiver requests for the Department of Treasury at 1-888-224-2950. They will encourage your
participation in EFT and address any questions or concerns you may have.
Routing or Transit Number (nine digits found at the lower left corner of your check):_____________________
Account Type (Check one box):

Checking

Savings

Account Number:_____________________________

14. HAVE YOU EVER FILED A CLAIM WITH VA FOR EDUCATION BENEFITS? (Check)
YES

NO

VA FORM 22-1990R, MAY 2012

PAGE 6

COURSE OF STUDY OR TRAINING
15. DO YOU KNOW THE NAME OR ADDRESS OF THE SCHOOL OR TRAINING ESTABLISHMENT YOU WANT TO ATTEND (Check)
YES

NO

(If "No," skip to Item 17)

16. SCHOOL NAME AND ADDRESS (Provide complete name and address including Street, City, State, ZIP Code and Country)

17. DATE YOUR TRAINING STARTED OR WILL START (Month, Day, Year)

18. COURSE OF STUDY TO ACHIEVE GOAL

19. HIGH DEMAND OCCUPATION (See Attachment A) (Identify the high demand occupation that your program of education will train you for)

MILITARY SERVICE INFORMATION
NOTE: It will help VA process your claim if you send a copy of your DD Form 214 (Member 4) for the last period of active duty service (excluding active duty for training)
20. ARE YOU NOW ON ACTIVE DUTY? (Check "No" if you are currently on drilling status in the Selected Reserve or if you are on active duty for training)
YES

NO

21. ARE YOU NOW ON TERMINAL LEAVE JUST BEFORE DISCHARGE? (Check)
YES

NO

22. WHAT IS YOUR LAST PERIOD OF ACTIVE DUTY SERVICE?
Date Entered Active Duty__________________ Date Separated from Active Duty_________________
23. SERVICE COMPONENT (Check Branch of Service)
ARMY

NAVY

MARINE CORPS

AIR FORCE

REMARKS
24. REMARKS (If more space is needed, please attach a separate sheet of paper. Be sure to include your name and social security number on each sheet)

CERTIFICATION AND SIGNATURE OF APPLICANT
I CERTIFY THAT my identified course of study will provide training towards my selected High Demand Occupation and all statements in my application are true and correct
to the best of my knowledge and belief.
PENALTY - Willful 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.
Signature of Applicant_________________________________
VA FORM 22-1990R, MAY 2012

Date Signed_____________________

PAGE 7