VA Form 22-1990n Application For VA Education Benefits Under National Cal

APPLICATION FOR VA EDUCATION BENEFITS UNDER THE
NATIONAL CALL TO SERVICE (NCS) PROGRAM
(VA FORM 22-1990N)

Use this form to apply for education benefits under the National Call to Service (NCS) program (section 510 of title 10,
U.S. Code). You should apply for this benefit if you first entered the military on or after October 1, 2003, signed an
enlistment contract with DoD (Department of Defense) under the NCS program, and you elected one of the two education
incentives provided by that program.
INFORMATION AND INSTRUCTIONS
FOR COMPLETING THE APPLICATION FOR VA EDUCATION BENEFITS UNDER THE NCS PROGRAM
VA VOCATIONAL AND EDUCATIONAL COUNSELING HELP AVAILABLE - If you need help planning your individual
educational and career goals, VA offers a wide range of counseling services to help you make these decisions. Services include
educational and vocational guidance and such testing as necessary for you to develop a greater understanding of your skills, talents,
and interests. For further information on VA counseling, call VA toll-free at 1-888-GI-BILL-1 (1-888-442-4551) or TDD at the
Federal Relay number 711.
NOTE: The numbers on the instructions match the item numbers on the application. Items not mentioned are self-explanatory.
Part II
ITEM 7. 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 address any questions or concerns you may have and encourage your participation in EFT.
ITEM 8A. Self explanatory, except for the following items:
"Vocational Flight Training." You must already have a private pilot's license. If you are taking an Airline Transport Pilot course, you
must have a valid first-class medical certificate on the date that you enter training. For all other flight courses, you must have a valid
second-class medical certificate on the date that you enter training.
"National Test Reimbursement." You can be reimbursed for the cost of approved tests for admission to, or credit at, institutions of
higher learning.
"Licensing or Certification Test Reimbursement." 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 affirmation of an individual's qualifications in a
specific occupation. Examples include EMT, CPA, MCSE, CCNP, etc.
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 VA Education Internet site www.gibill.va.gov.
HOW TO FILE YOUR CLAIM
Be sure to do the following:
(A) If you have selected a school or training establishment:
Step 1: Mail the completed application to the VA Regional Processing Office for the region of that school's physical address. See
page 2 for the addresses of these VA Regional Processing Offices.
Step 2: Tell the veterans certifying official at your school or training establishment that you have applied for VA education benefits.
Ask him or her to send your enrollment 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 its decision concerning your eligibility for education benefits.
(B) If you haven't selected a school or training establishment:
Step 1: Mail the completed application to the VA Regional Processing Office for the region of your home address. See page 2 for the
addresses of these VA Regional Processing Offices.
Step 2: Wait for VA to process your application and notify you of its decision concerning your eligibility for education benefits.
VA FORM
XXX 2014

22-1990N

SUPERSEDES VA FORM 22-1990N, JUL 2013,
WHICH WILL NOT BE USED.

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

DE
MA
PA
Foreign Schools

DC
NH
RI

ME
NJ
VT

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

IL
MI
NE
TN

IA
KY
MT
SD
WY

IN
MN
ND
WV

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

AL
FL
MS
OR
WA
APO/FPO AP

AR
HI
NM
SC
Philippines

AZ
ID
NV
TX
Guam

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

NC

APO/FPO AA

PR

US Virgin Islands

Privacy Act Notice: The 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 1.526 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 determine your eligibility for education benefits (38 U.S.C. 3471). Title 38, United States Code,
allows us to ask for this information. We estimate that you will need an average of 15 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.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 22-1990N, XXX 2014

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OMB Control No. 2900-0154
Respondent Burden: 15 minutes
Expiration Date: XXXXXXX

APPLICATION FOR VA EDUCATION BENEFITS UNDER THE
NATIONAL CALL TO SERVICE (NCS) PROGRAM
(Section 510, Title 10, U.S. Code)

INTERNET VERSION AVAILABLE - You may complete and send your application over the Internet at: www.gibill.va.gov

PART I - APPLICANT INFORMATION
2. SEX OF APPLICANT

1. SOCIAL SECURITY NUMBER 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. DIRECT DEPOSIT (Attach a voided personal check or provide the following information. See instructions for additional information.)

Account Type

Routing or Transit Number
Checking

Account Number

Savings

PART II - TYPE AND PROGRAM OF EDUCATION OR TRAINING

8A. TYPE OF EDUCATION OR TRAINING (See instructions for additional information)
COLLEGE OR OTHER SCHOOL (Including on-line courses)

APPRENTICESHIP OR ON-THE-JOB

VOCATIONAL FLIGHT TRAINING

CORRESPONDENCE

NATIONAL TEST REIMBURSEMENT (SAT, CLEP, ETC.)
LICENSING OR CERTIFICATION TEST REIMBURSEMENT
(MCSE, CCNA, EMT, NCLEX, ETC.)
8B. FULL NAME AND ADDRESS OF SCHOOL, IF KNOWN

VA DATE STAMP
(Do Not Write In This Space)

8C. PLEASE SPECIFY YOUR EDUCATIONAL OR CAREER OBJECTIVE, IF KNOWN (e.g. Bachelor of Arts in Accounting,
welding certificate, police officer, etc.)

(Check, if applicable)
If during the review made by VA I am found to be eligible for more than one benefit,
I authorize VA to pay the benefit with the highest monthly rate.
VA FORM
XXX 2014

22-1990N

SUPERSEDES VA FORM 22-1990N, JUL 2013,
WHICH WILL NOT BE USED.

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SOCIAL SECURITY NUMBER OF APPLICANT

PART III - SERVICE INFORMATION
NOTE: It will help VA process your claim if you send the following:
DD 2863 (National Call to Service (NCS) Election of Options)
DD Form 214 (Member 4) for all periods of active duty service
9A. ARE YOU NOW ON ACTIVE DUTY?
NO
YES
9B. ARE YOU NOW ON TERMINAL LEAVE JUST BEFORE DISCHARGE?
YES

NO

(If "Yes,"please provide a copy of your DD Form 214 (Member 4) when issued)
10. PLEASE COMPLETE THE FOLLOWING FOR EACH PERIOD OF MILITARY SERVICE

A. DATE ENTERED

B. DATE SEPARATED

D. SERVICE STATUS (Active duty, drilling reservist,
IRR, etc.)

C. SERVICE COMPONENT (USN, USAF,
USAR, ARNG, ETC.)

PART IV - ENTITLEMENT TO AND USAGE OF ADDITIONAL TYPES OF ASSISTANCE
11A. ARE YOU CURRENTLY PARTICIPATING IN A SENIOR ROTC SCHOLARSHIP PROGRAM
WHICH PAYS FOR YOUR TUITION, FEES, BOOKS AND SUPPLIES UNDER SECTION 2107,
TITLE 10, U.S. CODE?

YES

11B. FOR ACTIVE DUTY CLAIMANTS ONLY: Are you receiving or do you anticipate receiving
any money (including but not limited to Federal Tuition Assistance) from the Armed Forces
or Public Health Service for the course for which you have applied to the VA for education
benefits? If you receive such benefits during any part of your training, check "YES."
11C. FOR CIVILIAN EMPLOYEES OF THE U.S. GOVERNMENT ONLY: Do you expect to receive
funds from your agency or department for the same course(s) for which you expect to receive VA
education assistance? (If "Yes, " show the source of these funds.)

NO

YES

NO

YES

NO

APPLICATION SUBMISSION REMINDERS
Did you remember to .......
Write your complete mailing address?
Attach a copy of DD 2863 (National Call to Service (NCS) Election of Options)
IF SO, PLEASE SIGN AND DATE THE APPLICATION BELOW

PART V - 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. If on active duty, I also certify
that I have consulted with an Education Service Officer (ESO) regarding my education program.
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.
12A. SIGNATURE OF APPLICANT (DO NOT PRINT)

VA FORM 22-1990N, XXX 2014

12B. DATE SIGNED

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