Va Form 22-1990e Application for Family Member to Use Transferred Benefit

APPLICATION FOR FAMILY MEMBER TO USE TRANSFERRED BENEFITS
Use this form to apply for Transfer of Entitlement (TOE) to basic educational assistance under chapters 30 and 33 of title 38, U.S. Code
and chapter 1606 of title 10, U.S. Code. Use this form only if you are a dependent of an individual eligible to transfer benefits to his or
her dependents. The service member's military branch must have approved the request to transfer benefits. The eligible service member
must have designated you by name, the number of months transferred, and the period for which the transfer is effective.
Do not use this form to apply for benefits based upon your own military service. To apply for benefits based on your own service use,
VA Form 22-1990. That form can be downloaded at www.va.gov/vaforms, completed on-line and submitted electronically at
www.benefits.va.gov/gibill (click "Apply On Line" and select the "Education" option). It can also be obtained from the nearest VA
regional office, and it may also be available where you received this application.
INFORMATION AND INSTRUCTIONS
FOR COMPLETING THE APPLICATION FOR VA EDUCATION BENEFITS TOE 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 the Treasury requires all Federal benefit payments be made by electronic funds transfer (EFT), also called
direct deposit. To enroll in direct deposit, please attach a voided personal check, deposit slip, or provide the information requested in
Item 7. If you do not have a bank account, please visit https://www.benefits.va.gov/benefits/banking.asp. This website provides
information about the Veterans Benefits Banking Program (VBBP), and a link to banks and credit unions that may fit your needs. You
may also call 1-800-827-1000. If you elect not to enroll, you must contact representatives handling waiver requests for the Department of
the Treasury at 1-888-224-2950. They will encourage your participation in EFT and address any questions or concerns you may have.
ITEM 9A. Select the benefit transferred to you.
ITEM 9B. 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.benefits.va.gov/gibill.
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 XXXX

22-1990E

SUPERSEDES VA FORM 22-1990E, FEB 2020,
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

CO

CT

DC

DE

IA

IL

IN

KS

KY

MA

MD

ME

MI

MN

MO

MT

NC

ND

NE

NH

NJ

NY

OH

PA

RI

SD

TN

VA

VT

WI

WV

WY

US Virgin
Islands

Foreign
Schools

APO/FPO AA

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

AK

AL

AR

AZ

CA

FL

GA

HI

ID

LA

MS

NM

NV

OK

OR

PR

SC

TX

UT

WA

APO/FPO AP

Guam

Philippines

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 1.576 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 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
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 22-1990E, XXX XXXX

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OMB Control No. 2900-0154
Respondent Burden: 15 minutes
Expiration Date: XX/XX/XXXX

APPLICATION FOR FAMILY MEMBER TO USE TRANSFERRED BENEFITS
INTERNET VERSION AVAILABLE - You may complete and send your application over the Internet at: www.benefits.va.gov/gibill.

PART I - APPLICANT INFORMATION
2. SEX OF APPLICANT

1. SOCIAL SECURITY NUMBER OF APPLICANT

MALE

FEMALE

3. APPLICANT'S DATE OF BIRTH
Month
Day
Year

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)
Secondary:

Primary:
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 Direct Deposit information.)

Routing or Transit Number
8A. RELATIONSHIP TO SERVICE MEMBER
SPOUSE

Account Number

Account Type
Checking
Savings

CHILD

8B. DID YOU RECEIVE A HIGH SCHOOL DIPLOMA OR HIGH SCHOOL EQUIVALENCY CERTIFICATE?

(If "Yes," provide date)
YES

DATE:

NO

PART II - BENEFIT TRANSFERRED AND TYPE AND PROGRAM OF EDUCATION OR TRAINING

9A. BENEFIT TRANSFERRED TO YOU (Select one box)

9B. TYPE OF EDUCATION OR TRAINING (See instructions for additional information)
COLLEGE OR OTHER SCHOOL (Including on-line courses)

CHAPTER 33 - POST-9/11 GI BILL

VOCATIONAL FLIGHT TRAINING

CHAPTER 30 - MONTGOMERY GI BILL EDUCATIONAL
ASSISTANCE PROGRAM (MGIB)
CHAPTER 1606 - MONTGOMERY GI BILL-SELECTED
RESERVE EDUCATIONAL ASSISTANCE PROGRAM (MGIB-SR)

NATIONAL TEST REIMBURSEMENT (SAT, CLEP, ETC.)
LICENSING OR CERTIFICATION TEST REIMBURSEMENT

(MCSE, CCNA, EMT, NCLEX, ETC.)
APPRENTICESHIP OR ON-THE-JOB
CORRESPONDENCE
TUITION ASSISTANCE TOP-UP

9C. FULL NAME AND ADDRESS OF SCHOOL, IF KNOWN

VA DATE STAMP
(Do Not Write In This Space)

9D. PLEASE SPECIFY YOUR EDUCATIONAL OR CAREER OBJECTIVE, IF KNOWN (e.g. Bachelor of Arts in Accounting,

welding certificate, police officer, etc.)

VA FORM
XXX XXXX

22-1990E

SUPERSEDES VA FORM 22-1990E, FEB 2020,
WHICH WILL NOT BE USED.

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PART III - EDUCATION AND EMPLOYMENT INFORMATION

10A. DO YOU HOLD ANY FAA FLIGHT CERTIFICATES? (If "Yes," specify below)
YES

NO
10B. EDUCATION AFTER HIGH SCHOOL (Including apprenticeship, on-the-job training, and flight training)

NAME AND LOCATION OF
COLLEGE OR OTHER
TRAINING PROVIDER

DATES OF TRAINING
TO

FROM

NUMBER AND
TYPE OF HOURS

(Semester, Quarter
or Clock)

DEGREE, DIPLOMA, OR
CERTIFICATE RECEIVED

MAJOR FIELD OR
COURSE OF STUDY

10C. EMPLOYMENT (Only complete if you held a license or journeyman rating to practice a profession)
EMPLOYMENT

PRINCIPAL OCCUPATION

LICENSE OR RATING

NUMBER OF MONTHS WORKED

JOB 1 SINCE HIGH SCHOOL

JOB 2 SINCE HIGH SCHOOL

PART IV - ENTITLEMENT TO AND USAGE OF ADDITIONAL TYPES OF ASSISTANCE
11A. FOR APPLICANTS ON ACTIVE DUTY 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

YES

NO

YES

NO

for the course for which you have applied to the VA for education benefits?
11B. FOR APPLICANTS WHO ARE CIVILIAN EMPLOYEES OF THE U.S. GOVERNMENT ONLY:
Are you receiving or do you anticipate receiving any money (including but not limited to the Government
Employees Training Act) from your Agency for the same period for which you have applied to the VA for
education benefits? If you will receive such benefits during any part of your training, check "YES."

PART V - SERVICE MEMBER INFORMATION
12. SERVICE MEMBER'S SOCIAL SECURITY NUMBER

13. SERVICE MEMBER'S BRANCH OF SERVICE

14. SERVICE MEMBER'S NAME (First, Middle Initial, Last)

15. SERVICE MEMBER'S ADDRESS
Number and Street
Apt./Unit Number
City, State, ZIP Code

PART VI - 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.
16A. SIGNATURE OF APPLICANT (DO NOT PRINT)

VA FORM 22-1990E, XXX XXXX

16B. DATE SIGNED

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