22-8691 Application For Work-Study Allowance

OMB Approved No. 2900-0209
Respondent Burden: 15 minutes
Expiration Date: XX/XX/XXXX

APPLICATION FOR WORK-STUDY ALLOWANCE
PART I - IDENTIFICATION INFORMATION

1. NAME OF APPLICANT (First, Middle, Last)

2. MAILING ADDRESS OF APPLICANT (Number, and street or rural route, city or

P.O., State and 9 digit ZIP Code) (Include your email address to receive electronic
student payment letters)

3A. VA FILE NUMBER (For chapter 35, enter the veteran's file number.

Be sure to include the suffix indicator. For dependent's transfer of
entitlement cases, enter the file number of the person who transferred
entitlement to you)

3B. SOCIAL SECURITY NUMBER (If not shown in Item 3A)
3D. SEX OF APPLICANT
MALE

3C. DATE OF BIRTH OF APPLICANT (Month, Day, Year)

FEMALE

4A. EMAIL ADDRESS (If applicable)

4. TELEPHONE NUMBERS (Include Area Code Home/Cell)

CHAPTER 33 (Post- 9/11 GI Bill)(Including Fry and STEM Scholarships)

5. EDUCATION BENEFIT RECEIVING
CHAPTER 30 (Montgomery GI Bill - Active Duty)

CHAPTER 35 (Dependents Educational Assistance)

CHAPTER 31 (Veteran Readiness and Employment)

CHAPTER 1606 (Montgomery GI Bill - Selected Reserve)

CHAPTER 32 (Veterans Educational Assistance Program)

TRANSFER OF ENTITLEMENT PROGRAM (Parent or Spouse entitled to benefits)

PART II - SCHOOL INFORMATION

6A. NAME AND COMPLETE ADDRESS OF SCHOOL

6B. CURRENT ACADEMIC OR TRAINING PROGRAM

8. NEXT ENROLLMENT PERIOD YOU PLAN TO ATTEND

7. CURRENT ENROLLMENT INFORMATION
A. BEGINNING DATE

(Month, Day, Year)

B. ENDING DATE

A. BEGINNING DATE

(Month, Day, Year)

(Month, Day, Year)

B. ENDING DATE

(Month, Day, Year)

PART III - WORK STUDY INFORMATION

9. ADVANCE PAYMENT - DO YOU WANT AN ADVANCE PAYMENT? (See instructions for information on advance payment on reverse under "How Much Can I Earn?")
YES

NO

10. HAVE YOU EVER PARTICIPATED IN THE VA WORK-STUDY
PROGRAM BEFORE? (If "YES," please state where you worked)
YES

11. WORK SITE PREFERENCE (Tell us the school, VA facility or other government

facility where you would prefer to do VA related work. Be specific as many facilities
have the same name or perform the same services in different locations or cities.)

NO

12. WORK EXPERIENCE (Tell us about the jobs you had before,

other than VA work-study jobs. Please be as specific as possible.
If you have no work experience, place "NONE" in this space. If
needed, attach a separate sheet with your work-history)

13. SPECIFY THE DAYS AND HOURS DURING THE WEEK YOU ARE AVAILABLE TO WORK

(X)

DAYS

WHEN AVAILABLE (From & To)

MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
14. QUALIFICATIONS (Tell us about any special qualifications you have based on your education or work experience. Also, tell us what kinds of jobs interest you.
If needed, attach a separate sheet with this information)

15. SIGNATURE OF APPLICANT (Sign in ink)(Do no print) By signing this box, I, the applicant, understand that I may

not engage in VA Work Study duties until approved by VA.

16. DATE SIGNED

PRIVACY ACT INFORMATION: VA will not disclose information collected by this information collection to any source other than what has been authorized by the Privacy Act of 1974 or
Title 38 Code of Federal Regulations 1.576 for routine uses as identified in VA's system of records, 58 VA 21/22/28, Compensation, Pension, Education and Veteran Readiness and Employment
Records - VA as published in the Federal Register at http://www.rms.oit.va.gov/SOR_Records/58VA21_22.asp. An example of a routine use allows VA to send 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 VA to obtain further information as may be
necessary from the school for VA to properly process the veteran's education claim or to monitor his or her progress during training. Your obligation to respond is "required to obtain or retain
benefits". We cannot pay you any work-study benefits until we receive this information (38 U.S.C. 3485). Your responses are confidential (38 U.S.C. 5701). Any information provided by
applicants may be subject to verification through computer matching programs with other agencies.
Respondent Burden: We need this information to determine your eligibility for VA work-study benefits. 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 the 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/PRASearch. 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 information
collection.
VA FORM
EXISTING STOCKS OF VA FORM 22-8691, NOV 2020,
XXX XXXX
WILL NOT BE USED.

22-8691

HOW MUCH CAN I EARN?

Your hourly pay rate will be the greater of:
(1) The Federal minimum wage; or
(2) The minimum wage for the State in which you are
working.
The total number of hours you can work cannot be more than 25 times the number of
weeks in your enrollment period. If you elect to receive an advance payment, VA will
make your first payment in advance of your work for the lesser of:
(1) 40 percent of the total amount of the work-study
allowance to be paid under your contract agreement
with VA; or

Department of Veterans Affairs

WHO IS ELIGIBLE?

You are eligible if you're training in a college degree, vocational, or professional
program at least three-quarter time. You can receive a work-study allowance (in
addition to your education benefits) based on the number of hours of work you
perform. A work-study allowance is available under most educational assistance
programs administered by VA.

Official Business
Penalty for Private Use $300

STUDENT WORK-STUDY
ALLOWANCE PROGRAM

Student Work-Study
Allowance Program

(2) 50 hours at your hourly pay rate.
You can only receive one advance payment per contract agreement (original contract
agreement and any extension to that contract agreement).
If you do not elect to receive an advance payment, VA will pay you for any hours after
you work the hours.
Your final payment will be for the lesser of:

(1) 50 hours; or
(2) The number of hours remaining on your contract.

WHAT TYPE OF WORK MAY I DO?

You may do the following types of VA-related work:
VA paperwork at schools;
VA paperwork at VA offices or facilities;
VA outreach services under VA supervision;
Outreach services as provided by a State approving agency;
Provide hospital, home-care, or medical treatment to veterans at VA
medical facilities or other approved facilities (including a State home
receiving VA per diem assistance);
• Administrative (office) work at a national cemetery or a State veteran's
cemetery;
• Work at Department of Defense facilities related to education benefits
under the Montgomery GI Bill-Selected Reserve (MGIB-SR).
•
•
•
•
•

NOTE: Only claimants receiving MGIB-SR benefits can do this type of work.
NOTE: The position description duties (job activities) must be provided with the
initial Work Site Application, or if changes are made to the Work Site Activities.
NOTE: Educational facilities and Offices of Members of Congress are limited to the
type of work/duties their Work Study students can perform. These include, but are not
limited to the following:
• Dissemination of general information regarding Veteran benefits and/or
services;
• Preparation, processing, maintaining and organizing Veteran-related files;
• VA outreach in a cooperative supervisory effort with a VA employee
who is controlling the work activities;
• Performance of work specifically listed in the Work Site's job description;
• Tasks that require 100% performance of VA-related activities;
• Work for the specific Work Site listed on the contract agreement/time
record;
• Assisting Congressional Offices with preparing VA benefits claims;
• Distributing information from Congressional Offices to others about VA
and Non-VA benefits.

Veterans Benefits Administration
HOW DO I APPLY?
Complete the form on the other side of this page, and mail it to the Muskogee
VA Regional Processing Office that handles your education claim at P. O.
Box 8888, Muskogee, OK 74402-8888. You can get more information or
send us an email via VA's website www.gibill.va.gov by clicking on
"Questions and Answers" and then clicking on "Ask a Question & Find an
Answer." Or you can call us at our toll-free number, 1-888-GIBILL-1
(1-888-442-4551). If you use the Telecommunications Device for the Deaf,
the Federal Relay number
is 711.