Form VA Form 28-1905c VA Form 28-1905c Certification of Training Hours , Wages and Progress

OMB Approved No. 2900-0176
Respondent Burden: 15 minutes
Expiration Date: XXXXXXXX

CERTIFICATION OF TRAINING HOURS,
WAGES, AND PROGRESS

INFORMATION: Before completing this form, the Privacy Act and Respondent Burden on page 3.
This form will be completed by the certifying official when VA-ONCE is not an option to certify
training attendance under Chapter 31 of Title 38 U.S.C. and the training of eligible dependents under
Chapter 35 of Title 38 U.S.C. This is also used for reporting a claimant's wages paid and monthly
progress. This certification must be submitted to the Department of Veterans Affairs (VA) no later
than the 10th day of the month immediately following the month for which wages were paid.
Example: Wage statement for January is due no later than February 10th. For more information,
contact us at https//iris.custhelp.va.gov, or call us toll-free at 1800-827-1000. If you use a
Telecommunications Device for the Deaf (TDD), the Federal relay number is 711. VA forms are
available at www.va.gov/vaforms. After completing the form, if returning by mail, mail to: Veteran
Readiness and Employment (VR&E) Intake Center, Department of Veterans Affairs, P.O. Box 5210,
Janesville, WI, 53547-5210.

VA DATE STAMP
(DO NOT WRITE IN THIS SPACE)

1. CLAIMANT'S NAME (First, Middle Initial, Last)

2. VA FILE NUMBER (If applicable)

TYPE OF TRAINING
NOTE: You may complete the form online or by hand. If completing by hand, print neatly and legibly in ink, and completely fill in each applicable circle to
help expedite processing of the form.
3. SELECT APPROPRIATE TYPE OF TRAINING AND SPECIFIC PROGRAM.
OTHER SPECIALIZED PROGRAM

ACADEMIC PROGRAM (Specify below)
SPECIAL TRAINING

ADULT EDUCATION

CERTIFICATION

COMMUNITY-BASED WORK EXPERIENCE

FLIGHT TRAINING

COOPERATIVE COURSES

TRUCK DRIVING

FARM COOPERATIVE
INDEPENDENT INSTRUCTOR TRAINING

APPRENTICESHIP

INDEPENDENT STUDY
REHAB FACILITY TRAINING

NON-PAID WORK EXPERIENCE

TRAINING AT HOME
VOCATIONAL COURSE IN A REHABILITATION FACILITY

PAID OR NORMALLY PAID ON-JOB-TRAINING (OJT)

WORK HARDENING

CERTIFICATION
This certifies that the claimant named in Item #1 began or resumed the type of program specified in Item #3. The claimant continues to be pursuing or
enrolled in that program.
4. ATTENDANCE IN ALL TRAINING PROGRAMS (EXCEPT APPRENTICESHIP AND OJT)
4B. TYPE AND
NUMBER
OF HOURS

4A. TERM

BEGIN DATE
(MM/DD/YYYY)

VA FORM
XXXX

28-1905c

END DATE
(MM/DD/YYYY)

S - SEMESTER
Q - QUARTER
D - DEFICIENCY
R - RESIDENCE
C - CLOCK/SHOP

SUPERSEDES VA FORM 28-1905c, JUN 2019,
WHICH WILL NOT BE USED.

4C. TRAINING TIME
F = FULL-TIME
3/4 = TIME
1/2 = TIME
L = LESS THAN
1/2 TIME

4D. STANDARD CLASS
SESSION PER
WEEK
ONLY IF LESS THAN
THE TERM HOURS
CERTIFIED OR IF THE
TERM IS OF NONSTANDARD LENGTH

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5. REDUCTION IN TRAINING HOURS
5B. TYPE AND
NUMBER
OF HOURS

5A. TERM

BEGIN DATE
(MM/DD/YYYY)

S - SEMESTER
Q - QUARTER
D - DEFICIENCY
R - RESIDENCE
C - CLOCK/SHOP

END DATE
(MM/DD/YYYY)

5C. TRAINING TIME
F = FULL-TIME
3/4 = TIME
1/2 = TIME
L = LESS THAN
1/2 TIME

5D. STANDARD CLASS
SESSION PER
WEEK
ONLY IF LESS THAN
THE TERM HOURS
CERTIFIED OR IF THE
TERM IS OF NONSTANDARD LENGTH

6. TERMINATION OR COMPLETE WITHDRAWAL FROM TRAINING
6A. DATE OF LAST ATTENDANCE
(MM/DD/YYYY)

6B. REASON FOR TERMINATION OR COMPLETE WITHDRAWAL

7. APPRENTICESHIP AND PAID OJT
7A. TYPE OF INSTRUCTION
LISTED IN THE VA
TRAINING AGREEMENT

7B. BEGIN DATE
(MM/DD/YYYY)

END DATE
(MM/DD/YYYY)

7D. TOTAL
NUMBER
OF HOURS
(Completed by
end of last month)

7E. RATING
O - OUTSTANDING
S - SATISFACTORY
U - UNSATISFACTORY

8. FIRST TIME CERTIFICATION OR CHANGE IN TRAINEE'S RATE OF PAY (Do not consider overtime pay as a change in pay rate.)
8A. TRAINEE HOURLY OR MONTHLY RATE OF PAY
$

8B. JOURNEYMAN HOURLY OR MONTHLY RATE OF PAY

.

$

.

8C. BEGIN DATE OF RATE OF PAY LISTED IN ITEM #8 (MM/DD/YYYY)
8D. REASON FOR ENTRIES IN ITEM SPECIFIED ABOVE:

START OF TRAINING

INCREASE IN RATE OF PAY

OTHER (Specify):

VA FORM 28-1905c, XXXX

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9. SUMMARY OF TRAING PROGRESS OF SKILL DEVELOPMENT (Specify positive or negative job performance issues.)

I CERTIFY THAT the previous statements are true and correct to the best of my knowledge and belief.
PENALTY - Willful false reports concerning benefits payable by VA may result in fines or imprisonment or both.
10. SIGNATURE OF TRAINER
OR CERTIFYING OFFICIAL

11. DATE SIGNED
(MM/DD/YYYY)

PRIVACY ACT NOTICE: The responses you submit are considered confidential (38 U.S.C. 5701). Your obligation to respond is
required in order to obtain benefits. 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., civil or criminal law
enforcement, congressional communications, epidemiological or research studies, the collection of money owed to the United States,
litigation in which the United States is a party or has an interest, the administration of VA programs and delivery of VA benefits,
verification of identity and status, and personnel administration) 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.
Information that you furnish may be utilized in computer matching programs with other Federal or State agencies for the purpose of
determining your eligibility to receive VA benefits, as well as to collect any amount owed to the United States by virtue of your
participation in any benefit program administered by the Department of Veterans Affairs.
RESPONDENT BURDEN: Use this form to maintain adequate records to certify hours of attendance, wages and progress towards
the completion of the training program (U.S.C. 3677). 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. VA cannot conduct or sponsor a
collection 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 are 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 28-1905c, XXXX

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