Information Collection

On-The-Job Training Agreement (VA Form 28-1904)

IC 28956 under ICR 202104-2900-013 · OMB 2900-0678.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0678 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form VA Form 28-1904 On-The-Job Training Agreement (VA Form 28-1904)	Form
VA Form 28-1904 On-The-Job Training Agreement 28-1904(4-16-21).pdf www.va.gov/vaforms	Form
VA Form 28-1904 On-The-Job Training Agreement 28-1904(4-16-21).pdf www.va.gov/vaforms	Form

IC Title:

On-The-Job Training Agreement (VA Form 28-1904)

Agency IC Tracking Number:

2900-0678

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 21.212

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	VA Form 28-1904	On-The-Job Training Agreement	28-1904(4-16-21).pdf	www.va.gov/vaforms	Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records

Title: 58VA21/22/28, Compensation, Pension, Education, and Vocational Rehabilitation and Employment Records - VA

FR Citation: 86 FR 13752

Number of Respondents: 1,400

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 10 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	1,400	800	600
Annual IC Time Burden (Hours)	350	200	150
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.